PMC6040289_01
Prominent leaf-like pattern of the ducts surrounded by stromal overgrowth.
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fig1
Examination of the slides showed an overgrowth of epithelial and stromal components in pericanalicular and intracanalicular patterns with irregular large cystic spaces showing protruding leaf-like structures (Figure 1).
Hypercellular stroma with herringbone pattern, marked atypia, increased mitosis, and complete absence of ducts.
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fig2
Other areas showed significant cellular growth of the stromal spindle cells which appeared to be arranged in long intersecting fascicles and growing in herringbone pattern (Figure 2).
Abdominal CT scan showing (a) pancreatic mass involving the head of the pancreas, surrounding the celiac artery, in contact with the anterior aspect of the inferior vena cava, and (b) greatly enlarged pancreatic mass, extravasation of contrast from proximal splenic artery, and multiple heterogenous enhancements of the liver most likely indicating liver infarcts.
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fig3
The mass was in contact with the anterior aspect of the inferior vena cava (IVC) with no clear fat plane in between (Figure 3(a)). In addition, there were areas of the IVC which had markedly thinned wall and areas suspicious for active bleeding, especially from the proximal splenic artery (Figure 3(b)).
Spindle cell proliferation with focal herringbone pattern, cellular atypia, and increased mitosis.
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fig4
Numerous mitotic figures were identified (Figure 4).
Immunohistochemistry staining showing (a) neoplastic cells strongly positive for vimentin and (b) malignant cells negative for cytokeratin, actin, and s100.
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fig5
Immunohistochemical staining showed strong positivity for vimentin; however, the cells were negative for actin, S100, and cytokeratin (Figure 5).