Adenosquamous carcinoma of the pancreas

Abstract

BACKGROUND Adenosquamous carcinoma (ASCa) is a rare subtype of ductal adenocarcinoma of the pancreas with what to the authors' knowledge are limited cytologic descriptions. In the current study, the authors describe their experience with the fine‐aspiration biopsy (FNAB) diagnosis of ASCa and characterize cytologic features in 14 cases. METHODS Fourteen cases of ASCa were identified from pathology case files. Cytologic material was examined for cellularity, grade, tumor cell necrosis, and specific features of glandular and squamous differentiation. RESULTS The 10 females and 4 males had an average age of 70 years. Nine patients (64%) were reported to have Stage IV disease at the time of presentation. All tumors were high grade, with moderate to high cellularity. Tumor cell necrosis was noted in 12. Nine of the 14 cases (64%) demonstrated predominantly squamous differentiation with keratinization. Seven of these nine contained at least focal intracellular mucin or honeycombed glandular sheets. Two of the nine had rare cytoplasmic vacuoles as the only evidence of glandular differentiation. Five cases (36%) were predominantly glandular. All but one of these five cases contained atypical to malignant keratinized cells. One of the five cases lacked keratinization but had tumor cells with dense cytoplasm; the diagnosis of ASCa was confirmed on histology. In 13 patients for whom followup was known, 12 had died of disease (mean, 5.6 months) and 1 was alive at 13 months of follow‐up. CONCLUSIONS A specific diagnosis of ASCa is possible when aspirates show evidence of both squamous and glandular differentiation, although one component often predominates and features of dual differentiation may be focal. A purely squamous tumor should raise the suspicion of a metastasis, but also may represent undersampling of an ASCa. Cancer (Cancer Cytopathol) 2003;99:372–8. © 2003 American Cancer Society.

Adenosquamous carcinoma of the pancreas: Molecular characterization of 23 patients along with a literature review

“…Patients with ASCP present with symptoms similar in nature to patients with pancreatic adenocarcinoma, with abdominal pain, weight loss, back pain, nausea, vomiting, anorexia, and jaundice being the most common presenting symptoms [19,20,38] . As with pancreatic adenocarcinoma, there appears to be an increased risk of deep vein thrombosis [25] . In larger case series, patients are typically male, white, present in their sixth decade of life, and the tumor is located in the head of the pancreas [12,13,20] .…”

“…There is a transitional zone where the glandular structure blends into the squamous component [22] . There is an entity descriptive of pure squamous cell carcinoma of the pancreas, but this classification has been debated and is considered to be more secondary to metastasis to the pancreas from a non-pancreas primary carcinoma [15,25,26] . Tumor cell necrosis is frequently seen in patients with ASCP, along with high tumor grade [25,27] .…”

“…There is an entity descriptive of pure squamous cell carcinoma of the pancreas, but this classification has been debated and is considered to be more secondary to metastasis to the pancreas from a non-pancreas primary carcinoma [15,25,26] . Tumor cell necrosis is frequently seen in patients with ASCP, along with high tumor grade [25,27] . Other unusual reported pathology has included the presence of clear cell and rhabdoid components [27,28] .…”

Hypercalcemia associated with adenosquamous pancreatic carcinoma: a reason to initiate palliative treatment

“…The most frequent is ductal adenocarcinoma of the pancreatic head. Adenosquamous carcinoma of the pancreas is a rare variant (4,5) that is generally diagnosed at an advanced stage of disease and therefore has a poor prognosis (4,6).…”

Clinicopathological Features of Pancreatic Adenosquamous Carcinoma and Undifferentiated Carcinoma: A case series

“…Among the epithelial malignancies that occur in the pancreas, adenosquamous carcinoma (ASqC) (incidence, 0.38-4%) [1][2][3] and undifferentiated carcinoma (UC) (incidence, 2-7%) [4][5][6] are relatively rare. Thus we do not clearly know their biological characteristics.…”