Pancreatic Pathology Online

Pathology of Pancreatic Carcinoma with Mixed Differentiation

Dr Sampurna Roy MD                      


Syn: Mixed Acinar-Endocrine Carcinomas (MAEC)

Mixed acinar-endocrine carcinoma (MAEC) is a rare mixed tumor of the pancreas defined by both acinar and endocrine cell differentiation.

Carcinomas with mixed exocrine and endocrine tissue are rare.

The pancreatic tumour may exhibit ductal, acinar, or endocrine features, depending on the point at which neoplastic transformation occurs along the pathway of proliferation and differentiation of these cells.

Among these, the rare "mixed" tumors reported are:

1. Ductal - islet cell carcinoma

2. Acinar - islet cell carcinoma

3. Ductal - acinar - islet cell carcinoma.

Ductal, acinar and islet cell components of pancreas show a common embryogenesis from the foregut endoderm.

If the transformation occurs at an early stage, more than one line of differentiation may be expressed.

According to a study immunohistochemistry showed following features:

Intense diffuse cytoplasmic and membranous positivity of the neoplastic cells for AE1/AE3;

Focal mild membranous and cytoplasmic positivity for CA 19-9.

Intense diffuse cytoplasmic positivity for neuron specific enolase (NSE);

Negativity for CA 125, CA 15-3 and insulin;

Focally granular cytoplasmic positivity for chromogranin. 

Diffuse cytoplasmic and membranous positivity for synaptophysin.

Focal granular cytoplasmic positivity for gastrin, somatostatin and glucagon.


These tumours have the same prognosis as common ductal pancreatic carcinomas.

Mixed acinar-endocrine carcinoma have potentially more aggressive clinical course and different therapeutic implications and are an important consideration in the differential diagnosis of pancreatic neoplasms.

Mixed acinar-endocrine carcinoma of the pancreas should be considered in elderly male patients with large pancreatic mass and may warrant aggressive surgical resection and chemotherapy.


Further reading:

Mixed exocrine-endocrine tumor of the pancreas.

An unusual mixed tumor of the pancreas: sonographic and MDCT features

Hints to the diagnosis of mixed acinar-endocrine carcinoma on pancreatic fine-needle aspiration: avoiding a potential diagnostic pitfall.

Mixed acinar-endocrine carcinoma of the pancreas: new clinical and pathological features in a contemporary series.

Peri-ampullary mixed acinar-endocrine carcinoma.

Imaging findings in a case of mixed acinar-endocrine carcinoma of the pancreas.

Mixed acinar-endocrine carcinoma of the pancreas with intraductal growth into the main pancreatic duct: Report of a case.

Mixed acinar-endocrine carcinoma of the pancreas: a case report and review of the literature.

Pancreatic acinar cell carcinomas with prominent ductal differentiation: Mixed acinar ductal carcinoma and mixed acinar endocrine ductal carcinoma.

Pancreatic-type mixed acinar-endocrine carcinoma with alpha-fetoprotein production arising from the stomach: a report of an extremely rare case.



Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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