case_images: PMC2831459_01
case_images: CT scan showed a large heterogeneous cystic lesion in the head of the pancreas (arrow).
case_images: JO2010-242016.001.jpg
case_images: PMC2831459_01_JO2010-242016.001.jpg
case_images: fig1
case_images: A combination of imaging studies, including transabdominal ultrasound and computed tomography (CT) of the abdomen and pelvis (Figure 1), showed a large heterogeneous cystic lesion in the head of the pancreas measuring 10 x 6.9 x 5.5 cm displacing the second segment of the duodenum laterally.
case_images: Gross appearance of a large papillocystic pancreatic lesion.
case_images: JO2010-242016.002.jpg
case_images: PMC2831459_01_JO2010-242016.002.jpg
case_images: fig2
case_images: The patient underwent pancreaticododudenectomy in November 2007 Pathological examination showed a large cystic lesion involving the head of the pancreas with papillary and nodular projections (Figure 2).
case_images: Photomicrograph showing papillary projections lined by cuboidal cells.
case_images: JO2010-242016.003.jpg
case_images: PMC2831459_01_JO2010-242016.003.jpg
case_images: fig3
case_images: Histological section showed a papillary tumor with fibrovascular cores covered by uniform cells with granular apical accentuation characteristic of acinar cell carcinoma (Figure 3).
case_images: Immunohistochemical positive staining for trypsin marker.
case_images: JO2010-242016.004.jpg
case_images: PMC2831459_01_JO2010-242016.004.jpg
case_images: fig4
case_images: By immunohistochemistry, the tumor cells were positive for CAM 5.2, amylase, trypsin (Figure 4) and focally for synaptophysin, and negative for vimentin, insulin, glucagons, somastostatin, and electron microscopy confirmed the presence of zymogen granules characteristic of acinar cell carcinoma.