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Hepatoid carcinoma of the pancreas with lymphoid stroma: first description of the clinical, morphological, immunohistochemical, and molecular characteristics of an unusual pancreatic carcinoma

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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.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Pathology, Fondazione IRCCS Policlinico San Matteo, and Department of Molecular Medicine, University of Pavia, Pavia, Italy

    Alessandro Vanoli, Alessandra Viglio, Roberta Riboni, Vittorio Necchi & Marco Paulli

  2. Division of General Surgery 2, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy

    Francesca Argenti, Alessio Vinci, Luigi Pugliese & Andrea Pietrabissa

  3. Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy

    Alessandro Vanoli & Fausto Sessa

  4. Department of Pathology, Ospedale di Circolo, Varese, Italy

    Stefano La Rosa & Fausto Sessa

Authors
  1. Alessandro Vanoli
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  2. Francesca Argenti
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  3. Alessio Vinci
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  4. Stefano La Rosa
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  5. Alessandra Viglio
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  6. Roberta Riboni
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  7. Vittorio Necchi
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  8. Luigi Pugliese
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  9. Fausto Sessa
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  10. Andrea Pietrabissa
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  11. Marco Paulli
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Correspondence to Alessandro Vanoli.

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Vanoli, A., Argenti, F., Vinci, A. et al. Hepatoid carcinoma of the pancreas with lymphoid stroma: first description of the clinical, morphological, immunohistochemical, and molecular characteristics of an unusual pancreatic carcinoma. Virchows Arch 467, 237–245 (2015). https://doi.org/10.1007/s00428-015-1788-6

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  • DOI: https://doi.org/10.1007/s00428-015-1788-6

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