SYP and neoplasm: Cytopathologic examination revealed small tumor cells with central nuclei (hematoxylin and eosin, original magnification ×100) (Fig. 2) and small tumor cells with mild pleomorphism (hematoxylin and eosin, original magnification ×400) (Fig. 3) from both pancreatic and hepatic lesions; positive cytoplasmic reaction to synaptophysin (Fig. 4); and positive nuclear reaction to Ki-67 with a low proliferation index (about 5%) (Fig. 5).