Case Reports

Case 1

A 49-year-old female presented to her family doctor having suffered from lumbar pain. She had an abnormal shadow by abdominal X-ray, but had left it unattended. She was admitted to our hospital because of the tumor shadow being found again by a routine medical check. Abdominal US and CT scan revealed a ping-pong-ball sized tumor in the pancreatic tail. A distal pancreatectomy was performed. The resected tumor measured 6 X 6 X 3.7 cm and the cut surface showed a yellowish-white solid tumor forming focally cystic changes with marked calcification and ossification (fig. 1). The tumor invaded into the capsule in the anterior region of the pancreas, but not into the surrounding pancreatic tissue. Histologically, the tumor was composed of small round cells with pseudopapillary structures and a microcystic pattern with mucinous material.

Case 2

A 12-year-old girl was admitted to a hospital with a chief complaint of abdominal pain and nausea. Abdominal X-ray and US of the abdomen revealed a tumor of the pancreatic tail. A distal pancreatectomy and splenectomy was performed. The resected tumor measuring 5 X 4 X 4 cm was elastically hard and had a thick fibrous capsule. The cut surface showed a solid white tumor with hemorrhagic cyst. Histologically, the tumor was composed of solid sheets of round-to-ovoid cells with solid and pseudopapillary structures, and focally pseudorosettes. Focally, a few mitotic figures were observed. In the solid areas, some tumor cells had PAS-positive globules, and these also were found in the imprint cytological specimens of the tumor (fig. 2). Cholesterol granuloma and calcification were seen in the cystic area. The tumor extended directly into the surrounding pancreatic parenchyma with capsular penetration. Moreover, metastases to the parapancreatic and omental lymph nodes were found (fig. 3).

Case 3

A 20-year-old female presented to her family doctor complaining of abdominal pain. Abdominal US and a CT scan confirmed the finding of a cystic lesion in the pancreatic head, suggestive of cystadenoma. An enucleation of the tumor was performed. The tumor measuring 7 X 7 X 3 cm revealed a well-circumscribed unilocular cyst with a thin fibrous capsule, and the cyst contained dark red material. The inner surface of the cyst wall was covered by papillary tumor cells. Histologically, on the cystic lumen, the oval-shaped tumor cells were arranged around a fibrovascular stalk with a pseudopapillary pattern (fig. 4).

Case 4

A 62-year-old female with no significant previous medical history was admitted to hospital because of abdominal discomfort and mass. Abdominal US and a CT scan revealed a protruded solid tumor arising from the pancreatic body. Complete excision of the tumor was performed. The

Fig. 1. Case 1. a Cut surface of the tumor reveals solid, cystic, and hemonecrotic areas. b Histological feature of the tumor is composed of solid nests with marked calcification and ossification. HE. X10.

Fig. 2. Case 2. a Cut surface shows solid and cystic areas with necrosis. b In imprint cytological finding, the tumor cells have round nuclei with hyaline globules. Papanicolaou stain. X 1,000.

Fig. 1. Case 1. a Cut surface of the tumor reveals solid, cystic, and hemonecrotic areas. b Histological feature of the tumor is composed of solid nests with marked calcification and ossification. HE. X10.

Fig. 2. Case 2. a Cut surface shows solid and cystic areas with necrosis. b In imprint cytological finding, the tumor cells have round nuclei with hyaline globules. Papanicolaou stain. X 1,000.

tumor was well-encapsulated and measured 8 X 7 X 5 cm. The cut surface was solid without cystic formation. Histologically, the tumor was composed of ovoid cells with mild nuclear atypia and a few multinucleated giant cells. However, mitotic figures were very rare (fig. 5).

The postoperative course of all patients was uneventful and no recurrence was observed.

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