title: Hepatoid carcinoma of the pancreas with lymphoid stroma: first description of the clinical, morphological, immunohistochemical, and molecular characteristics of an unusual pancreatic carcinoma.
abstract: We report a case of tumour in the head of the pancreas observed in a 57-year-old man with a history of worsening jaundice and elevated alpha-fetoprotein (AFP) serum level, who underwent Whipple pancreatoduodenectomy. Histologically, the tumour was predominantly composed of solid sheets of large eosinophilic cells with a prominent lymphoid infiltration without association neither with DNA microsatellite instability nor Epstein-Barr virus infection. The tumour was diffusely and strongly positive for hepatocyte paraffin-1 (Hep Par-1) and glypican-3 leading to the diagnosis of hepatoid carcinoma. Strong cytoplasmic staining for AFP was focally observed. Moreover, tumour cells showed countless cytoplasmic eosinophilic globules immunoreactive for the stress protein p62. A primary hepatocellular carcinoma of the liver was ruled out by careful clinical analysis. Hepatoid carcinoma is an extremely rare pancreatic neoplasm, and here, we describe the first case of such variant associated with lymphoid stroma. The characteristic histologic features and the immunophenotypic profile help in distinguishing this carcinoma from other pancreatic tumours, notably from medullary carcinoma.
authors.affiliation: Department of Pathology, Fondazione IRCCS Policlinico San Matteo, and Department of Molecular Medicine, University of Pavia, Pavia, Italy, ale.vanol@virgilio.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vanoli
authors.forename: Francesca
authors.initials: F
authors.lastname: Argenti
authors.forename: Alessio
authors.initials: A
authors.lastname: Vinci
authors.forename: Stefano
authors.initials: S
authors.lastname: La Rosa
authors.forename: Alessandra
authors.initials: A
authors.lastname: Viglio
authors.forename: Roberta
authors.initials: R
authors.lastname: Riboni
authors.forename: Vittorio
authors.initials: V
authors.lastname: Necchi
authors.forename: Luigi
authors.initials: L
authors.lastname: Pugliese
authors.forename: Fausto
authors.initials: F
authors.lastname: Sessa
authors.forename: Andrea
authors.initials: A
authors.lastname: Pietrabissa
authors.forename: Marco
authors.initials: M
authors.lastname: Paulli
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology*
chemical_list: D014408:Biomarkers, Tumor