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Mixed exocrine-endocrine tumor of the pancreas.
JOP. 2005 Sep 10;6(5): 449-54.
CONTEXT:
Neoplasms of the pancreas usually show ductal, acinar or endocrine
differentiation. Tumors with mixed exocrine and endocrine components
are unusual. We herein describe a case of a mixed ductal-endocrine
tumor. CASE REPORT: A 65-year-old woman was referred to our department
with a diagnosis of carcinoma of the tail of the pancreas. The patient
had a short history of upper abdominal pain, nausea and melena. Upper
gastrointestinal endoscopy revealed gastric fundus varices and CT scan
demonstrated an inhomogeneous tumor located in the tail of the
pancreas infiltrating the spleen and the splenic vein. The patient
underwent distal pancreatectomy and splenectomy, and had an uneventful
recovery. Pathological examination revealed a mixed ductal-endocrine
tumor. The endocrine component was immunoreactive for glucagon,
gastrin and somatostatin, and non-reactive for insulin. CONCLUSIONS:
Because of the rarity and unpredictable biologic behavior of these
tumors, the need for adjuvant therapy has not yet been well-defined.
The patient has had a follow-up CT scan every six months, and one and
a half years later remains disease free.
A case of
mixed acinar-endocrine carcinoma of the pancreas discovered in an
asymptomatic subject.Int
J Pancreatol. 2000 Jun;27(3):249-57.
A 50-yr-old
Japanese man was found to have a hypoechoic mass 3 cm in diameter in
the pancreatic head on an ultrasonography (US) examination without
symptoms. A computed tomography (CT) scan demonstrated a 3-cm solid
mass in the pancreatic head, and it was more clearly delineated as a
low-density area on enhanced CT. Angiography showed a tumorlike stain,
3 cm in size, in the pancreatic head. The preoperative diagnosis was
"special type of pancreatic tumor such as acinar cell carcinoma or
non-functioning islet cell tumor." The patient was treated by
pylorus-preserving pancreatoduodenectomy. Histological,
immunohistochemical, and electron-microscopic studies of the surgical
specimen led to a definitive diagnosis of a mixed acinar-endocrine
carcinoma. The patient is currently well, with no signs of tumor
recurrence, 18 mo after the operation. Our search of the Japanese and
English-language literature retrieved only 15 well-documented cases of
mixed acinar-endocrine carcinoma. Imaging in the reported cases
revealed features of either acinar cell carcinoma or islet cell tumor,
or both, which can may be detected even in small tumors more easily
than conventional invasive ductal carcinoma of the pancreas because
the detectability of this rare tumor on US and CT seems to be good.
Mixed
exocrine-endocrine tumors of the pancreas.Semin
Diagn Pathol. 2000 May;17(2):104-8.
Neoplasms of
the pancreas usually show either ductal, acinar, or endocrine
differentiation. Mixed exocrine-endocrine pancreatic neoplasms, in
which the endocrine component is significant and comprises one-third
to one-half of the tumor tissue, are rare. Truly mixed tumors have to
be distinguished from exocrine neoplasms with scattered endocrine
cells. In ductal adenocarcinomas, the scattered endocrine cells seem
to be nonneoplastic. In other malignancies such as acinar cell
carcinoma and pancreatoblastoma, scattered endocrine cells most likely
represent an integral component of the tumor.
Mixed ductal-endocrine
carcinoma of the pancreas presenting as gastrinoma with Zollinger-Ellison
syndrome: an autopsy case with a 24-year survival period.Virchows
Arch. 1999 Dec;435(6):606-11.
We report an
autopsy case of mixed ductal-endocrine carcinoma of the pancreas
presenting as gastrinoma with Zollinger-Ellison syndrome. A
38-year-old Japanese male was found to have Zollinger-Ellison syndrome
and pancreatic gastrinoma, and gastrectomy and resection of the
pancreatic tumor were performed. However, hypergastrinemia persisted,
and the patient died of disseminated carcinomatosis at 62 years of
age, 24 years after the onset of Zollinger-Ellison syndrome. At
autopsy, the main tumor was present in the residual pancreas, and
metastases were noted in many organs. In the pancreas and other
organs, ductal and endocrine carcinoma areas were mixed and there was
a gradual transition between the two. No acinar differentiation was
noted. The ductal elements were positive for mucins and
carcinoembryonic antigen but negative for neuroendocrine markers,
while endocrine elements were positive for chromogranin A and
synaptophysin and to a lesser extent for gastrin, but negative for
mucins and carcinoembryonic antigen. The ductal elements comprised
about 30% of the tumor cells, and endocrine elements 70%. According to
the revised World Health Organization classification, our case was
diagnosed as mixed ductal-endocrine carcinoma. Our case is rare
because the tumor manifested as gastrinoma with Zollinger-Ellison
syndrome and the patient survived for 24 years. To the best of our
knowledge, no such case has been reported. Our case suggests that
pancreatic endocrine tumors may evolve into mixed ductal-endocrine
carcinomas.
Malignant mixed exocrine-endocrine tumor of the pancreas with unusual
intracytoplasmic inclusions.
Ultrastruct Pathol. 1993
Sep-Oct;17(5):483-93.
A case
of malignant mixed exocrine-endocrine tumor of the pancreas is
reported. Electron microscopy revealed abundant neurosecretory
granules in most cels. Zymogen granules indicating acinar
differentiation were seen in a few cells. Ductal features, including
microvilli with prominent filamentous cores and intracytoplasmic mucin
granules, were also noted in this lesion. immunocytochemical strains
were positive for serotonin and glucagon. Unusual intracytoplasmic
fibrillary inclusions are described and their possible origin
discussed.
Pancreatic
mixed ductal-islet tumors. Is this an entity?Int
J Pancreatol. 1992 Feb;11(1):23-9.
Thirty-eight human pancreatic cancer specimens
were studied for the reactivity of cancer cells with monoclonal
antibodies against insulin, glucagon, somatostatin, pancreatic
polypeptide (PP), vasoactive intestinal peptide (VIP), gastrin,
calcitonin, and with argyrophilic reactivity. Immunoreactivity with
one or several antibodies or argyrophilic reactivity were found in 30
(79%) cases. In 17 cases, the number of endocrine cells was excessive
and morphologically consistent with the mixed ductal-islet tumor.
Although most immunoreactive cells were located at the base of the
malignant glands, some had intraepithelial location and were also
present in the invasive portion of cancers, indicating their malignant
nature. Endocrine cell proliferation were found in the pancreatic
tissue adjacent to the carcinoma in 8 out of 12 specimens examined. In
these cases, the immunoreactive cells were either distributed among
the acinar cells or ductal cells. More endocrine cells were found in
the hyperplastic ducts; however, no correlation was found between the
degree of hyperplasia and the occurrence of any type of immunoreactive
cells. Although several types of endocrine cells occurred in different
pancreatic regions (head, body, and tail), PP cells were restricted to
tissues taken from the head of the pancreas. Experimental data and
similar observations by other investigators led us to conclude that
participation of endocrine cells in ductal-type carcinomas is a
general phenomenon and does not justify the classification of these
lesions to mixed ductal-islet entity. However, because immunoreactive
cells were more common and numerous in well-differentiated carcinomas,
they may have some prognostic values.
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