Out of the Ordinary, but Not Out of the Question: Atypia in Pancreatic Lesions Is Not Always Carcinoma.

Pancreatic perivascular epithelioid cell tumours (PEComas) are exceptionally rare mesenchymal neoplasms. Endoscopic ultrasound-guided fine-needle biopsy shows suggestive morphologic features, while correlation with immunochemistry results supports the diagnosis. Accurate identification is crucial, as it directly influences clinical decision-making and may enable organ-preserving surgical management.