However, in our case of ALES, the tumor cells demonstrated epithelial differentiation with diffuse CK and CK5/6 positivity, but was negative for α-inhibin, SF1, CD56, and WT1, which basically ruled out the diagnosis of primary adrenal granulosa cell tumor, and further ruled out the possibility of pancreas metastasis of adult testis granulosa cell tumor [20]. This evidence concerns the gene KRT5 and neoplasm.