Pancreatic adenocarcinoma with multiple eosinophilic extracellular deposits consistent with noncalcified psammoma bodies

Abstract

Dear Editor, Adenocarcinomas commonly show extracellular mucin deposits, which, e.g., in breast cancer, may undergo secondary degenerative changes such as calcification. Psammoma bodies representing lamellated calcifications are a common morphologic feature of papillary carcinoma of the thyroid, serous adenocarcinoma of the ovary, and meningiomas. A 63-year-old male presented with unspecific epigastric pain and obstructive jaundice. Abdominal computed tomography revealed a mass lesion within the head of the pancreas, measuring 1.8 cm in the largest diameter, with infiltration of the duodenal wall, stricture of the distal bile duct, and dilatation of the biliary system. In addition, cancer spread to regional lymph nodes and liver was noted (Fig. 1). Endoscopy disclosed ulceration of the duodenal mucosa by penetrating tumor and multiple biopsies were obtained. Upon histology, the tumor turned out to be a poorly differentiated ductal adenocarcinoma. The tumor infiltrated the duodenal mucosa, showed multifocal lymphatic permeation, and was characterized by multiple eosinophilic extracellular deposits that were commonly, yet not invariably surrounded by cancer cells (Fig. 2a–b). The deposits were PAS-positive (Fig. 2c) and appeared lamellated, consistent