case_images: PMC10481800_01
case_images: Endoscopic ultrasound image, conventional cytology, cell block, and immunohistochemistry of a metastatic leiomyosarcoma to the pancreas; (a) hypoechoic tumor with sharply delineated margins. (b) Cytology smear showing pleomorphic spindle cells, Papanicolaou x200. (c) Cell block section showing fascicules of spindle cells, cell-block, H&E x200. (d) Malignant cells positive for H-caldesmon, immunohistochemistry on cell-block, x200.
case_images: Cytojournal-20-18-g001.jpg
case_images: PMC10481800_01_Cytojournal-20-18-g001.jpg
case_images: F1
case_images: EUS was performed to take a biopsy, in which the neoplasm is well-defined, located in the neck and body of the pancreas, measuring 4.2 x 2.6 cm, hypoechoic and with irregular edges [Figure 1a]. The smears showed cohesive and spiculated cell groups, suspected recurrent leiomyosarcoma [Figure 1b]. The fresh clot fragments were fixed in 10% formalin to obtain the cell block, fascicles of cells with the same characteristics were observed in the sections. [Figure 1c], H-caldesmon immunohistochemical marker was performed [Figure 1d], which was positive, showing its muscular origin.
case_images: PMC10481800_02
case_images: Endoscopic ultrasound image, conventional cytology, cell block, and immunohistochemistry of a metastatic breast carcinoma to the pancreas, (a) tumor with irregular margins. (b) Clusters and single cells, with increased nuclear to cytoplasmic ratio, Papanicolaou x200. (c) Nest of malignant cells with some glandular lumens, cell-block. H&E x200. (d) Malignant cells positive for GATA 3, block-cell immunohistochemistry x200.
case_images: Cytojournal-20-18-g002.jpg
case_images: PMC10481800_02_Cytojournal-20-18-g002.jpg
case_images: F2
case_images: A neoplasm was observed in the head and body of the pancreas, measuring 2.9 x 2.1 cm, with irregular borders and no infiltration data [Figure 2a]. The FNA revealed malignancy, with cell groups and single cells with hyperchromatic and prominent nucleoli were observed in the smears [Figure 2b]. The fresh clot fragments were fixed in 10% formalin to obtain the cell block, cell nests with some lumens are observed in the cell-block section, with nuclear variability, hyperchromasia, so an adenocarcinoma was suspected [Figure 2c]. GATA3 immunohistochemical marker was performed [Figure 2d] and was interpreted as positive, which supports the diagnosis of metastatic breast carcinoma.
case_images: PMC10481800_03
case_images: Endoscopic ultrasound image, conventional cytology, cell block and immunohistochemistry of a metastatic hepatic carcinoma to the pancreas, (a and b) hypoechoic tumor with well-defined borders. (c) Clusters of malignant cells with increased nuclear to cytoplasmic ratio and granular cytoplasm, Papanicolaou x200. (d) Malignant cells with hyperchromatic nuclei, in nests and trabecular architecture, cell-block H&E x200. (e) Malignant cells positive for Glypican 3, immunohistochemistry on cell-block, x200.
case_images: Cytojournal-20-18-g003.jpg
case_images: PMC10481800_03_Cytojournal-20-18-g003.jpg
case_images: F3
case_images: Ultrasound revealed a 4.5 x 4.1 cm tumor in the tail of the pancreas, hyperechoic, and with irregular borders [Figure 3a and b]. FNA cytology smears showed groups of polygonal cell and granular cytoplasm [Figure 3c]. The fresh clot fragments were fixed in 10% formalin to obtain the cell block, in the sections, sheets of cells were observed with hyperchromatic nuclei rejected to the periphery [Figure 3d]. Immunohistochemical marker was made based on Glypican 3 [Figure 3e], which was positive, corroborating its hepatic origin.
case_images: PMC10481800_04
case_images: Endoscopic ultrasound image, conventional cytology, cell block and immunohistochemistry of a metastatic serous carcinoma to the pancreas, (a and b) hyperechoic tumor with irregular margins. (c) Clusters of malignant cells with papillary architecture, Papanicolaou x200. (d) Cells with hyperchromatic nuclei in hierarchical papillae with fibrovascular core, cell-block, H&E x200. Malignant cells positive for PAX8 (e) and WT1 (f), immunohistochemistry on cell-block, x200.
case_images: Cytojournal-20-18-g004.jpg
case_images: PMC10481800_04_Cytojournal-20-18-g004.jpg
case_images: F4
case_images: The tumor was in the head and neck of the pancreas, measuring 3.9 x 3.8 cm, being hyperechoic, heterogeneous, and with irregular borders [Figure 4a and b]. The FNA aspiration smears showed cell groups with papillary architecture [Figure 4c]. The fresh clot fragments were fixed in 10% formalin to obtain the cell block, in the sections, the same characteristics were observed: Papillary architecture, hyperchromatic nuclei, and scant cytoplasm [Figure 4d]. Given the suspicion of a metastatic serous carcinoma, immunohistochemical markers, PAX8 [Figure 4e] and WT1 [Figure 4f], were requested, which were positive, supporting the diagnosis of metastasis.
case_images: PMC10481800_05
case_images: Endoscopic ultrasound image, conventional cytology, cell block and immunohistochemistry of a metastatic renal cell carcinoma to the pancreas. Tumor in head (a) and tail (b) of pancreas, hypoechoic and irregular margins. (c) Single cells with abundant clear cytoplasm, Papanicolaou x200. (d) Cell nests with hyperchromatic nuclei and clear vacuolated cytoplasm, cell-block H&E x200. Malignant cells positive for CD10 (e) and PAX8 (f), immunohistochemistry on cell-block, x200.
case_images: Cytojournal-20-18-g005.jpg
case_images: PMC10481800_05_Cytojournal-20-18-g005.jpg
case_images: F5
case_images: EUS-guided FNA biopsy of the pancreatic neoplasms was performed. EUS showed two tumors, one in the body measuring 10.6 x 10.95 mm and the other one in the tail of the pancreas, measuring 17.9 x 14.3 mm, both hypoechoic and heterogeneous [Figure 5a and b]. In the FNA cytology smear, cohesive groups with pale and granular cytoplasm were observed [Figure 5c]. The fresh clot fragments were fixed in 10% formalin to obtain the cell block, in the sections, the same cell nests with clear cytoplasm were observed [Figure 5d]; immunohistochemistry on cell-block revealed CD10 and PAX8 positivity [Figure 5e and f], thus confirming the diagnosis of metastasis of a clear cell variety renal cell carcinoma.