logo logo
Search: Organ site Search: Tumor / Syndrome
or
WHO Classification of Tumours
Mixed acinar-neuroendocrine-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
Click to access Pubmed
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




Click to access Pubmed
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




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




Click to access Pubmed
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
Click for details
Hruban RH, Pitman MB, and Klimstra DS
Tumors of the Pancreas. Armed Forces Institute of Pathology
Washington, DC 2007




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




Click to access Pubmed
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




Click to access Pubmed
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




Click to access Pubmed
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
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



.

Mixed acinar-neuroendocrine-ductal carcinomas are extremely rare and poorly documented, but show mixed morphology, with acinar patterns, cells with neuroendocrine differentiation and areas simulating infiltrating ductal adenocarcinoma

Click to access Pubmed
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



. Immunohistochemistry is positive for acinar, neuroendocrine, and ductal markers, and mucin production is also evident. One of the reported cases arose in association with high-grade pancreatic intraepithelial neoplasia (PanIN)
Click for details
Hruban RH, Pitman MB, and Klimstra DS
Tumors of the Pancreas. Armed Forces Institute of Pathology
Washington, DC 2007



.
There is an insufficient number of recorded cases to define the biological behaviour of mixed acinar carcinomas, but, like pure acinar cell carcinomas, they appear to be aggressive

Click to access Pubmed
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




Click for details
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



.