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WHO Classification of Tumours
Mixed acinar-ductal carcinoma
Pancreas


Definition

Carcinomas with mixed differentiation are malignant epithelial neoplasms of the pancreas with significant components of more than one distinct direction of differentiation
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Hoorens A, Lemoine NR, McLellan E, Morohoshi T, Kamisawa T, Heitz PU, Stamm B, Rüschoff J, Wiedenmann B, Klöppel G (1993)
Pancreatic acinar cell carcinoma. An analysis of cell lineage markers, p53 expression, and Ki-ras mutation.
Am J Pathol 143: 685-98




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Horie A, Haratake J, Jimi A, Matsumoto M, Ishii N, Tsutsumi Y (1987)
Pancreatoblastoma in Japan, with differential diagnosis from papillary cystic tumor (ductuloacinar adenoma) of the pancreas.
Acta Pathol Jpn 37: 47-63




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Schron DS, Mendelsohn G (1984)
Pancreatic carcinoma with duct, endocrine, and acinar differentiation. A histologic, immunocytochemical, and ultrastructural study.
Cancer 54: 1766-70




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Ulich T, Cheng L, Lewin KJ (1982)
Acinar-endocrine cell tumor of the pancreas. Report of a pancreatic tumor containing both zymogen and neuroendocrine granules.
Cancer 50: 2099-105



. “Collision tumours” composed of two topographically separate neoplasms are not included in the mixed differentiation. Rare acinar neoplasms have a substantial proportion (> 30%) of more than one cell type
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Labate AM, Klimstra DL, Zakowski MF (1997)
Comparative cytologic features of pancreatic acinar cell carcinoma and islet cell tumor.
Diagn Cytopathol 16: 112-6




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Nojima T, Kojima T, Kato H, Sato T, Koito K, Nagashima K (1992)
Alpha-fetoprotein-producing acinar cell carcinoma of the pancreas.
Hum Pathol 23: 828-30




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Ohike N, Kosmahl M, Klöppel G (2004)
Mixed acinar-endocrine carcinoma of the pancreas. A clinicopathological study and comparison with acinar-cell carcinoma.
Virchows Arch 445: 231-5




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Villanueva RR, Nguyen-Ho P, Nguyen GK (1994)
Needle aspiration cytology of acinar-cell carcinoma of the pancreas: report of a case with diagnostic pitfalls and unusual ultrastructural findings.
Diagn Cytopathol 10: 362-4




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Hruban RH, Pitman MB, and Klimstra DS
Tumors of the Pancreas. Armed Forces Institute of Pathology
Washington, DC 2007



. Of these, the best characterized is mixed acinar-neuroendocrine carcinoma
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Labate AM, Klimstra DL, Zakowski MF (1997)
Comparative cytologic features of pancreatic acinar cell carcinoma and islet cell tumor.
Diagn Cytopathol 16: 112-6



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Mixed acinar-ductal carcinoma have one of two different patterns

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Stelow EB, Bardales RH, Shami VM, Woon C, Presley A, Mallery S, Lai R, Stanley MW (2006)
Cytology of pancreatic acinar cell carcinoma.
Diagn Cytopathol 34: 367-72




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Stelow EB, Shaco-Levy R, Bao F, Garcia J, Klimstra DS (2010)
Pancreatic acinar cell carcinomas with prominent ductal differentiation: Mixed acinar ductal carcinoma and mixed acinar endocrine ductal carcinoma.
Am J Surg Pathol 34: 510-8




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Hruban RH, Pitman MB, and Klimstra DS
Tumors of the Pancreas. Armed Forces Institute of Pathology
Washington, DC 2007



. Some exhibit extensive intra- or extracellular mucin accumulation in association with acinar elements. There may be nests of acinar cells floating in colloid-like pools of mucin, or the neoplastic elements may have a combination of typical acinar elements mixed with columnar or signet ring-like cells with cytoplasmic mucin. Mucin staining (mucicarmine or Alcian blue) is positive, as is immunohistochemical labelling for trypsin and chymotrypsin. Individual cells can have multiple directions of differentiation. Other mixed acinar-ductal carcinomas have an individual gland pattern of infiltration with an associated desmoplastic stromal response, reminiscent of infiltrating ductal adenocarcinoma, but nonetheless show significant acinar differentiation by immunohistochemistry
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Bosman FT, Carneiro F, Hruban RH, Theise ND (Eds.)
WHO Classification of Tumours of the Digestive System.
4th Edition
International Agency for Research on Cancer: Lyon 2010



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