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Axial (A, B, C) and coronal (D) contrast enhanced CT scans of abdomen. Well defined hypodense lesions seen in the tail and neck region of pancreas (arrows in 'A' and 'B') without any obvious evidence of mass effect. Similar lesions are noted at upper pole regions of both the kidneys (arrow in 'C').There is a large hypodense mass lesion in upper retroperitoneum with loss of fat planes with head of pancreas (star in 'C 'and marked in 'D'). Patient also had hepatosplenomegaly. Radiological differential of lymphoma likely Non Hodgkin type was suggested.
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Contrast-enhanced CT scan (CECT) of abdomen revealed a well-defined, hypodense and hypo-enhancing mass lesion of size 5.4 x 6.8 x 6.6 cm in the pancreatic head without any calcification, few non-enhancing necrotic areas within the uncinate process, and dilated pancreatic duct (Figure 1).
A. CT guided Core biopsy from the pancreatic mass was showing a small round cell tumour arranged in diffused sheet (H & E 40X). B. On higher power the tumour cells had round to convoluted nuclei, dense chromatin, inconspicuous nucleoli and scant basophilic cytoplasm.
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On haematoxylin and eosin-stained (H&E) section, a tumor comprising of small to medium sized monomorphic tumor cells arranged in diffuse sheets and focally in perivascular pattern was seen (Figure 2).
A & B. Tdt and Pax 5 were expressed throughout the tumour cells. C. CD10 positivity was also noted diffusely. D. PanCK highlighting few of the residual pancreatic ducts amidst the tumour cells.
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On immunohistochemistry (IHC), tumor cells were positive for Tdt (strong diffuse nuclear expression) and focally expressed CD34 and CD20 (Figure 3).
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