case_images: PMC6915151_01
case_images: (a and b) showing contrast-enhanced T1 MR images of the pancreatic (a) and splenic (b) lesions, arrows point to the lesions; (c) shows the gross image of the IPT-like FDCT in the pancreas; (d) shows the gross image of the IPT-like FDCT in the spleen.
case_images: CRIPA2019-2648123.001.jpg
case_images: PMC6915151_01_CRIPA2019-2648123.001.jpg
case_images: fig1
case_images: Multiplanar, multisequence magnetic resonance imaging was performed with and without 7 mLs MultiHance contrast to reveal a 7.0 cm anterior-posterior x 4.4 cm, transverse x 4.0 cm craniocaudad, dumbbell-shaped mass in the pancreatic tail containing no clear dividing plane of fat between the mass and the posterior gastric body wall or the superior margin of the pancreas (Figure 1). On imaging, both masses appeared to restrict diffusion of the organs (Figures 1(a) and 1(b)). Grossly, the portion of distal pancreas measured 8.5 x 5.5 x 3.2 cm and contained a single, well-circumscribed, firm, white nodule, measuring 7.0 x 4.2 x 4.0 cm, the cut surfaces of which displayed irregular yellow foci and gray regions of necrosis (Figure 1(c)). The portion of spleen measured 14.0 x 8.0 x 4.0 cm and contained a solitary mass featuring morphology similar to that of the pancreas, measuring 3.0 x 2.7 x 2.8 cm (Figure 1(d)).
case_images: Composite H&E. (a) Shows atypical spindle cell proliferation with intermixed chronic inflammatory cells (200 magnification); (b) shows suppurative granuloma with palisade of histiocytes and overlying atypical spindle cell proliferation (100 magnification).
case_images: CRIPA2019-2648123.002.jpg
case_images: PMC6915151_01_CRIPA2019-2648123.002.jpg
case_images: fig2
case_images: These epithelioid granulomas had an associated intermixed lymphoplasmacytic inflammatory infiltrate and a prominent atypical spindle cell proliferation (Figure 2).
case_images: High power H&E of atypical spindle cells with intermixed lymphoplasmacytic inflammation (400 magnification (40X)).
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case_images: PMC6915151_01_CRIPA2019-2648123.003.jpg
case_images: fig3
case_images: These cells contained variably sized nuclei, prominent nucleoli, and distinctly irregular nuclear contours (Figure 3).
case_images: Reticulin stained tissue section showing nonobstructive phlebitis (400 magnification (40X)).
case_images: CRIPA2019-2648123.004.jpg
case_images: PMC6915151_01_CRIPA2019-2648123.004.jpg
case_images: fig4
case_images: No discrete storiform pattern of fibrosis was noted on either a haematoxylin and eosin or elastic stain; however, obliterative phlebitis was focally noted, as well as phlebitis without obstruction of the lumen (Figure 4).
case_images: Composite ancillary studies confirming IPT-like FDCT. (a) CD21 immunohistochemical positivity (400 magnification); (b) CD23 immunohistochemical positivity (400 magnification); (c) CD35 immunohistochemical positivity (400 magnification); (d) EBV-encoded (EBER) in situ hybridization positivity (200 magnification).
case_images: CRIPA2019-2648123.005.jpg
case_images: PMC6915151_01_CRIPA2019-2648123.005.jpg
case_images: fig5
case_images: The neoplastic follicular dendritic cells expressed CD21, CD23, and CD35 at least focally and demonstrated abundant cells positive for in situ EBV hybridization, consistent with IPT-like FDCT (Figure 5).