Minute mixed ductal‐endocrine carcinoma of the pancreas with predominant intraductal growth

Abstract

We report a rare case of minute (5 mm x 4 mm) mixed ductal-endocrine carcinoma of the pancreas with predominant intraductal growth. A 34-year-old Japanese man was admitted because of elevated serum pancreatic enzymes. Endoscopic retrograde pancreatography revealed an unidentified material of 18 mm within the main pancreatic duct. Stone or parasite with acute pancreatitis was suspected clinically, and the biopsy revealed malignant cells positive for CA19-9, carcinoembryonic antigen (CEA) and synaptophysin. No apparent tumor was identified in the pancreas by various imaging techniques. Resection of pancreatic body and tail was performed. Grossly, the main pancreatic duct in the pancreatic body was occluded by as much as 20 mm. The pancreas had minute carcinoma of 5 mm x 4 mm just around the occluded main pancreatic duct. The tumor cells invaded the main pancreatic duct and spread within it as long as 20 mm. Histologically, the carcinoma had biphasic pattern; one was ductal carcinoma with tubular formations and another was carcinoma with neuroendocrine features. These two elements were admixed, and the ductal element comprised 30% while the endocrine element comprised 70%. The ductal element was immunoreactive for cytokeratins, CEA and CA19-9, while the endocrine element was immunoreactive for chromogranin A and synaptophysin. No immunoreactivity for pancreatic enzymes was noted. Ultrastructural observations showed dense core granules and no zymogen granules. Our case is unique clinically in that the tumor manifested as an intraductal material and no apparent tumor was found by imaging modalities, and pathologically in that the tumor was rare mixed ductal-endocrine carcinoma and the tumor was very small and mainly grew within the main pancreatic duct.

Primary Clear Cell Adenocarcinoma of the Peritoneum

“…Mucins (neutral and acidic) were present in the surface of tumor cells. An immunohistochemical study was performed by Dako's ENVISION method, as previously described (Terada et al 2002(Terada et al , 2004. The antibodies and the immunohistochemical results are shown in Table 1.…”

Neuroendocrine tumor within main pancreatic duct: a case report

“…The few cases reported in the literature have been divided into two categories 3) : those showing intraductal tumor accompanied by a pancreatic parenchymal component, and those comprising purely intraductal pancreatic NET (without a parenchymal component). In the former case, the NET arising in the vicinity of the main pancreatic duct could grow into and along the duct, while the latter type might theoretically have derived from totipotential stem cells located in the epithelium of major ducts 4) . In the present study, the majority of the tumor was necrotic and determining the pathway of tumor occurrence was difficult.…”

Serous surface papillary cystadenoma of fallopian tube clinically presenting with ectopic pregnancy

“…[5,6] The immunoreactivities of tumor cells were as follows: cytokeratin (CK) 7 +++ (see Figure 2D), CK20-, estrogen receptor (ER) +++ (see Figure 2E), progesterone receptor (PgR) +++, WT-1 +++ (see Figure 2F), Ki-67 ++ (labeling index = 30%) (see Figure 2G), p53 ++ (relatively diffuse) (see Figure 2H), CDX-2 -, TTF-1 -, and hCG -. SSPC of the fallopian tube was the final pathological diagnosis.…”