PMC2762244_01
(a) MRCP in 2003. Cystic dilation of branch ducts is observed in the pancreas head (arrow). A duct-cyst junction is visible (yellow arrowhead). (b) MRCP in 2004 shows the increasing of size and dilation of the main pancreatic duct. (c) MRCP in 2005. The boundary between the main pancreatic duct and the cystic components of branch ducts disappears. (d) MRCP in 2006. Filling defects in the main pancreatic duct are visible (arrow).
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fig1
A continuous image of 64-year-old man, who was referred to the Department of Medicine at our hospital for further evaluation of gallbladder stones, was shown in Figure 1. Representative images and results for IHC are shown in Figure 4 and Table 1.
(a) Resected specimens show marked dilation of the main pancreatic duct and papillary tumor (arrow) with cystic dilation of branch ducts (arrowhead). (b) Representative section and histologic distribution of the tumor. The boundary between the main pancreatic duct and a branch duct is visible (arrow). (c) Gastric-type adenoma is made up of columunar cells with basally-oriented nuclei, showing closely packed glands with anastomosing pattern (d) Intestinal-type carcinoma shows marked pseudostratification and nuclear atypia showing villous configuration (e) In a branch duct, intestinal-type carcinoma components with arborizing features are observed (f) A minimally invasive lesion is observed adjacent to branch ducts. Floating tumor cells in the mucous lake is visible (I, arrow).
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fig2
The standard study for resected specimen was described in Figure 2.
A schematic presentation of histologic subtypes in the present case (a). An immunohistochemical image for MUC2 at the boundary between gastric-type adenoma and intestinal-type carcinoma. Only the intestinal-type carcinoma shows diffuse staining for MUC2 (b).
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fig3
Each subtype was confirmed by mucin phenotype (Figure 3, right column). Schematic presentation of histologic distribution in the present case is shown in Figure 3 (left column). 
Representative immunohistochemical images in several components of the present tumor.
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fig4
Representative images and results for IHC are shown in Figure 4 and Table 1.