Mixed Duct-Acinar-Islet Cell Tumor of the Pancreas: Report of a Case

Tanakaya, Kohji; Teramoto, Norihiro; Konaga, Eiji; Takeuchi, Hitoshi; Yasui, Y.; Takeda, Atsushi; Yunoki, Yasuhiro; Murakami, Ichiro

doi:10.1007/s005950170207

Cited by 27 publications

(13 citation statements)

References 6 publications

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“…To the best of our knowledge, there have been only seven case reports in mixed ductal-endocrine tumors, [3][4][5][6][7][8][9] four case reports in mixed acinar-endocrine tumors [10][11][12][13] and four case reports in mixed ductal-acinar-endocrine tumors [14][15][16][17] in the English medical reports. These reported cases were rather large tumors with metastases.…”

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confidence: 99%

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

Terada

Kawaguchi

Furukawa

et al. 2002

Pathology International

203

145

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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.

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confidence: 99%

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

Terada

Kawaguchi

Furukawa

et al. 2002

Pathology International

203

145

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“…Of these cases, 8 (Cases 3–8, 11, and 12) (4, 6–8) were consistent with the criteria for mixed acinar‐endocrine tumor of the pancreas proposed by Kimstra et al (4). In Cases 2, 9, and 14–17 (9–13) endocrine components predominated over acinar components. Furthermore, Cases 2 and 9 (9, 12) were similar to the present case and should have been diagnosed as endocrine tumors with acinar differentiation.…”

Section: Discussionmentioning

confidence: 98%

Pancreatic endocrine tumor with partial acinar cell differentiation

Minakawa¹,

Oka²,

Nihei³

et al. 2006

APMIS

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We examined a 70-year-old woman in whom a pancreatic endocrine tumor with partial acinar cell differentiation had been diagnosed. She had neither endocrine nor exocrine symptoms. The tumor was located in the pancreatic tail and measured 12.5 x 9.5 x 8 cm. It had a capsule, was composed of multiple adhesion nodules, and was elastically soft, medullary, and yellowish white. The neoplastic cells had large, irregular, oval nuclei; prominent eosinophilic nucleoli; and abundant eosinophilic cytoplasm with many fine granules. The cells had proliferated in islet-like solid medullary, trabecular, acinar, and papillary patterns. Most neoplastic cells were strongly positive for synaptophysin. 10 to 25% of the neoplastic cells were positive for alpha1-antitrypsin. Neuroendocrine and zymogen granules were simultaneously observed in the cytoplasm of the same neoplastic cells at the ultrastructural level. The tumor may be considered an amphicrine tumor.

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“…The tumours are predominantly located on the pancreatic tail, or left limb, 9 a feature of this case. The tumours are grossly large in size, in comparison with smaller insulinomas 10,11 and the mass in this dog would be subjectively considered larger than most insulinomas. Mixed type metastasis to local nodes is a necessary feature in diagnosis of all MAECs and precludes the possibility of a collision tumour, whereby two tumour types arise side by side.…”

Section: Discussionmentioning

confidence: 98%

Pancreatic mixed acinar‐endocrine carcinoma in a dog

Belshaw¹,

Bacon²,

Foale³

et al. 2005

Vet Comparative Oncology

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A 10.5-year-old crossbreed dog was presented with a history of hypoglycaemic episodes and elevated serum insulin concentration. A pancreatic mass was removed at surgery along with an enlarged draining lymph node. An unresectable hepatic nodule was also present. Immunohistochemistry confirmed the pancreatic and lymph node masses as functional mixed acinar-endocrine carcinoma, previously unreported in domestic species. Persistent hypoglycaemia and hyperinsulinaemia post-operatively was highly suggestive of the hepatic mass being a functional metastasis. The dog was managed on prednisolone and remained asymptomatic 9 months post-operatively. This tumour type has only been rarely reported in human patients and may highlight the need for more rigorous immunohistochemical staining of pancreatic masses in veterinary species to identify the prevalence of this tumour type.

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Mixed Duct-Acinar-Islet Cell Tumor of the Pancreas: Report of a Case

Cited by 27 publications

References 6 publications

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

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

Pancreatic endocrine tumor with partial acinar cell differentiation

Pancreatic mixed acinar‐endocrine carcinoma in a dog

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