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Adenosquamous carcinoma of the pancreas with clear cell and rhabdoid
components. A case report.JOP.
2007 May 9;8(3):330-4.
CONTEXT: In as
much as no such variant of this pancreatic tumour has been previously
reported in the literature, we report an unusual case of an
adenosquamous carcinoma of the pancreas characterized by clear cells
and rhabdoid cells. CASE REPORT: A 75-year-old man presented with
upper abdominal distention, dyspepsia, jaundice, and significant
weight loss over a period of 3 months. Imaging of the abdomen showed a
solid mass with cystic components in the region of the uncinate
process of the pancreas. Endoscopic retrograde pancreatography showed
mild to moderate dilatation of the intrapancreatic biliary tract and
of the pancreatic duct, and a biliary stent was placed. The patient
subsequently underwent a Whipple's procedure with curative intent.
Histological evaluation of the pancreatic mass revealed an
adenosquamous carcinoma displaying both clear cell and rhabdoid
components. CONCLUSIONS: Assessing the predominant histology of
pancreatic adenosquamous carcinoma variants such as those
characterized by clear cells and rhabdoid cells may help select and
improve upon therapies in this aggressive lesion.
Adenosquamous
carcinoma of the pancreas.Digestion.
2005;72(2-3):104-8.
BACKGROUND/AIMS: Adenosquamous carcinoma (ASC) of the pancreas is rare
and correct preoperative diagnosis is difficult. Case reports of ASC
of the pancreas are sporadic and have typically employed small series.
This study investigated the clinicopathological features of 7 cases of
ASC of the pancreas and reviewed the pertinent literature to elucidate
this rare disease. METHODOLOGY: Seven patients (4 men and 3 women; age
range 38-79 years; median 66 years) with ASC of the pancreas who
underwent surgical treatment at Chang Gung Memorial Hospital between
February 1993 and April 2000 were retrospectively reviewed. RESULTS:
Symptoms of ASC were as follows: abdominal pain (85.7%), body weight
loss (85.7%), jaundice (42.9%) and anorexia (42.9%). The tumors were
located at the head of the pancreas in 4 patients (57.1%), at the body
in 2, and at the tail in 2. One patient had ASC at the body and tail.
Most cases (5/7, 71.4%) were anemic. Seven (100%) and 5 patients
(71.4%) had elevated serum CEA and CA19-9 levels, respectively.
Curative pancreaticoduodenectomy was performed on 2 patients, bypass
surgery on 3, and exploratory laparotomy on 2. Two patients underwent
intraoperative radiotherapy. Three patients received postoperative
adjuvant chemotherapy. No surgical mortality or morbidity occurred.
Five of 7 patients (71.4%) died within 6 months after surgery. The
median survival of the 7 patients was 4.41 months (range 1.12-22.42).
CONCLUSIONS: Patients with ASC present symptoms similar to those of
adenocarcinoma of the pancreas. Most patients had dismal prognosis
despite aggressive surgery with or without adjuvant therapy.
Adenosquamous
carcinoma of the pancreas with an acantholytic pattern together with
osteoclast-like and pleomorphic giant cells.J
Clin Pathol. 2005 Sep;58(9):987-90.
A 45 year old
man presented with abdominal pain, loss of appetite, and significant
weight loss over a period of about four weeks. Imaging of the abdomen
showed a mass in the region of the head of the pancreas. In view of
the size of the mass and the clinical picture, a Whipple's procedure
was performed. Histological evaluation of the pancreatic tumour showed
an adenosquamous carcinoma (predominantly composed of squamous
carcinoma), which was extensively infiltrative with perineural
invasion and involvement of peripancreatic lymph nodes. Areas of
pancreatic intraepithelial neoplasia grade III and merging of the
squamous and adenocarcinoma components were evident. Unusual
histological features that characterised this case included a
pronounced acantholytic pattern within the squamous carcinoma
component, and the presence of both osteoclastic and pleomorphic giant
cells. Giant cells have not been documented previously in association
with an adenosquamous carcinoma. Although an acantholytic pattern has
been noted in squamous carcinomas in other sites, this is the first
report of such a pattern in an adenosquamous carcinoma of the
pancreas.
Adenosquamous pancreatic cancer producing parathyroid hormone-related
protein.
J Gastroenterol.
2004;39(2):176-80.
