case_images: PMC3884205_01
case_images: a Enhanced CT revealed a cystic lesion (arrowheads) without a solid component in the pancreas head. b Magnetic resonance cholangiopancreatography revealed that the cystic lesion (arrowheads) was multilocular and connected to the MPD. c EUS revealed a multilocular lesion (arrowheads) with neither mural nodules nor wall thickness. d ERCP revealed cystic dilation of the branch ducts measuring 15 mm (arrowheads) without dilation of the MPD.
case_images: crg-0007-0449-g01.jpg
case_images: PMC3884205_01_crg-0007-0449-g01.jpg
case_images: F1
case_images: MPD (fig. 1a). Magnetic resonance cholangiopancreatography revealed that the cystic lesion was multilocular and connected to the MPD, which was not dilated (fig. 1b). On endoscopic ultrasonography (EUS), neither mural nodules nor wall thickness within the cystic lesion were detected (fig. 1c). ERCP revealed a 15-mm cystic dilation of the branch ducts without dilation of the MPD (fig. 1d).
case_images: The atypical columnar cells had loss of polarity, enlarged and hyperchromatic irregular nuclei and partially intracytoplasmic mucin.
case_images: crg-0007-0449-g02.jpg
case_images: PMC3884205_01_crg-0007-0449-g02.jpg
case_images: F2
case_images: However, cytological examination of the pancreatic juice collected during ERCP showed atypical columnar cells with loss of polarity, enlarged and hyperchromatic irregular nuclei and partially intracytoplasmic mucin (fig. 2).
case_images: Hematoxylin and eosin staining (original magnifications: a x20, b x200, c x400). a Low-power field showed dilated branch ducts and small nests of invasive carcinoma surrounded by myxoid stroma (curved lines). Insets indicate images of the right side. b The dilated branch ducts were lined by mildly to severely dysplastic columnar epithelium. c Small nests of irregular glands with enlarged nuclei were invading the pancreatic parenchyma.
case_images: crg-0007-0449-g03.jpg
case_images: PMC3884205_01_crg-0007-0449-g03.jpg
case_images: F3
case_images: Pathological examination of the resected specimen showed a multilocular cystic lesion (fig. 3a), 16 x 9 x 15 mm in size, composed of dilated pancreatic branch ducts lined by columnar epithelium with mostly low-grade to focally high-grade dysplasia showing micropapillary growth (fig. 3b). In addition, small nests of irregular glands with enlarged nuclei invading the pancreatic parenchyma were noted over a distance of 11 mm, surrounded by myxoid stroma (fig. 3c).