case_images: PMC1236970_01
case_images: Contrast enhanced abdominal computed tomography showing an ill defined mass revealing faint inhomogeneous low density in the body of the pancreas.
case_images: 1477-7819-3-59-1.jpg
case_images: PMC1236970_01_1477-7819-3-59-1.jpg
case_images: F1
case_images: The mass was located in the body of the pancreas and was ill-defined with faint inhomogeneous low density at both the arterial and the venous phases of computerized tomography (CT) scan (Figure 1).
case_images: A. Macroscopic photograph of the tumor. Sectioned surface reveals a non-encapsulated, circumscribed, gray-white, firm, solid mass with partially lobulate margin and irregular small cysts. B. Low power view of microscopic features of the tumor. Cystic or glandular epithelial components are set in abundant dense stroma (hematoxylin and eosin, x 40)
case_images: 1477-7819-3-59-2.jpg
case_images: PMC1236970_01_1477-7819-3-59-2.jpg
case_images: F2
case_images: The mass was predominantly solid with some cystic spaces, which contained mucinous fluid (Figure 2A). Glandular or small cystic structures were scattered in the predominant stroma, which created the tumor's solid appearance (Figure 2B).
case_images: Microscopic photograph of the tumor. A. Cystic structure is lined by benign columnar mucinous epithelial cells (arrow). Subepithelial stroma is composed of bland looking spindle cells (asterisk) mimicking ovarian stroma (hematoxylin and eosin, x 200). B. Stromal cells are immunoreactive against calretinin (x 200). C. Stromal cells are reactive against progesterone receptor (x 400). D. Columnar epithelia are accompanied by intestinal metaplasia with scattered goblet cells (right) as well as pseudopyloric metaplasia (left) (hematoxylin and eosin, x 200). E. Scattered endocrine cells (arrows) are highlighted by reactivity to chromogranin A (x 400). F. Cysts are lined by benign transitional-type epithelium, beneath which the stroma is hyalinized (hematoxylin and eosin, x 200). G. Transitional cells are immunoreactive to high molecular weight cytokeratin (x 400).
case_images: 1477-7819-3-59-3.jpg
case_images: PMC1236970_01_1477-7819-3-59-3.jpg
case_images: F3
case_images: The subepithelial stroma was cellular and composed of bland looking spindle cells mimicking ovarian stroma (Figure 3A). The columnar epithelia contained occasional goblet cells and endocrine cells and revealed abundant pseudopyloric metaplasia (Figure 3D). Some cysts were lined by bland looking polygonal or ovoid stratified cells suggestive of benign transitional epithelia (Figure 3F). Transitional epithelia were diffusely reactive to high molecular weight cytokeratin (Figure 3G), whereas mucinous epithelia were not reactive to it. Scattered endocrine cells were highlighted by positive reactivity to chromogranin A (Figure 3E). The stromal cells were diffusely positive for CD 34 and vimentin, and focally positive for calretinin (Figure 3B) and progesterone receptor (Figure 3C), while negative for estrogen receptor, alpha-smooth muscle actin, desmin, c-kit, CD99, S100 protein and cytokeratin.