Abstract
Adamantinoma-like Ewing's sarcoma (ALES) is a rare variant of Ewing sarcoma that is defined by complex epithelial differentiation, including expression of cytokeratin and p40 and frequent keratin pearl formation, having characteristic EWSR1-FLI1 translocation, typically observed in the head and neck region of middle-aged individuals. We present the first reported case of a 22-year-old female with ALES arising in the pancreatic neck, sharing similarities with its head and neck counterpart in the form of morphological, immunohistochemical, and high grade histological features. The case highlights diagnostic challenges and expands the understanding of ALES in uncommon anatomical locations.