Presentation
Work up for abdominal pain and jaundice.
Patient Data
Mild dilatation of intra and extra hepatic bile ducts was seen, and CBD measured 12 mm in caliber.
A 21 mm isodense mass was noted in the uncinated process of the pancreas, which enhances less than normal pancreatic parenchyma on post contrast late arterial phase images.
Post operative changes due to the Whipple procedure are seen as partial pancreaticoduodenectomy, pancreaticojejunostomy, hepaticojejunostomy, cholecystectomy and gastrojejunostomy. There is no local tumoral recurrence at the surgical site and no regional lymphadenopathy. Pneumobilia is evident.
A 12 mm ill defined low enhancing mass like lesion is present at the left liver lobe, which becomes isodense with surrounding parenchyma on delayed images.
Diastasis recti with a few small midline fascial defects are seen at the anterior abdominal wall.
Case Discussion
The patient underwent the Whipple procedure, and histopathology evaluation confirmed:
The section reveals tissue fragments, including the pancreas, small intestine with the duodenal ampullary region, lymph nodes and gallbladder. The subampullary area represents simple adenomatous proliferation. The pancreas tissue represents a neoplasm composed of an atypical proliferation of pleomorphic cells that are invasive, arranged in aggregates, in an organoid pattern, and in solid sheets. Intervening are scattered multinucleated tumor giant cells, the neoplasm shows occasional gland-like structures, lined by atypical cuboidal to columnar epithelial cells, despite cellular pleomorphism, mitosis is rare, necrosis absent. The tumor invaded peripancreatic fat and between smooth muscle bundles of the surrounding gastrointestinal wall.
IHC stains are positive for CD10, CD56, PR and B-cathenin and negative for NSE, SMA, EMA, and CD15.
All included lymph nodes showing reactive hyperplasia.
Histopathology diagnosis:
Pancreatic carcinoma, anaplastic pleomorphic type with the neuroendocrine feature.
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