case_images: PMC11082267_01
case_images: Preoperative imaging examination of the patient. (A, B) Abdominal arterial phase CT imaging suggested the presence of a 4 cm irregular mass with inhomogeneous enhancement in the pancreatic head (denoted by thick arrow in A), along with enlarged lymph nodes around the head of the pancreas (approximately 2cm in diameter, thick arrow in B) and an dilated main pancreatic duct with maximum width of 8mm (denoted by thin arrow in B); (C) Magnetic resonance imaging indicated truncation of both the common bile duct and the main pancreatic duct resulting from a mass in the pancreatic head.
case_images: fonc-14-1335647-g001.jpg
case_images: PMC11082267_01_fonc-14-1335647-g001.jpg
case_images: f1
case_images: Abdominal enhanced computed tomography (CT) and magnetic resonance imaging (MRI) revealed an irregular mass measuring approximately 47x35mm in the head of the pancreas, with uneven abnormal enhancement characteristics. Additionally, multiple lymph nodes in the hilar and retroperitoneal regions were found to be enlarged, along with dilation of the distal pancreatic duct, upper common bile duct, and intrahepatic bile ducts ( Figure 1 ).
case_images: Pathological outcomes of the patient. Preoperatively, (A) (x200): Hematoxylin-eosin staining revealed heteromorphic tumor cells in the pancreas tissue obtained from fine needle aspiration. Postoperatively, (B) (x100): Hematoxylin-eosin staining showed that the poorly differentiated tumor exhibited hepatoid differentiation, with neoplastic cells growing in a sheet-like or trabecular pattern along with sinusoids. (C) (x200): Hematoxylin-eosin staining demonstrated polygonal or cubic eosinophilic cells with abundant cytoplasm and enlarged, prominent nuclei. (D-H) (x100): Immunohistochemistry staining revealed tumor cells expressing CK7, CK8/18, CK19 (with weak positivity), AFP, and Glypican-3, respectively; (I) (x100). Hematoxylin-eosin staining displayed heteromorphic tumor cells proliferating within the lymph node.
case_images: fonc-14-1335647-g002.jpg
case_images: PMC11082267_01_fonc-14-1335647-g002.jpg
case_images: f2
case_images: The immunohistochemical results were as follows ( Figure 2 ): AFP (+), Glypican-3 (+), Hep Par-1(-), Arginase-1 (-), CK7 (+), CK8/18 (+), CK19 (+), CK20 (-), E-Cadherin (+), EMA(+), Vimentin (-), beta-catenin (+), P53 (+), RB1 (+), Ki-67 (Li approximately 40%).