case_images: PMC8565694_01
case_images: Cephalic pancreatic tumour predominantly cystic in tight contact with the superior mesenteric vein.
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case_images: 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.
case_images: Surgical specimen: antrum, duodenum, first jejunal loop, head of the pancreas presenting tumor mass and distal commone bile duct.
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case_images: The surgical team decided to continue the surgery with the Whipple procedure, removing the entire expansive process (Figure 2).
case_images: 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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case_images: The tumor growth patterns were pushing border, endoluminal/polypoid and infiltrative into the stroma (Figures 3-5).
case_images: 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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case_images: The tumor growth patterns were pushing border, endoluminal/polypoid and infiltrative into the stroma (Figures 3-5).
case_images: Invasive front of UCOGC with desmoplastic stroma, small recent hemorrhagic area and entraped adipocites (HE, x100).
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case_images: acc-06-01-6-g005
case_images: The tumor growth patterns were pushing border, endoluminal/polypoid and infiltrative into the stroma (Figures 3-5).
case_images: 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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case_images: The main pancreatic duct was dilated, focally with high grade dysplasia, associating foci of invasive ductal adenocarcinoma (Figure 6).
case_images: Main pancreatic duct towards apullary zone with high grade dysplasia (HE, x100).
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case_images: High grade PanIN versus immature squamos metaplasia (HE, scanned specimen).
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case_images: Small main pancreatic duct branches with low and high grade intraepithelial neoplasia (HE, x100).
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case_images: 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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