Mixed acinar-endocrine carcinoma of the pancreas: New clinical and pathological features in a contemporary series

Run Yu, Lily Jih, Jing Zhai, Nicholas N. Nissen, Steven Colquhoun, Edward Wolin, Deepti Dhall

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

OBJECTIVE: The objective of this study was to characterize the novel clinical and pathological features of mixed acinar-endocrine carcinoma of the pancreas. METHODS: This was a retrospective review of medical records and surgical pathology specimens of patients with a diagnosis of mixed acinar-endocrine carcinoma of the pancreas at Cedars-Sinai Medical Center between 2005 and 2011. Additional immunohistochemistry was performed on the specimens of some patients. RESULTS: Five patients were identified. The median age at presentation was 74 years (range, 59-89 years), and all patients were male. The presenting symptoms were all related to tumor mass effects. The median size of the tumor was 10 cm (range, 3.9-16 cm). Preoperative clinical diagnosis aided by fine-needle aspiration biopsy was incorrect in all 5 cases. Most tumors (3/5) exhibited predominantly endocrine differentiation without hormonal production. Only 10% to 30% of cells were truly amphicrine, whereas most were differentiated into either endocrine or acinar phenotype. The clinical behavior ranged from moderate to aggressive with postoperative survival from 2.5 months to more than 3 years. Four patients received neoadjuvant or adjuvant chemotherapy with variable responses. CONCLUSIONS: Mixed acinar-endocrine carcinoma of the pancreas appears to be not uncommon in men, may harbor predominantly endocrine component, is often misdiagnosed by cytology, and exhibits variable clinical behavior. Mixed acinar-endocrine carcinoma of the pancreas should be considered in older patients with sizable pancreatic mass and may warrant aggressive surgical resection and chemotherapy.

Original languageEnglish (US)
Pages (from-to)429-435
Number of pages7
JournalPancreas
Volume42
Issue number3
DOIs
StatePublished - Apr 2013
Externally publishedYes

Fingerprint

Acinar Cell Carcinoma
Islets of Langerhans
Neoplasms
Surgical Pathology
Adjuvant Chemotherapy
Fine Needle Biopsy
Diagnostic Errors
Medical Records
Cell Biology
Immunohistochemistry
Phenotype
Drug Therapy
Survival

Keywords

  • Acinar cell carcinoma
  • Mixed acinar-endocrine carcinoma of the pancreas
  • Neuroendocrine carcinoma

ASJC Scopus subject areas

  • Hepatology
  • Internal Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

Mixed acinar-endocrine carcinoma of the pancreas : New clinical and pathological features in a contemporary series. / Yu, Run; Jih, Lily; Zhai, Jing; Nissen, Nicholas N.; Colquhoun, Steven; Wolin, Edward; Dhall, Deepti.

In: Pancreas, Vol. 42, No. 3, 04.2013, p. 429-435.

Research output: Contribution to journalArticle

Yu, R, Jih, L, Zhai, J, Nissen, NN, Colquhoun, S, Wolin, E & Dhall, D 2013, 'Mixed acinar-endocrine carcinoma of the pancreas: New clinical and pathological features in a contemporary series', Pancreas, vol. 42, no. 3, pp. 429-435. https://doi.org/10.1097/MPA.0b013e318264d073
Yu, Run ; Jih, Lily ; Zhai, Jing ; Nissen, Nicholas N. ; Colquhoun, Steven ; Wolin, Edward ; Dhall, Deepti. / Mixed acinar-endocrine carcinoma of the pancreas : New clinical and pathological features in a contemporary series. In: Pancreas. 2013 ; Vol. 42, No. 3. pp. 429-435.
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AB - OBJECTIVE: The objective of this study was to characterize the novel clinical and pathological features of mixed acinar-endocrine carcinoma of the pancreas. METHODS: This was a retrospective review of medical records and surgical pathology specimens of patients with a diagnosis of mixed acinar-endocrine carcinoma of the pancreas at Cedars-Sinai Medical Center between 2005 and 2011. Additional immunohistochemistry was performed on the specimens of some patients. RESULTS: Five patients were identified. The median age at presentation was 74 years (range, 59-89 years), and all patients were male. The presenting symptoms were all related to tumor mass effects. The median size of the tumor was 10 cm (range, 3.9-16 cm). Preoperative clinical diagnosis aided by fine-needle aspiration biopsy was incorrect in all 5 cases. Most tumors (3/5) exhibited predominantly endocrine differentiation without hormonal production. Only 10% to 30% of cells were truly amphicrine, whereas most were differentiated into either endocrine or acinar phenotype. The clinical behavior ranged from moderate to aggressive with postoperative survival from 2.5 months to more than 3 years. Four patients received neoadjuvant or adjuvant chemotherapy with variable responses. CONCLUSIONS: Mixed acinar-endocrine carcinoma of the pancreas appears to be not uncommon in men, may harbor predominantly endocrine component, is often misdiagnosed by cytology, and exhibits variable clinical behavior. Mixed acinar-endocrine carcinoma of the pancreas should be considered in older patients with sizable pancreatic mass and may warrant aggressive surgical resection and chemotherapy.

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