PMC5278113_01
(a) Contrast-enhanced computed tomography (CT) scan showed a poorly enhanced and indistinct nodule in the pancreas body (white arrowhead). (b) The distal side of the main pancreatic duct (MPD) was dilated (white arrow). (c) The mass in the pancreas body was 10 mm in diameter 53 days later (yellow arrowhead). (d) The mass showed low signal intensity on T2-weighted images obtained by magnetic resonance imaging (MRI) (red arrowhead).
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The distal side of the main pancreatic duct (MPD) was dilated (Fig. 1a and b). The mass in the pancreas body gradually became clearer, and a mass of 10 mm in diameter was detected 53 days later by CT (Fig. 1c). The mass showed low signal intensity on T2-weighted images and diffusion-weighted images obtained by magnetic resonance imaging (MRI) (Fig. 1d).
(a) Magnetic resonance cholangiopancreatography (MRCP) showed stenosis of the MPD adjacent to the mass (white arrowhead). (b) Endoscopic retrograde cholangiopancreatography (ERCP) also showed stenosis of the MPD (yellow arrowhead). (c) Cytology of pancreatic juice did not reveal malignant cells.
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Magnetic resonance cholangiopancreatography (MRCP) showed stenosis of the MPD adjacent to the mass (Fig. 2a). Endoscopic retrograde cholangiopancreatography (ERCP) also showed stenosis of the MPD (Fig. 2b). Cytology of pancreatic juice collected during the ERCP did not reveal malignant cells (Fig. 2c).
(a) Macroscopically, a well-circumscribed mass in the pancreas body was observed (white arrows). (c, d) Magnified view of the black frame area in (b). The tumor cells had proliferated invasively in the pancreatic parenchyma (black arrowhead). An irregularly arranged pseudopapillary structure composed of fairly uniform tumor cells was seen around the fibrous nodule. (e) Magnified view of the yellow frame area in (b). Fibrous and degenerative change induced a deformity of the wall of the MPD (asterisk indicating MPD). (f) The border region between the fibrous nodule and the tumor contained calcification, old hemorrhage and cholesterin crystals.
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Macroscopically, a well-circumscribed mass, measuring 12 mm, in the pancreas body was observed (Fig. 3a and b). The tumor cells had proliferated invasively in the pancreatic parenchyma (Fig. 3c and d). The tumor located adjacent to the MPD and the fibrous and degenerative change had caused a deformity of the wall of the MPD (Fig. 3e). The border region between the fibrous nodule and the tumor contained calcification, old hemorrhage and cholesterin crystals (Fig. 3f).
Immunohistochemically, the tumor was positive for ss-catenin (a), vimentin (b), CD10 (c), and synaptophysin (Syn) (d) but negative for chromogranin (CgA) (e). The Ki67 labeling index was approximately 3% (f).
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Immunohistochemically, the tumor was positive for ss-catenin, vimentin, CD10, synaptophysin (Syn) (Fig. 4a-d), CD56, and neuron-specific enolase (NSE), but negative for chromogranin (CgA) (Fig. 4e) and insulin. The Ki67 labeling index was approximately 3% (Fig. 4f).