Welcome to PBPS Challenging Cases (Case 1)

 Instructions for participation:

  1. Review this digital case as though it arrived to you in consultation. 
  2. Provide your diagnosis, differential diagnoses and suggested ancillary tests at the bottom of this page within 2 weeks of the post date*.
  3. All responses will be collated and compiled along with the final diagnosis.
  4. 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

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. 

Representative scanned H&E slides (select link to open images)

H&E 1

https://pathpresenter.net/public/display?token=f8789272

H&E 2

https://pathpresenter.net/public/display?token=ca3927d4

Select scanned immunohistochemical (IHC) stains (select link to open images):

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

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. The final diagnosis as well as others’ responses will be posted soon. Please come back later.