PMC5771966_01
Arterial-portal phase of the contrast CT. (a) White arrow showed a hypovascular irregular mass of pancreas; white arrowhead showed cystic lesion adjacent to solid mass revealed hematoma at the pancreatic tail.
gr1.jpg
PMC5771966_01_gr1.jpg
fig0005
Abdominal computed tomography (CT) using contrast media revealed a 3cm-in-size of hypovascular mass lesion accompanied with a 6.5cm-in-size of pseudocyst at the distal side in the pancreatic tail (Fig. 1).
EUS guided FNA. Arrow was 3cm-in-size of solid mass and arrow head was cystic lesion with thick wall.
gr2.jpg
PMC5771966_01_gr2.jpg
fig0010
The 3cm-in-size of irregular hypoechoic mass lesion was observed in the pancreas tail and the pancreatic cancer was suspected and the 6.5 cm-in-size of cystic mass lesion adjacent to solid mass was also detected (Fig. 2). As it seemed to be closed to jejunal loop, the fine needle aspiration (FNA) was attempted for hypoechoic solid mass lesion at the proximal-side (Fig. 2).
Histological findings of specimens by EUS-FNA. (a) Hematoxylin-Eosin stain of weak expansion image, (b) Strong expansion; acinar, diffuse, or tubular proliferation of eosinophilic or basophilic cuboidal tumor cells with increased N/C ratio, (c) Immunohistochemitry. Positive stain of BCL-10, (d) Positive stain of trypsin.
gr3.jpg
PMC5771966_01_gr3.jpg
fig0015
The enough specimen could be obtained and cytological diagnosis showed acinar cell carcinoma of the pancreas, which showed a plenty of cells with tubular proliferation of eosinophilic or basophilic cuboidal tumor cells with increased oval nuclei with high nuclear/cytoplasm (N/C) ratio, hyper-chromatin condensation and scattered mitosis (Fig. 3a and b). BCL10 and trypsin at cytoplasmic membrane (Fig. 3c and d), and negative expression of synaptophysin and chromogranin A (as markers for neuroendocrine neoplasm). By these results, the solid mass was diagnosed as the acinar cell carcinomas (ACC) of pancreas.
At 1 h after administration of 18-FDG PET. Arrow showed an accumulation according to a solid mass lesion but no significant accumulation was observed at other lesions.
gr4.jpg
PMC5771966_01_gr4.jpg
fig0020
The positron-emission tomography (PET) showed high accumulation of 18-fluorodeoxy-glucose (FDG) at the solid mass lesion (Fig. 4), otherwise no accumulation at cystic pancreatic mass and other lesions systemically.
Formalin-fixed resected specimen. Arrow showed a 3cm-in-size of solid mass lesion at the pancreatic tail.
gr5.jpg
PMC5771966_01_gr5.jpg
fig0025
The pathological diagnosis of resected specimen showed a 2.7 cm-in-size of nodular mass lesion and adjacent cystic lesion (Fig. 5) and the cystic lesion was just pseudocyst.
Histological findings of resected specimens. (a) Hematoxylin-Eosin stain of weak expansion image, (b) Strong expansion; Atypical epithelial cells with hyperchromatic nuclei, notable nucleoid and amphophilic to eosinophilic granular cytoplasm proliferate in acinar pattern, (c) Immunohistochemitry. Positive stain of BCL-10, (d) Positive stain of trypsin as well as FNA specimen.
gr6.jpg
PMC5771966_01_gr6.jpg
fig0030
Partly, nest-like and trabecular patterns were noted. (Fig. 6a and b).