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Clinical History

A 13 year old female presented to her primary care provider with new onset fatigue and an enlarging right forearm mass. Complete blood count performed at that time revealed anemia and thrombocytopenia as well as circulating blasts. CT scan revealed a 3.5 cm pancreatic tail mass along with an enlarged right axillary lymph node. The differential diagnosis of the pancreatic mass by imaging included primary and metastatic neoplastic processes. Core needle biopsy of the right forearm mass was performed followed by excisional biopsy of the enlarged axillary lymph node and endoscopic ultrasound-guided (EUS) fine needle aspiration of the pancreatic mass.

Cytopathology Features

The cytology specimen from EUS-guided FNA of the pancreatic mass revealed hypercellular smears composed of single and scattered large clusters of neoplastic cells (Figures 1-3). Some round pseudoglandular structures simulating rosettes were present. The tumor cells exhibited anisonucleosis, high nuclear-cytoplasmic ratios, irregular nuclear membranes, and inconspicuous nucleoli. The nuclei were predominantly round to ovoid in shape with focal nuclear molding. Rare mitotic figures were present without apparent necrosis.  Fine cytoplasmic vacuoles were apparent. The cell block sections showed similar cytomorphologic features (Figures 4-5).


Cameron C. Felty, DO and Xiaoying Liu, MD

Dartmouth-Hitchcock Medical Center
Lebanon, New Hampshire

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