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(A, B) Late arterial phase CT image demonstrating beginning of splenic vein tumor thrombus (A, white arrow), and indistinct, mildly enhancing pancreatic tail lesion (B, red arrow).
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During her evaluation for this a CT was performed which reported splenic vein occlusion at the level of the mid body of the pancreas, and a 17 mm mildly enhancing mass within the tail of the pancreas (Fig. 1).
(A, B) Gross photograph of a tan lobulated mass (arrows) within the pancreatic parenchyma.
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Pathology evaluation revealed a 3.3 cm x 2.2 cm x 2.8 cm tumor within the distal pancreas (Fig. 2).
Gross photograph of tumor thrombus (black arrow) protruding from the splenic vein.
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The spleen was unremarkable; the splenic vein, however, had a large tumor thrombus which grossly protruded on gross sectioning (Fig. 3).
(A) Hematoxylin and eosin stain at 40x demonstrating intermediate grade pancreatic neuroendocrine tumor. (B) Immunohistochemistry stain with diffusely positive synaptophysin staining.
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Histological evaluation revealed an intermediate grade PNET with surrounding fat necrosis (Fig. 4A). PNET (Fig. 4B). Peri-neural and vascular invasion were identified.