PMC6514515_01
a Abdominal contrast computed tomography showed pancreatic head cysts and pancreatic head and tail tumors (arrows). b In another slice from the abdominal contrast computed tomography, a tumor was found in the pancreatic body (arrow). c Magnetic resonance cholangiopancreatography showed huge cysts in the pancreatic head, but there was no irregularity or deviation of the pancreatic duct. d In endoscopic ultrasonography, the tumor showed clear margins, had low marginal echo, and internal high echo.
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F1
Abdominal contrast computed tomography (CT) and magnetic resonance cholangiopancreatography revealed a massive cyst of 55 mm in the pancreatic head, a 20 mm mass with a gradually increasing contrast effect on the caudal side of the cyst, and nodular lesions of 10 mm each with a contrast effect in the pancreatic body and tail (Fig. 1a, b, c). Endoscopic ultrasonography-fine needle aspiration (EUS-FNA) was performed to the pancreatic head and pancreatic body masses respectively (Fig. 1d); a strong variance of acinar cells and pancreatic ductal epithelium were seen from both specimens, and they both had the same histology (Fig. 2a).
a Cytology showed a strong variance of acinar cells and pancreatic ductal epithelium. b The resected specimen showed three tumorous lesions in addition to the huge cyst, and each lesion was independently present with pancreatic tissue interposed. c Morphologically, the cells showed strong polymorphism, such as having a spindle shape or polynuclear formation, and proliferated densely; cancer and sarcoma components were mixed. d Immunostaining for keratin CAM5.2 was negative.
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F2
The pancreatic head cyst was accompanied by multiple small walled nodules, and the same histological findings were obtained from each cystic wall nodule and pancreatic tumor (Fig. 2b). Morphologically, the cells with strong polymorphism such as a spindle shape or polynuclear formation proliferated densely, and osteogenesis was also recognized in the lesion, which is a characteristic of anaplastic pancreatic ductal carcinoma (Fig. 2c). Immunohistochemistry showed that cytokeratin AE1/AE3, CAM5.2 (a small molecule keratin), S-100, and CD68 were negative, but vimentin and smooth muscle actin were positive (Fig. 2d).