PMC8565694_01
Cephalic pancreatic tumour predominantly cystic in tight contact with the superior mesenteric vein.
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Abdominal computed tomography (Figure 1) revealed a heterogeneous tumor of 83/130/100 mm, predominantly cystic, belonging to the head of the pancreas, in close contact with the superior mesenteric vein and spleno-mesenteric vein (on a length of over 55 mm), narrowing the vessels without thrombosis; Wirsung duct was dilated (10 mm in diameter); peritumoral lymphadenopathies were noted.
Surgical specimen: antrum, duodenum, first jejunal loop, head of the pancreas presenting tumor mass and distal commone bile duct.
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The surgical team decided to continue the surgery with the Whipple procedure, removing the entire expansive process (Figure 2).
UCOCG - solid area with 'pushing border' margin composed of pleomorphic mononuclear cells, ovoid or spindlle, and numerous diffusely spread large cells with eosinophilic cytoplasm and 5-20 centrally located blunt nuclei (HE, x100).
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The tumor growth patterns were pushing border, endoluminal/polypoid and infiltrative into the stroma (Figures 3-5).
Dilated pancreatic duct mostly covered with columnar epithelium and endoluminal tumor growth (HE, scanned specimen). Large insert - stratified ductal epithelium with citological atypia (at the polipoid tumor stalk) with a sudden morphology switch to UCOGC (pleomorhic mononuclear cells with abundant large multinucleated cells). Small insert - "Incomplete" duct asociated with micropapillary features mimicking giant cells (highly sugestive for invasive ductal carcinoma).
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The tumor growth patterns were pushing border, endoluminal/polypoid and infiltrative into the stroma (Figures 3-5).
Invasive front of UCOGC with desmoplastic stroma, small recent hemorrhagic area and entraped adipocites (HE, x100).
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The tumor growth patterns were pushing border, endoluminal/polypoid and infiltrative into the stroma (Figures 3-5).
Main pancreatic duct with dysplastic epithelium and isolated duct-like structures with pleomorphic nuclei and mild desmoplastic response (ductal carcinoma foci) (HE, x100).
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The main pancreatic duct was dilated, focally with high grade dysplasia, associating foci of invasive ductal adenocarcinoma (Figure 6).
Main pancreatic duct towards apullary zone with high grade dysplasia (HE, x100).
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High grade PanIN versus immature squamos metaplasia (HE, scanned specimen).
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Small main pancreatic duct branches with low and high grade intraepithelial neoplasia (HE, x100).
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CD 68 positive mononuclear inflamatory cells (hystiocyte) and large round benign-looking cells with centrally numerous nuclei (osteoclast-like giant cells) (IHC, anti-CD68, x100).
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