An autopsy
case of adenosquamous pancreatic cancer in a 61-year-old male patient
with an elevated serum level of parathyroid hormone-related protein (PTH-rP)
is reported. He was admitted to our hospital with a 1-month-long
history of abdominal discomfort and progressive abdominal fullness. A
computed tomography (CT) scan of the abdomen showed a retroperitoneal
mass, approximately 10 cm in diameter, involving the pancreas, with
round enhancement on contrast examination. Histological examination of
a specimen taken by CT-guided needle biopsy suggested squamous cell
carcinoma or transitional cell carcinoma. Laboratory data on admission
revealed a high serum calcium level and high PTH-rP level. The calcium
level initially responded to intravenous hydration, furosemide,
calcitonin, and bisphosphonates, decreasing from 15.0 to 9.0 mg/dl.
However, the hypercalcemia recurred after 10 days. The patient
developed carcinomatous peritonitis and acute renal failure, and died
on the 25th hospital day. Autopsy revealed a mass in the pancreatic
body to tail, invading the retroperitoneum, with progressive
carcinomatous peritonitis. Histological examination of the mass
revealed infiltrating carcinoma, showing squamous differentiation with
focal intracytoplasmic lumina formation, consistent with pancreatic
adenosquamous carcinoma. Immunohistological examination showed
positive staining for PTH-rP. Adenosquamous carcinoma of the pancreas
is relatively rare; only a few cases associated with hypercalcemia and
for which PTH-rP has been identified as a causative factor have been
reported. This is the first case in which immunohistochemistry proved
localized PTH-rP in adenosquamous pancreatic cancer cells, associated
with persistent hypercalcemia.
Adenosquamous
carcinoma of the pancreas: preoperative diagnosis and molecular
alterations.J
Gastroenterol. 2003;38(12):1171-5.
Adenosquamous
carcinoma of the pancreas is a rare tumor which has a less favorable
prognosis than common ductal cell carcinoma of the pancreas, and a
definite preoperative diagnosis of this tumor is quite difficult. We
herein report two cases of this rare variant. The patients were a
41-year-old man (patient 1) and a 67-year-old woman (patient 2).
Patient 1 had a hypoechoic mass measuring 3 cm in the uncus of the
pancreas, while patient 2 had a huge mass, measuring 8 cm, in the tail
of the pancreas. Patient 2 was successfully diagnosed preoperatively
as having an adenosquamous carcinoma, by cytological examination of
the pure pancreatic juice obtained by endoscopic retrograde pancreatic
juice aspiration. A pylorus-preserving pancreatoduodenectomy was
performed for patient 1, and a distal pancreatectomy with resection of
the spleen and the left kidney was performed for patient 2. Subsequent
pathological findings of these two tumors revealed adenosquamous
carcinoma of the pancreas. K- ras point mutation, p53 overexpression,
and telomerase activity in both tumor specimens were detected by the
mutant allele specific amplification method, immunohistochemical
staining, and telomeric repeat amplification protocol assay,
respectively. The two patients died of recurrent disease 5 and 4
months, respectively, after surgery. Cytological examination of pure
pancreatic juice is a useful modality for the preoperative diagnosis
of this tumor, and frequent molecular alterations may be associated
with the poor prognosis of adenosquamous carcinoma of the pancreas.
Adenosquamous carcinoma of the pancreas: cytologic features in 14
cases.Cancer.
2003 Dec 25;99(6):372-8.
BACKGROUND:
Adenosquamous carcinoma (ASCa) is a rare subtype of ductal
adenocarcinoma of the pancreas with what to the authors' knowledge are
limited cytologic descriptions. In the current study, the authors
describe their experience with the fine-aspiration biopsy (FNAB)
diagnosis of ASCa and characterize cytologic features in 14 cases.
METHODS: Fourteen cases of ASCa were identified from pathology case
files. Cytologic material was examined for cellularity, grade, tumor
cell necrosis, and specific features of glandular and squamous
differentiation. RESULTS: The 10 females and 4 males had an average
age of 70 years. Nine patients (64%) were reported to have Stage IV
disease at the time of presentation. All tumors were high grade, with
moderate to high cellularity. Tumor cell necrosis was noted in 12.
