PMC7268146_01
Ultrasound image showing the hypoechoic mass in the left limb of the pancreas (arrow)
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An abdominal ultrasound was performed by an internal medicine specialist, who noted a 12.4 x 13.5 mm hypoechoic mass affecting the left limb of the pancreas (Figure 1).
Cytology of a second aspirate of the hypoechoic pancreatic mass: (a) representative image of mixed inflammation; (b) representative clusters of cohesive epithelial cells suspected to be exocrine pancreatic cells, showing mild-to-moderate anisocytosis and anisokaryosis. The bars in (a) and (b) represent 50 mum
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On cytology, a population of cohesive epithelial cells with moderate cellular atypia on a background of marked inflammation were described (Figure 2).
Photomicrograph showing the moderately differentiated pancreatic adenocarcinoma. (a) The neoplastic population is arranged in incomplete glandular structures (haematoxylin and eosin, bar = 500 microm). (b) Neoplastic cells are columnar and display moderate anisocytosis and anisokaryosis; thick fibrous bands (desmoplasia) interspace the neoplastic cells (haematoxylin and eosin, bar = 100 microm)
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Histopathology of the pancreatic mass showed effacement of tissue with neoplastic epithelial cells, with 22/10 mitoses/high-power field, consistent with a moderately differentiated pancreatic adenocarcinoma (Figure 3).
Gross image of the body wall nodule (circle) 2 weeks following partial pancreatectomy
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At a revisit 2 weeks postoperatively, the owners reported a mass at the left ventrolateral abdomen (Figure 4) and ongoing melaena.
Fine-needle aspirate smear of the body wall nodule, stained with Wright's Giemsa. (a) Clumps of polygonal epithelial cells with round nuclei and a variable amount of granular blue cytoplasm with indistinct cell borders, suspected to be of exocrine pancreatic origin, in a light blue proteinaceous background containing blood and ruptured cells. The cells display several atypical features, including moderate anisocytosis and anisokaryosis, lacy chromatin with prominent nucleoli and a variable nuclear to cytoplasmic ratio. (b) Pink granular material (arrowhead) associated with the atypical epithelial cells, suggestive of a glandular secretion. The bars in (a) and (b) represent 20 microm
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Cytology showed neoplastic epithelial cells with occasional acinar-like arrangements and fine pink pigment or globular material consistent with a carcinoma of glandular-origin, highly suspicious for metastatic pancreatic adenocarcinoma (Figure 5).