case_images: PMC3679691_01
case_images: CT abdomen with "sausage-shaped" pancreas.
case_images: CRIM.SURGERY2013-809023.001.jpg
case_images: PMC3679691_01_CRIM.SURGERY2013-809023.001.jpg
case_images: fig1
case_images: His pancreatic duct was normal in calibre (Figures 1 and 2).
case_images: CT abdomen revealing a bulky pancreatic head.
case_images: CRIM.SURGERY2013-809023.002.jpg
case_images: PMC3679691_01_CRIM.SURGERY2013-809023.002.jpg
case_images: fig2
case_images: His pancreatic duct was normal in calibre (Figures 1 and 2).
case_images: Portal vein narrowed with evidence of impingement on CT axial and sagittal images.
case_images: CRIM.SURGERY2013-809023.003.jpg
case_images: PMC3679691_01_CRIM.SURGERY2013-809023.003.jpg
case_images: fig3
case_images: The portal and superior mesenteric veins were significantly narrowed and impinged (Figure 3).
case_images: Endoscopic retrograde cholangiopancreatography (ERCP) images with dilated biliary tree down to a strictured distal bile duct.
case_images: CRIM.SURGERY2013-809023.004.jpg
case_images: PMC3679691_01_CRIM.SURGERY2013-809023.004.jpg
case_images: fig4
case_images: His intrahepatic and extrahepatic biliary tree was dilated to the lower third of the common bile duct (CBD), at which point the lower CBD appeared narrowed (Figure 4). 
case_images: An irregular hypoechoic area within the head of the pancreas above, which the common bile duct tapered.
case_images: CRIM.SURGERY2013-809023.005.jpg
case_images: PMC3679691_01_CRIM.SURGERY2013-809023.005.jpg
case_images: fig5
case_images: There was a 33 x 45 mm irregular hypoechoic area seen within the head of the pancreas, above which the CBD tapered (Figure 5).
case_images: EUS-guided FNA of the pancreatic mass.
case_images: CRIM.SURGERY2013-809023.006.jpg
case_images: PMC3679691_01_CRIM.SURGERY2013-809023.006.jpg
case_images: fig6
case_images: EU-guided fine-needle aspiration (FNA) biopsy of the head of the pancreas performed revealed loosely fibrous stromal tissue with mildly distorted, reactive ductal epithelial element, and lymphocytic infiltration (Figure 6).
case_images: Histopathology revealed carcinoma with squamous differentiation and some admixed tumour cells containing intracytoplasmic mucin.
case_images: CRIM.SURGERY2013-809023.007.jpg
case_images: PMC3679691_01_CRIM.SURGERY2013-809023.007.jpg
case_images: fig7
case_images: Histology revealed a moderately differentiated 30 mm adenosquamous carcinoma of the head of the pancreas with invasion of the duodenal wall and metastases into 4 of 40 lymph nodes; margins were clear, and his portal vein was clear with extensive changes of autoimmune pancreatitis (Figures 7 and 8).
case_images: Histopathology of areas with gland formation (adenocarcinoma).
case_images: CRIM.SURGERY2013-809023.008.jpg
case_images: PMC3679691_01_CRIM.SURGERY2013-809023.008.jpg
case_images: fig8
case_images: Histology revealed a moderately differentiated 30 mm adenosquamous carcinoma of the head of the pancreas with invasion of the duodenal wall and metastases into 4 of 40 lymph nodes; margins were clear, and his portal vein was clear with extensive changes of autoimmune pancreatitis (Figures 7 and 8).
case_images: Histopathology showed inflammatory, sclerosing process involving benign region of pancreatic tissue. There was fibrosis atrophy of exocrine elements and lymphoplasmacytic inflammation. Residual pancreatic islets are also present.
case_images: CRIM.SURGERY2013-809023.009.jpg
case_images: PMC3679691_01_CRIM.SURGERY2013-809023.009.jpg
case_images: fig9
case_images: The nonneoplastic portion of the pancreas showed extensive chronic pancreatitis with features consistent with autoimmune pancreatitis and squamous metaplasia (Figure 9).