Kevin Van Smaalen, MD
Emory University School of Medicine
Atlanta, Georgia

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Clinical History

A 76 year-old female with a history of a brain tumor status-post resection and radiotherapy 3 years prior who now presents with a new 2.4 cm FDG avid pancreatic uncinate process soft tissue mass that is well-circumscribed and without pancreatic duct dilation. An endoscopic ultrasound FNA of the pancreatic mass is performed.

Educational Objective 1: Recognize the cytomorphologic and immunohistochemical features of SFT/HPC

Educational Objective 2: Understand the importance of prognosis and behavior of SFT/HPC

Educational Objective 3: Understand the genetic mutation associated with SFT/HPC

Educational Objective 4: Review of common tumors that metastasize to the pancreas

Cytopathology Features

The air-dried preparation shows sheets of bland oval cells with moderate pleomorphism and increased nuclear/cytoplasmic ratios.

The Papanicolaou stain shows that these cells have homogeneous granular chromatin and smooth nuclear membranes. Some cells have prominent nucleoli, but most are inconspicuous.

The cell block shows highly cellular groups of epithelioid cells with a haphazard arrangement admixed with thin-walled blood vessels. Numerous mitotic figures can be seen. No areas of necrosis are identified.

Immunohistochemical stains show diffusely positivity for STAT6 and focal positivity for CD34.

Figure 1: FNA of pancreatic mass, Diff-Quik stain, 40x

Figure 2: FNA of pancreatic mass, Papanicolaou stain, 40x

Figure 3: FNA of pancreatic mass, Cell Block H&E, 20x

Figure 4: FNA of pancreatic mass, Cell Block STAT6, 20x