Mixed acinar-endocrine carcinomas of the pancreas Journal Article


Authors: Klimstra, D. S.; Rosai, J.; Heffess, C. S.
Article Title: Mixed acinar-endocrine carcinomas of the pancreas
Abstract: Acinar cell carcinoma is a rare pancreatic neoplasm that may contain scattered endocrine cells in as many as 40% of cases. In addition, unusual tumors exist in which the acinar and endocrine components each constitute a significant proportion (>25%) of the neoplasm; we propose to designate them as 'mixed acinar-endocrine carcinomas.' In a study of five such cases, we found one case with segregated areas of acinar and endocrine cells that were identifiable in routinely stained sections and four cases with morphologically uniform cell populations where the divergent differentiation was only detected immunohistochemically. The tumors occurred in adults (age range, 48-81; mean, 68); there were two men and three women. None of the patients presented with symptoms related to either enzyme or hormone liberation. Histologically, the tumors were very cellular; various combinations of solid, trabecular, acinar, and glandular growth patterns were noted. The cells contained d-PAS-positive granules and showed immunohistochemical positivity for pancreatic enzymes (trypsin, chymotrypsin, and lipase) and endocrine markers (chromogranin and synaptophysin); specific endocrine hormones were found in two cases. Double immunohistochemical staining for acinar and endocrine markers showed that most cells expressed only one line of differentiation. Ultrastructural study of two cases showed two populations of granules. Two of the patients died of their tumors (mean survival, 10.5 months), one with widespread metastases. Two patients were alive with disease at 12 months after diagnosis, and one patient was lost to follow-up after 3 months. This rare type of pancreatic neoplasm provides further evidence of the close histogenetic relationship between the exocrine and endocrine components of this organ.
Keywords: immunohistochemistry; adult; aged; cancer surgery; clinical feature; case report; follow up; electron microscopy; tumor localization; metastasis; differential diagnosis; tumor biopsy; pancreas enzyme; acinar cell carcinoma; chromogranin; chymotrypsin; tumor diagnosis; triacylglycerol lipase; pancreas islet cell tumor; trypsin; synaptophysin; hormone release; pleomorphic adenoma; pancreas adenoma; human; male; female; article
Journal Title: American Journal of Surgical Pathology
Volume: 18
Issue: 8
ISSN: 0147-5185
Publisher: Lippincott Williams & Wilkins  
Date Published: 1994-08-01
Start Page: 765
End Page: 778
Language: English
DOI: 10.1097/00000478-199408000-00002
PROVIDER: scopus
PUBMED: 8037290
DOI/URL:
Notes: Export Date: 14 January 2019 -- Article -- Source: Scopus
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  1. Juan Rosai
    181 Rosai
  2. David S Klimstra
    978 Klimstra