Clinical history:
A 32-year-old male with a history of Hodgkin’s lymphoma and biliary atresia. He had undergone transplant and was found to have distal pancreas mass during surveillance.
Pathologic Findings:
Distal pancreatectomy revealed a 4.3 cm, well circumscribed, predominantly solid mass abutting the splenic vein.
Please see two representative scanned H&E slides for histologic features.
Performed immunohistochemical stains reveal that the tumor cells:
– Express: CAM 5.2 (scanned), CK19, CK5, Ber-EP4, claudin-4 (focal), calretinin (scanned), SATB2 (patchy), CD99 (patchy, membranous), inhibin (rare cells), CD10 (focal) and a Ki67 stain reveals a
proliferative rate of 15%.
– Do NOT express: CK7, CK20, CDX2, trypsin, chymotrypsin, carboxyl ester lipase, chromogranin, synaptophysin, INSM1, insulin, glucagon, somatostatin, pancreatic polypeptide, p40, p63, monoclonal CEA, EMA, TTF1, HepPar-1, Glypican-3, GATA3, PAX8, NKX3.1, SF-1, WT1, D2-40, SALL4, CD117, DOG1, CD34, SMA, calponin, ERG, CD45, S100, SOX10, melanoma cocktail
– Other: aberrant beta-catenin (nuclear and cytoplasmic, (scanned), E-cadherin (membranous), p53 wild-type, RB1 retained, ATRX retained, MMR retained, mucicarmine negative,
No mutations, deletions or fusions were seen by NGS.
HE-1
https://pathpresenter.net/public/display?token=f8789272
HE-2
https://pathpresenter.net/public/display?token=ca3927d4
Cam 5.2 IHC
https://pathpresenter.net/public/display?token=6e1b407d
Calretinin IHC
https://pathpresenter.net/public/display?token=b4d3bde0
Beta-catenin IHC
https://pathpresenter.net/public/display?token=cb61d7fb
NOTE: The case will be open for 2 weeks for discussion. Please leave a reply of your proposed diagnosis, differential diagnosis and suggested ancillary tests (bottom of this page). We will collect the replies and post the final diagnosis with discussion.