Solitary fibrous tumor of the pancreas Runjan Chetty, MB BCh, FRCPath, FRCPC, DPhil ⁎ , Richa Jain, MBBS, MD, Stefano Serra, MD Department of Pathology, University Health Network/University of Toronto, Toronto, Ontario, Canada M5G 2C4 Abstract A 67-year-old woman was found to have an incidental pancreatic mass on computed tomographic examination of her abdomen in the course of investigation of hematuria. The radiologic features were of a hypervascular mass in the uncinate process of the head of the pancreas, and a preoperative diagnosis of a neuroendocrine tumor was favored. A Whipple procedure was performed. The uncinate process contained a 2.6-cm well-circumscribed mass. Histologic evaluation showed a lesion composed of alternating hypercellular areas made up of spindle-shaped cells and hypocellular areas with hyalinized, keloidal-like fibrous tissue. Occasional dilated vascular channels and entrapped pancreatic tissue were present within the lesion. Immunohistochemistry showed the lesion to be CD34, CD99, and bcl-2 positive. No evidence of atypia was noted, and the overall impression was of a benign solitary fibrous tumor of the pancreas. This is an unusual primary spindle cell neoplasm of the pancreas and should be considered in the differential diagnosis of all spindle cell lesions that occur in the pancreas. Crown Copyright © 2009 Published by Elsevier Inc. All rights reserved. Keywords: Pancreas; Solitary fibrous tumor, Spindle cell tumor 1. Introduction Solitary fibrous tumor (SFT) is a histologically character- istic mesenchymal tumor of probable fibroblastic origin that has been described in pleural and extrapleural settings. In the latter context, SFT is somewhat ubiquitous, and examples have been described in soft tissue and visceral locations. Solitary fibrous tumor in the pancreas is extremely rare, and only 4 previous reports have appeared in the English language literature [1-4]. The purpose of this article is to highlight a further case of SFT occurring in the pancreas, review the pertinent literature, address briefly the radiologic differential diagnosis, and discuss the pathologic differential diagnosis. 2. Case report A 67-year-old woman was noted to have hematuria on routine urinalysis. In the course of investigating the hematuria, a computed tomography scan of abdomen revealed a 2.6-cm hypervascular mass in the uncinate process of pancreas, which showed progressive postcon- trast enhancement, suggestive of a neuroendocrine tumor (Fig. 1). An octreotide scan was done that showed a normal distribution of the tracer in the body and the tumor was not octreotide-avid. The patient did not have jaundice or other symptoms of obstruction. There is no history of hypoglycemia, and the patient's random blood glucose levels were always within the normal range. In view of the location of the lesion and the radiologic features suggest- ing a neuroendocrine tumor, a Whipple operation was performed. Six months after the procedure, the patient is alive and well. 3. Materials and methods The specimen was received in 10% buffered formalin, grossed according to the departmental grossing protocol for Available online at www.sciencedirect.com Annals of Diagnostic Pathology 13 (2009) 339 – 343 ⁎ Corresponding author. Department of Pathology, University Health Network/Toronto Medical Laboratories, The Toronto General Hospital, Eaton Wing, Toronto, Ontario, Canada M5G 2C4. Tel.: +1 416 340 3661; fax: +1 416 340 5517. E-mail address: runjan.chetty@uhn.on.ca (R. Chetty). 1092-9134/$ – see front matter. Crown Copyright © 2009 Published by Elsevier Inc. All rights reserved. doi:10.1016/j.anndiagpath.2009.02.006