PanNET : Grade 2

Case History: 35 y/o male with abdominal pain, nausea, vomiting, diarrhea of several weeks' duration. He subsequently developed weight loss and jaundice. Imaging studies revealed a 4 cm mass in the head of the pancreas. The patient underwent Whipple procedure. The specimen showed a 4 cm soft, yellow-tan, well-circumscribed mass in the pancreatic head. Foci of hemorrhage were present. The tumor was positive for chromogranin and negative for gastrin, glucagon, insulin, somatostatin, and PP. The final diagnosis was : Well-differentiated Pancreatic Neuroendocrine Tumor, Grade 2.

By definition, grade 2 tumors have 2-20 mitoses/10 HPF and Ki-67 index between 3-20%.