Ductal adenocarcinoma of the pancreas with psammomatous calcification: Report of a case with immunohistochemical study for bone morphogenetic protein

We report a case of invasive ductal adenocarcinoma of the pancreas with psammomatous calcification. A 57-year-old man was admitted to our hospital complaining of abdominal pain and vomiting. Carcinoma of the head of the pancreas was diagnosed based on precise clinical examinations. A subtotal stomach-preserving pancreaticoduodenectomy was subsequently performed. Histological examination of the surgical specimen revealed a well-differentiated adenocarcinoma composed of irregular tubular structures involving the head of the pancreas. Conspicuously, numerous tiny psammomatous-type calcifications were observed, mainly within the neoplastic lumen, but also in association with carcinoma cells that had infiltrated the lymphatics and lymph nodes. In addition, expression of bone morphogenetic protein, cartilage and bone-inducing factor cloned from demineralized bone matrix and the transforming growth factor-beta subfamily was immunohistochemically examined for carcinoma cells. Reactivity for multiple kinds of bone morphogenetic protein (types 5, 6 and 7) was identified in the cytoplasm of carcinoma cells. Psammoma body formation is an unusual event in invasive ductal adenocarcinoma of the pancreas, with only one similar case previously reported in the English literature. We also discuss the formation of psammomatous calcifications by pancreatic cancer cells.