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Case History: 29 y/o male who presented with abdominal pain, early satiety, and weight loss. CT abdomen showed a large solid mass in the head of the pancreas.

Whipple specimen showed a 8.0 cm poorly-circumscribed pink-tan tumor with areas of necrosis, hemorrhage, and fibrosis. This photomicrograph from the tumor shows columnar and polygonal cells with elongated nuclei arranged in anastomosing trabeculae. There is moderate amount of hyalinized stroma. The tumor was positive for chromogranin and synaptophysin and negative for multiple hormonal markers (insulin, glucagon, somatostatin, VIP, gastrin, and serotonin). Final Diagnosis: Pancreatic Neuroendocrine Tumor, Grade 2 (based on mitotic count and Ki-67 labeling index).

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