title: Pancreatic mucinous cystic neoplasm with sarcomatous stroma metastasizing to liver: a case report and review of literature.
abstract: We report a case of mucinous cystic neoplasm of pancreas with sarcomatous stroma metastasizing to the liver. The tumor occurred in a male patient aged 46 years. Symptoms included persistent epigastric and right upper quadrant pain. Radiographically, the pancreas contained four large cystic masses located in the neck, body, and tail. Histologically, the cysts were lined with benign, mucinous epithelium with underlying bland, storiform, ovarian-like stroma. An undifferentiated focally hyalinized, sarcomatous stroma composed of bland spindle cells showing short fascicular growth pattern and focal nuclear palisading was associated with the epithelial component in one of the cysts. These cells showed strong immunoreactivity with vimentin and inhibin (weak), they were negative for CD34, estrogen receptor, progesterone receptor, androgen, calretinin, S-100, CD117, melan A, chromogranin, and synaptophysin. A morphologically and immunohistochemically identical metastatic sarcomatous focus was identified in the liver without any glandular component. This case is unique in its clinically malignant behaviour and metastatic nature despite its morphologically benign epithelial and stromal components.
authors.affiliation: Biliary and Pancreatic Surgery of New York, Beth Israel Medical Center, New York, USA. waynedocny@yahoo.com
authors.forename: Michael
authors.initials: M
authors.lastname: Wayne
authors.forename: Deniz
authors.initials: D
authors.lastname: Gur
authors.forename: Gil
authors.initials: G
authors.lastname: Ascunce
authors.forename: Ben
authors.initials: B
authors.lastname: Abodessa
authors.forename: Violette
authors.initials: V
authors.lastname: Ghali
mesh_terms: D018282:Cystadenocarcinoma, Mucinous / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D012196:Review Literature as Topic; D012509:Sarcoma / Q000473:pathology* / Q000601:surgery; D017154:Stromal Cells / Q000473:pathology*; D014057:Tomography, X-Ray Computed