title: Pleomorphic carcinoma of the pancreas with massive lymphocytic stromal infiltration and long-term survival after resection.
abstract: BACKGROUND
  Pleomorphic carcinoma of the pancreas is a rare tumor with an extremely poor prognosis. The mean survival time is reported to be approx 3 mo.
  A 56-yr-old Japanese man presenting with general fatigue, loss of weight, and high fever was found to have a large hypervascular mass in the body of the pancreas with regional lymph node metastases. Laboratory investigation revealed leukocytosis, elevated erythrocyte sedimentation rate (ESR), and high serum C-reactive protein (CRP). In addition to distal pancreatectomy, splenectomy and lymph node dissection were performed. Histology showed the presence of pleomorphic large cells with bizarre mono- or multinuclei, growing in sarcomatoid pattern without mutual cohesiveness. Another noticeable finding was massive lymphocytic infiltration of the stroma of the neoplasm. Immunohistochemically, the infiltrating lymphocytes consisted of cytotoxic type of T cells. In addition, in situ hybridization for Epstein-Barr virus-encoded RNA (EBAR-1) was not seen in the tumor cells or in lymphocytes. After surgery the patient did not undergo chemotherapy or radiotherapy. He has been well without recurrence for 8 yr.
  
  
  CONCLUSIONS
  We report a case of pleomorphic carcinoma, possibly lymphoepithelioma-like carcinoma, of the pancreas with massive lymphocytic stromal infiltration and long-term survival after resection. Cytokine responses and cellular immunoreactivity may have contributed to a long-term survival, which is unusual in the common type of pleomorphic carcinoma of the pancreas.
authors.affiliation: Department of Surgery, Jichi Medical School, Tochigi, Japan. kurihara@jichi.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Kurihara
authors.forename: H
authors.initials: H
authors.lastname: Nagai
authors.forename: K
authors.initials: K
authors.lastname: Kasahara
authors.forename: T
authors.initials: T
authors.lastname: Kawai
authors.forename: K
authors.initials: K
authors.lastname: Saito
authors.forename: K
authors.initials: K
authors.lastname: Kanazawa
mesh_terms: D002277:Carcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D013156:Splenectomy; D017741:Survivors