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Case 3
Pancreatic neoplasia
G. Dell'Antonio
– San Raffaele Hospital
(Pictures by dr. Dell'Antonio)
Clinical history
A 31y.o. man (with silent anamnesis) has an abdominal US for epigastralgia. This shows a 4 cm nodule of the pancreatic tail.
Further clinical examinations are in the normal range except AST, ALT and Alpha-fetoprotein.
Macroscopicalal description
During surgery a pink-whitish, 6 cm nodule of the pancreatic tail, which adheres to the stomach and the spleen, is removed. A 6 cm liver nodule is also identified.
Microscopicalal description
The tumor has both papillary and cystic features ( Picture 1 - Picture 2) with a diffuse and glandular component ( Picture 3). Sometime the papillae grow in a large lumen (Picture 4). There are fibrous-papillary areas ( Picture 5), others completely formed by glands or admixed to some with diffuse pattern ( Picture 6) with ill-defined cells ( Picture 7); sometime there are necrotic areas ( Picture 8). The nuclei show one or more peripheral nucleoli ( Picture 9). The cytoplasm is eosinophilic and homogeneous, non granular and rarely shows mucus-production ( Picture 10). In the infiltrative areas no neuro-tropism is evident ( Picture 11).
The liver nodule is a metastasis without peculiar morphologic features ( Picture 12); there are no lymph nodes metastases. The immunohistochemical staining show positivity for CK7 ( Picture 13), focal weak positivity for CEA and are negative for Vimentin ( Picture 14), CK20, GICA, Synaptophysin, Chromogranin and Alpha-fetoprotein. Alfa-1-antichimotrypsin and anti-trypsin are not reliable.
Diagnosi
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