Case Report This work is licensed under the Creative Commons Attribution 4.0 License. Published by Pacifc Group of e-Journals (PaGe) A Rare Case of Mixed Ductal Neuroendocrine Tumor of the Pancreas Introduction Collision tumors are tumors that have at least two types of tumors in the same anatomical site with no area of mixing within the transition zone. [1] In 2010 WHO classifcation of neuroendocrine tumors consists of an adenocarcinoma component and a neuroendocrine carcinoma component in which each of the components accounts for 30% of the tumor. Such tumors are defned as mixed adenoneuroendocrine carcinomas. [2] Occurrence of exocrine and endocrine tumors of the pancreas is extremely rare. [2,3] Pancreatic neuroendocrine tumors express markers such as synaptophysin, neuron specifc enolase and chromogranin-A. [4] Sometimes these tumors are associated with acute or chronic pancreatitis which may be due to obstruction of the pancreatic duct by the tumor. [5] In this article we present a rare case of mixed adenoneuroendocrine pancreatic carcinoma Case Report A 60-year-old male patient came with chief complaints of pain abdomen more over the left hypochondrium and epigastric region since 6months which was associated with weight loss of 10kgs in 3 months. He did not have any history of vomiting, loose stools, chest pain, palpitations, Breathlessness. He was a known Case of diabetes mellitus since 18 months and is on regular treatment for the same. There was history of repeated attacks of pancreatitis in the past. No History of hypertension, bronchial asthma, T.B or thyroid disorders was found. Family medical history was not contributory in this case .Personal history the patient consumed mixed diet, had normal sleep, decreased appetite, normal bowel and bladder habits. Past history of alcohol consumption present. On examination pulse rate was 70/min, Blood Pressure was 130/90 mm Hg, No pallor, icterus or pedal edema. Systemic examination showed mild epigastric tenderness and no palpable mass. The hematological parameters were as follows Hb- 12.6 g/dl, WBC- 5700 cells/ cumm3, Platelet count – 1.9 lakhs, Blood group – A positive, Urea – 37 mg/dl, S. Creat – 1.1 mg/dl, Na- 138 mmol/L, Potassium – 4.5 mmol/dL, Fasting blood Glucose – 156 mg/dL, T. Bilirubin – 0.7 mg/dL, SGOT – 38 IU, SGPT – 30 IU, ALP – 92 IU/L, Protein – 5.6 g/dL, Albumin – 3.9 g/dL, Serum amylase – 900 U/L, Serum lipase – 1600 U/L, HIV / HbsAg – negative. Only fasting blood glucose and serum amylase levels were found to be raised all other parameters were within normal limits. Chest X Ray showed normal radiographic study. ECG showed normal sinus rhythm. Echo showed ejection fraction of 60%, no regional wall motion abnormalities were noted. Mild concentric LVH was seen. Endoscopic ultrasound guided fne needle aspiration cytology from pancreatic head mass showed only a few atypical cells which was reported as suspicious of malignancy. CT of abdomen and pelvis showed severe atrophy of pancreatic parenchyma in the region of uncinate process, Vidya Viswanathan 1 *, Harsh Kumar 1 , Charusheela Gore 1 , Shrikant Kurhada 2 and Rumaanah Khan 1 1 Department of Pathology, Dr D Y Patil Medical college Hospital and Research Centre 2 Consultant Laparoscopic Surgeon, Dr D Y Patil Medical college Hospital and Research Centre ABSTRACT Collision tumors are tumors that have at least two types of tumors in the same anatomical site with no area of mixing within the transition zone. In 2010 WHO classifcation of neuroendocrine tumors consists of an adenocarcinoma component and a neuroendocrine carcinoma component in which each of the components accounts for 30% of the tumor. Such tumors are defned as mixed adenoneuroendocrine carcinomas. Occurrence of exocrine and endocrine tumors of the pancreas is extremely rare. The aim of our study was to describe a case in a 60 years old male who was diagnosed with this rare tumor. Gross, microscopic features and immunohistochemistry were used to diagnose this rare condition. Immunohistochemistry markers such as synaptophysin, chromogranin, EMA and Pan CK were used to come to a defnitive diagnosis. Synaptophysin and chromogranin were found to be positive in the neuroendocrine component. EMA and Pan CK were found to be positive in the ductal component. Hence a diagnosis of mixed ductal neuroendocrine tumour (collision tumor) was made. Keywords: Collision Tumor, Mixed, Rare, IHC DOI: 10.21276/APALM.2946