Composite pheochromocytoma masquerading as solid-pseudopapillary neoplasm of pancreas

Figure 1 Contrast enhanced computed tomography and endoscopic ultrasound for pancreas. A: Contrast enhanced computed tomography shows 10.8 cm × 8.1 cm × 9.1 cm solid cystic mass arising from body and tail of the pancreas; B: Endoscopic ultrasound showing a well-encapsulated heteroechoic mass inseparable from tail of pancreas.

Figure 2 HE stain. A: Scattered ganglion cells with plump cytoplasm surrounded by intersecting bundles of Schwann cells (HE stain × 200); B: Two distinct components of the tumour–pheochromocytoma comprising of atypical polygonal chromaffin cells and ganglioneuroma component (arrow) with sheets of mature ganglion cells surrounded by fascicles of schwann cells (HE stain × 200); C: The chromaffin cells were strongly positive for synaptophysin (× 100); D: The ganglion cells were strongly positive for neurofilament protein (× 100); E: The gangliocytes were strongly positive for vimentin (× 200); F: The sustentacular cells of the pheochromocytoma component showed characteristic staining of S-100 (× 200).