Pancreatic adenosquamous carcinoma and intraductal papillary mucinous neoplasm in a CDKN2A germline mutation carrier

Figure 1 Computed tomography image. A: Computed tomography (CT) image of the solid-cystic pancreatic mass with distal atrophy of the pancreas and pancreatic duct dilatation; B: CT three years before in which no pancreatic lesions were present.

Figure 2 Endoscopic ultrasonography image. A: Radial endoscopic ultrasonography (EUS) view of the mass; B: Lineal guided EUS fine needle aspiration of the solid component of the mass.

Figure 3 Endoscopic ultrasonography fine needle aspiration biopsies and surgical specimen. A and B: Positive cytology from the pancreatic mass (adenocarcinoma with a significant keratinizing component suggestive of adenosquamous carcinoma), Papanicolaou staining 20 × and 40 ×, respectively; C and D: A solid-cystic pancreatic mass (gross pathology).

Figure 4 Microscopic pathology of the surgical specimen. A: Intraductal papillary mucinous neoplasm with adenocarcinoma component, hematoxylin and eosin (H and E) 10 ×; B-D: Squamous metaplasia and evident infiltrative squamous carcinoma, H and E 10 ×, 20 × and 40 ×, respectively; E: Adenocarcinoma with perineural invasion, alcian blue 20 ×; F: Peripancreatic lymph node metastasis (adenocarcinoma component), H and E 20 ×.

Figure 5 Immunohistochemical study in the surgical specimen. A: CK5/6 strong positivity in squamous component (metaplasia and carcinoma), × 20; B: Strong nuclear p63 immunopositivity in the invasive squamous carcinoma. The adenocarcinoma area display poor p63 nuclear positivity, × 20; C: MUC5a negativity in the squamous carcinoma component and strong positive in ductal epithelial cells, × 20; D: MUC1/EMA positivity in the squamous metaplasic component, × 20.