case_images: PMC9178976_01
case_images: (a) Post-contrast dorsal view (matrix 512 x 512, window level 76 HU, window width 372 HU, field of view adjusted to patient size, patient in sternal recumbency) showing a large rounded well-encapsulated, hypodense mass arising from the left pancreatic lobe. Craniolateral displacement of the spleen (orange arrow) and the liver (yellow arrow) was noted. (b) Post-contrast transverse view (matrix 512 x 512, window level 76 HU, window width 372 HU, field of view adjusted to patient size, patient in sternal recumbency) showing a large, rounded, well-encapsulated, hypodense mass arising from the left pancreatic lobe. Lateral displacement of the spleen (yellow arrow) was noted
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case_images: The remainder of the mass was hypodense and fluid filled (Figure 1).
case_images: A population of slender spindle cells (black arrow) was revealed by cytology. Magnification x100
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case_images: However, an inflamed mesenchymal neoplasm could not be ruled out (Figure 2).
case_images: Intraoperative photograph showing the large pancreatic mass within the omental bursa; the greater and lesser omentum adhered to the mass. The distal left pancreatic limb was present (black arrow)
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case_images: Exploration revealed a large multilocular cystic mass within the mid-distal portion of the left limb of the pancreas (Figure 3).
case_images: (a) Low (x0.5 magnification) and (b) high-power (x40 magnification) view of the spindle cell population. Areas of cavitation and necrosis are seen (black arrow)
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case_images: There were some admixed lymphocytes and plasma cells throughout, and areas of necrosis filled with fibrin and red blood cells, with some accompanying macrophages displaying erythrophagocytosis (Figure 4).
case_images: Positive cytoplasmic staining with (a) desmin and (b) smooth muscle actin (both x40 magnification)
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case_images: Desmin, M0760, 1:100) and actin: (Dako Monoclonal Mouse, Anti-Human Smooth Muscle Actin, Clone 1A4, M0851, 1:400). Desmin (smooth and striated muscle) and smooth muscle actin (smooth muscle) staining revealed a widespread moderate-to-strong cytoplasmic labelling of the proliferating cellular population (Figure 5).