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- Review this digital case as though it arrived to you in consultation.
- Provide your diagnosis, differential diagnoses and suggested ancillary tests at the bottom of this page within 2 weeks of the post date*.
- All responses will be collated and compiled along with the final diagnosis.
- Please return to this page in the coming weeks to view the final diagnosis as well as others’ responses.
PBPS Challenging Case 1 – July 11, 2022
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.
Distal pancreatectomy revealed a 4.3 cm, well circumscribed, predominantly solid mass abutting the splenic vein.
Representative scanned H&E slides (select link to open images)
Select scanned immunohistochemical (IHC) stains (select link to open images):
Cam 5.2 IHC
Summary of all IHC stains performed:
– 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
Next generation sequencing (NGS) result: No mutations, deletions or fusion detected
Case was submitted by: Dr. Klaudia Nowak from Toronto General Hospital, and Dr. Olca Basturk from Memorial Sloan Kettering Cancer Center.
*NOTE: The submission of case discussion has been closed.
*Thank you all for your feedback on the Pancreatobiliary Pathology Society’s first challenging case. A panel of experts (Drs. Volkan Adsay, Michelle Reid, and Huamin Wang) has also reviewed the case and rendered their diagnoses. Please see the discussion summary now posted HERE for details.