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WHO Classification of Tumours
Mixed acinar-neuroendocrine 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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Hruban RH, Pitman MB, and Klimstra DS
Tumors of the Pancreas. Armed Forces Institute of Pathology
Washington, DC 2007




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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



. 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-neuroendocrine carcinoma
In many of these neoplasms, the only evidence for divergent differentiation is provided by immunohistochemical labelling. Although different regions of the neoplasm may suggest acinar or neuroendocrine differentiation morphologically, many areas have intermediate features, and immunohistochemistry generally shows a mixture of cells expressing acinar or neuroendocrine markers (or both). Most reported acinar-neuroendocrine carcinomas have been composed predominantly of acinar elements

Click to access Pubmed
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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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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