Ill-defined, highly cellular nodules of cytologically atypical spindle cells, intermingling with scattered adenocarcinomatous elements within a myxoid stroma were determined by scanning light microscopy ( Fig. (H&E magnification, ×40) (D) Keratin staining (MNF1) was positive in the glandular and spindle cell elements of the tumor (magnification, ×10). A scant cytoplasm and no distinct features of specific mesenchymal differentiation were identified. (C) Scattered malignant epithelial cells merged imperceptibly with the cytologically atypical spindle cells. (B) Spindle cell component of the tumor with background myxoid matrix (H&E magnification, ×10). The tumor nodule is indicated by the arrow. (A) Intact speciman consisting of the pancreatic body and tail with the attached spleen and portion of stomach. The patient was alive and well 26 months after the surgery. In addition, laparoscopic distal (near-total) pancreatectomy, splenectomy and partial gastrectomy were performed. A second population of more primitive tumor cells was identified with high nuclear/cytoplasmic ratios within a richly mucinous stromal background. A fine-needle aspiration of the mass was performed prior to surgery and revealed high-grade malignant epithelial cells in a pseudopapillary pattern. According to these radiological observations, an initial clinical diagnosis of an adenocarcinoma or neuroendocrine tumor was formed. The mass was homogeneously enhanced and exhibited diffuse peripancreatic stranding. A pre- and post-contrast helical abdominal (pancreatic and portal venous phase) and pelvic (venous phase) CT demonstrated a unilocular, non-enhancing, cystic mass measuring 3.7×2.7 cm that obstructed the main pancreatic duct within the body of the pancreas. Endoscopic ultrasound identified a well-circumscribed, hypoechoic mass adjacent to the portal vein within the pancreatic body. An 85-year-old Caucasian male presented to Northwestern Memorial Hospital (Chicago, IL, USA) with signs and symptoms resembling earlier episodes of pancreatitis that had been experienced over the past 8 months. The need for written consent was waived by the Institutional Review Board of Northwestern University (Chicago, IL, USA). SC IHC: diffuse pan-CK, CK5.2, p53 (D+), synaptophysin, chromogranin, calponin, S100, SMA, CK19, MUC1, nuclear β-Catenin, p63, EMA and CD10 (−) K-ras mutation at codon 12 of exon 2 in SC and epithelial componentsĤ/succumbed to hepatic and peritoneal metastases SC, scattered OGC IHC (SC): vimentin (D+), pan-CK, CK, 7, CK8/18, EMA, CEA, CD34, CD56, CD68, CD117, desmin, SMA, myogenin, S100, ER and PR (−) Mucinous cyst adeno and anaplastic carcinoma K-ras mutation at codon 12 (and codon 34) of exon 2 in SCĠ/Succumbed to DIC on post-operative day 13 SC, foci of OGC around hemorrhage IHC (SC): vimentin, CD10 (D+), CK AE1/AE3 (F+), CK7, CK20, CEA, EMA, SMA and S100 (−) Not identified, but associated with choledochal cystĩ/succumbed to sarcomatoid carcinoma metastatic to the liver SC, separate focus of OGC IHC (SC): CK8/18 and vimentin (D+) SC IHC:vimentin (D+), CK (F+), CEA, SMA, desmin and CD68 (−) SC IHC: CK AE1, variable CK AE3, EMA, MUC1-ARA (D+), S100, SMA (F+), desmin, vimentin, NSE and CEA (−)ģ/succumbed to diffuse peritoneal carcinomatosis Sarcomatoid (spindle cell) carcinoma defined in this way rarely presents in the pancreas, with, to the best of our knowledge, only six cases reported in the English literature. No light microscopic or immunohistochemical evidence of specific mesenchymal differentiation was identified, and the spindle cells, as in the case of the carcinoma, were diffusely keratin-positive. Microscopic examination of the 3.3-cm mass located in the body of the pancreas revealed a small, but high-grade, adenocarcinomatous component that blended imperceptibly with malignant spindle cells. The individual subsequently underwent a distal pancreatectomy, splenectomy and partial gastrectomy. The current study presents the case of an 85-year-old Caucasian male with a tumor mass in the body of the pancreas. Sarcomatoid (spindle cell) carcinoma of the pancreas is a rare, high-grade epithelial malignancy composed predominantly or exclusively of spindle cells demonstrating evidence of epithelial derivation, but no features indicative of a specific line of mesenchymal differentiation.

Spindle cell carcinoma