case_images: PMC6837828_01
case_images: Coronal post-contrast computed tomography image demonstrating an ill-defined, enhancing mass in the head of the pancreas (black arrow), with a poor plane of separation from the D2 segment of the duodenum (white arrow) and peripancreatic extension to the porta hepatis (white star). Secondary findings of ascites (black star).
case_images: SAJR-23-1760-g001.jpg
case_images: PMC6837828_01_SAJR-23-1760-g001.jpg
case_images: F0001
case_images: Computed tomography imaging showed an ill-defined, enhancing mass in the head of the pancreas (Figures 1-3), with a poor plane of separation from the D2 segment of the duodenum (Figures 1 and 3). Enhancing soft tissue, which extended beyond the confines of the pancreatic head into the region of the porta hepatis, was also noted and appeared to be contiguous with this mass (Figure 1).
case_images: Sagittal post-contrast computed tomography image illustrating a bulky, inhomogeneously enhancing mass in the head of the pancreas (black arrow) with ill-defined margins and extension into the porta hepatis (white star).
case_images: SAJR-23-1760-g002.jpg
case_images: PMC6837828_01_SAJR-23-1760-g002.jpg
case_images: F0002
case_images: Computed tomography imaging showed an ill-defined, enhancing mass in the head of the pancreas (Figures 1-3), with a poor plane of separation from the D2 segment of the duodenum (Figures 1 and 3).
case_images: Axial post-contrast computed tomography image demonstrating the locally invasive pancreatic mass (black arrow) with a poor plane of separation from the D2 segment of the duodenum (white arrow).
case_images: SAJR-23-1760-g003.jpg
case_images: PMC6837828_01_SAJR-23-1760-g003.jpg
case_images: F0003
case_images: Computed tomography imaging showed an ill-defined, enhancing mass in the head of the pancreas (Figures 1-3), with a poor plane of separation from the D2 segment of the duodenum (Figures 1 and 3).
case_images: Coronal T2-weighted (T2W) magnetic resonance images: (a) Pancreatic mass (white star) with ill-defined margins and a lobulated contour (broken white arrow). Evidence of peripancreatic extension to the porta hepatis. This lesion is locally invasive, as demonstrated by the inseparability from the D2 segment of the duodenum (solid white arrow); (b) Associated findings of dilated intrahepatic bile ducts (broken black arrow) and ascites (black star).
case_images: SAJR-23-1760-g004.jpg
case_images: PMC6837828_01_SAJR-23-1760-g004.jpg
case_images: F0004
case_images: The MRI abdomen demonstrated a pancreatic mass of poorly defined margins that had progressively enlarged and extended across tissue planes (Figure 4a and b). There was encasement of the superior mesenteric artery as demonstrated by the sandwich sign (Figure 5a and b), peripancreatic extension into the porta hepatis (Figure 4a) and also intrahepatic bile duct dilatation (Figure 4b).
case_images: Axial T2-weighted (T2W) magnetic resonance images showing the pancreatic head mass with intermediate signal intensity and encasement of the superior mesenteric artery (white arrow) in (a) and (b) - sandwich sign.
case_images: SAJR-23-1760-g005.jpg
case_images: PMC6837828_01_SAJR-23-1760-g005.jpg
case_images: F0005
case_images: There was encasement of the superior mesenteric artery as demonstrated by the sandwich sign (Figure 5a and b), peripancreatic extension into the porta hepatis (Figure 4a) and also intrahepatic bile duct dilatation (Figure 4b).
case_images: Photon microscopy of the pancreatic histology specimen with different magnification: (a) this low power image shows residual pancreatic tissue (centre circle) with surrounding lobules of the neoplastic infiltrate (4 x 10 magnification); (b) This higher power view of the same area (a) shows pancreatic acina, with surrounding and intermingled lobules of the neoplastic infiltrate (arrows) (10x10 magnification); (c) The neoplasm comprises spindled cells in swirling nodules. Slit-like vascular spaces are present (arrow). Extravasated red blood cells (oval) and hyaline globules (triangle) can be seen. Haemosiderin pigment is noted (square) (10x10 magnification); (d) This higher power view of the same area (c) better demonstrates the extravasated red blood cells (arrow) and hyaline globules (arrow head). Occasional inflammatory cells are visible (circle) (20x10 magnification); (e) This high-power image shows the spindle cell detail (40x10 magnification). The nuclei are elongated and bland with little pleomorphism and pale cytoplasm, with indistinguishable cell borders (arrow head). Haemosiderin pigment is evident (circle) and occasional extravasated red blood cells are present (arrow); (f) This image shows pancreatic acina and adjacent tumour. In the centre is a nodule of tumour bulging into a vessel, the so-called 'promontory sign' (circle) (20x10 magnification).
case_images: SAJR-23-1760-g006.jpg
case_images: PMC6837828_01_SAJR-23-1760-g006.jpg
case_images: F0006
case_images: Microscopy (Figure 6a-f) showed representation of pancreatic parenchyma, which contained a lobulated spindle cell neoplasm with slit-like vascular spaces, extravasated red blood cells, haemosiderin and hyaline globules.