case_images: PMC9529642_01
case_images: CT abdomen and pelvis with contrast demonstrating a necrotic 9.8 cm x 12.1 cm left upper quadrant mass which completely obscures the pancreatic body and tail and infiltrates the spleen and gastric fundal wall (arrows). a. Axial Image; b. Coronal Image.
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case_images: PMC9529642_01_jchim-12-05-060f1.jpg
case_images: f1-jchim-12-05-060
case_images: ALP 175 U/L, AST 45 U/L, ALT 18 U/L, and lipase 40 U/L. A CT of the abdomen and pelvis with contrast revealed: a 9.8 cm x 12.1 cm heterogeneous necrotic left upper quadrant mass (Fig. 1), most likely originating from the pancreas, completely obscuring the pancreatic body and tail and also infiltrating the spleen and the gastric fundal wall; a splenic vein thrombosis was also present; and the pancreatic head was grossly unremarkable.
case_images: CT abdomen and pelvis with contrast demonstrating a heterogeneous hypodense 5.6 cm x 4.7 cm mass within the left iliac muscle (arrows). a. Axial Image; b. Coronal Image.
case_images: jchim-12-05-060f2.jpg
case_images: PMC9529642_01_jchim-12-05-060f2.jpg
case_images: f2-jchim-12-05-060
case_images: Furthermore, a 5.6 cm x 4.7 cm heterogeneous hypodense left iliac intramuscular mass was found (Fig. 2).
case_images: Pathologic examination of the muscle mass biopsy specimen. a. Hematoxylin and eosin stain (100x magnification): poorly differentiated carcinoma with necrosis; b. Immunohistochemistry stain for Pancytokeratin (100x magnification) positive; c: Immunohistochemistry stain for Cam 5.2 (100x magnification) positive.
case_images: jchim-12-05-060f3.jpg
case_images: PMC9529642_01_jchim-12-05-060f3.jpg
case_images: f3-jchim-12-05-060
case_images: Pathologic examination of the core biopsy specimen demonstrated poorly differentiated carcinoma with necrosis (Fig. 3a). On immunohistochemistry studies the specimen was positive for pancytokeratin (Fig. 3b), Cam 5.2 (Fig. 3c), Vimentin, and CK7; the sample was negative for leukocyte common antigen, HMB45/MART-1, S-100, SOX10, prostate specific antigen, ERG, CK7, CK20, thyroid transcription factor-1, CDX-2, p40, PAX-8, synaptophysin and desmin.