case_images: PMC2782216_01
case_images: (A) An abdominal computerized tomography reveals the presence of a large cystic mass, arising from the tail of pancreas. (B) The resected tumor is a 8x7x6-cm hemorrhagic and cystic mass in the tail of the pancreas.
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case_images: PMC2782216_01_jkms-20-516-g001.jpg
case_images: F1
case_images: An abdominal computerized tomography revealed the presence of a large cystic mass, arising from the tail of pancreas (Fig. 1A). The resected tumor was a 8x7x6-cm hemorrhagic and cystic mass in the tail of the pancreas, mimicking pancreatic pseudocyst (Fig. 1B).
case_images: Histologically, the tumor is composed of typical ductal adenocarcinoma (closed arrow) and surrounding mononuclear stromal cells (open arrow) intermingled with osteoclast-like giant cells (closed arrow head) and pleomorphic large cells (open arrow head) (H&E x200).
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case_images: PMC2782216_01_jkms-20-516-g002.jpg
case_images: F2
case_images: Histologically, the tumor was composed of typical ductal adenocarcinoma and surrounding mononuclear stromal cells intermingled with osteoclast-like giant cells and pleomorphic large cells (Fig. 2).
case_images: Immunohistochemical staining of cytokeratin (A) and CD-68 (B). Cytokeratin (CK) is strongly positive for ductal carcinoma cells, whereas both osteoclast-like giant cells and mononuclear cells are negative for CK. However, osteoclast-like giant cells and mononuclear cells are positive for histiocytic markers, CD-68 (x200).
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case_images: PMC2782216_01_jkms-20-516-g003.jpg
case_images: F3
case_images: Immunohistochemically, cytokeratin (CK) and epithelial membrane antigen (EMA) are strongly positive for ductal carcinoma cells, whereas both osteoclast-like giant cells and mononuclear cells were negative for CK (Fig. 3A) and EMA. Osteoclast-like giant cells and mononuclear cells were positive for histiocytic markers, CD-68 (Fig. 3B) and lysozyme.
case_images: Electron microscopically, the nucleus of the mononuclear cell contains prominent nucleoli, with dispersed clumps of heterochromatin. The cytoplasm contained ample mitochondria, and moderate amount of rough endoplasmic reticulum (x4,000).
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case_images: PMC2782216_01_jkms-20-516-g004.jpg
case_images: F4
case_images: The cytoplasm contained ample mitochondria, and moderate amount of rough endoplasmic reticulum (Fig. 4) (Table 2).
case_images: Electron microscopically, osteoclast-like giant cell has multiple nuclei with dispersed chromatin and a fine chromatin rim. The cytoplasm is characterized by abundant mitochondria of varying size, free ribosomes, and dilated empty rough endoplasmic reticulum cisternae (x4,000).
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case_images: PMC2782216_01_jkms-20-516-g005.jpg
case_images: F5
case_images: The cytoplasm was characterized by abundant mitochondria of varying size, free ribosomes, and dilated empty rough endoplasmic reticulum cisternae (Fig. 5) (Table 2).