The patient proceeded to EUS with FNA.
Histopathology
MACROSCOPIC DESCRIPTION: EUS-FNA Pancreatic Head Mass: 2 wet-fixed and 2 air-dried smears prepared. Also received in formalin multiple small cores of blood clot processed as a cell block.
MICROSCOPIC DESCRIPTION: The hypercellular smears and cell block section contain abundant neoplastic cells presenting as single cells, loosely cohesive clusters and branching papillary structures with fibrovascular cores. The neoplastic cells demonstrate monotonous round to oval nuclei, coarsely granular chromatin, inconspicuous nuclei and scant pale cytoplasm. Metachromatic hyaline globules are present. Immunohistochemical results show tumour cells stain: CKAE1/3 +/-, Vimentin+, CD56+, Chromogranin-, Synaptophysin+, B-catenin+ (nuclear), alpha-1-antitrypsin+; consistent with pancreatic solid pseudopapillary neoplasm.
DIAGNOSIS: Solid pseudopapillary neoplasm.