Nine of the 14 cases (64%) demonstrated predominantly squamous
differentiation with keratinization. Seven of these nine contained at
least focal intracellular mucin or honeycombed glandular sheets. Two
of the nine had rare cytoplasmic vacuoles as the only evidence of
glandular differentiation. Five cases (36%) were predominantly
glandular. All but one of these five cases contained atypical to
malignant keratinized cells. One of the five cases lacked
keratinization but had tumor cells with dense cytoplasm; the diagnosis
of ASCa was confirmed on histology. In 13 patients for whom followup
was known, 12 had died of disease (mean, 5.6 months) and 1 was alive
at 13 months of follow-up. CONCLUSIONS: A specific diagnosis of ASCa
is possible when aspirates show evidence of both squamous and
glandular differentiation, although one component often predominates
and features of dual differentiation may be focal. A purely squamous
tumor should raise the suspicion of a metastasis, but also may
represent undersampling of an ASCa.
Adenosquamous
carcinoma of the pancreas: a clinicopathologic series of 25 cases.
Mod Pathol. 2001 May;14(5):443-51.
BACKGROUND:
Adenosquamous carcinoma is a rare aggressive subtype of pancreatic
adenocarcinoma. We describe the clinical, pathologic, and molecular
characteristics of 25 of these lesions, the largest series to date.
METHODS: Twenty-five cases of adenosquamous carcinoma of the pancreas
diagnosed between 1961 and 1994 were retrieved from the files of the
Endocrine Registry of the Armed Forces Institute of Pathology.
Histologic features were reviewed, histochemical, immunohistochemical,
and molecular (k-ras) studies were performed, and patient follow-up
was obtained. RESULTS: The patients included 17 men and eight women,
aged 28 to 82 years (mean, 65.4 y). The patients usually experienced
weight loss (n = 17) or painless jaundice (n = 11), while also
presenting with other abdominal symptoms. The tumors affected the head
most frequently (n = 17), followed by the tail (n = 9) or body (n =
4). Five cases involved more than one anatomic region of the pancreas.
Microscopically, all tumors demonstrated dual differentiation toward
adenocarcinoma and squamous cell carcinoma. All cases tested were
immunoreactive with keratin (AE1:AE3 and CK1), whereas other keratin
markers were variably expressed: CK5/6 (88%), CK7 (68%), Cam5.2 (41%),
and CK20(26%). CA-19-9 (84%) and CEA (74%) were positive in the
majority of the cases. K-ras oncogene mutations were identified in
seven of 13 cases. All patients died from their disease an average of
5.8 months after diagnosis (range, 1 to 33 months). CONCLUSIONS:
Adenosquamous carcinoma of the pancreas represents a distinct clinical
and pathologic entity, demonstrating the expected immunoprofile and k-ras
oncogene mutation of a ductal origin, with a worse prognosis than
ductal adenocarcinoma.
Pancreatobiliary adenosquamous carcinoma (report of two cases).
Pathologica. 2000 Oct;92(5):323-6.
Adenosquamous
carcinomas are rare malignant tumors of the pancreas and periampullary
region. We present two cases of pancreatic and periampullary
adenosquamous carcinoma with clinicopathologic, histo- and
immunohistochemical findings. A 51-year-old and a 48-year-old man
presented with right upper quadrant pain of three months duration and
jaundice for two weeks. Both cases had an elevation of liver enzymes
and CA 19-9. In the first case, computerized tomography showed a 3
cm-mass at the pancreatic head. In the second one, endoscopic
retrograde choledocopancreatography (ERCP) revealed a mass at the
ampulla Vateri localization. A pancreatoduodenectomy was performed for
both cases. Gross pathologic examination displayed a solid, gray-white
colored 4 cm-tumor at the pancreatic head and a solid, pink-white
colored, 2 cm-tumor at the periampullary region bulging into the
duodenal lumen. Microscopically, both tumors were composed of solid
nests of squamous cells with pearl formation and mucin-containing
glandular cells and diagnoses were adenosquamous carcinoma.
Furthermore, histo- and immunohistochemical findings were consistent
with microscopic diagnoses.
Adenosquamous
carcinoma of the pancreas.Arch
Surg. 1999 Jun;134 (6): 599-603.
HYPOTHESIS:
Adenosquamous carcinoma of the pancreas is a rare but particularly
virulent variant of invasive ductal carcinoma. This review will
demonstrate the aggressive biologic activity, histopathologic
features, and DNA flow cytometric characteristics of this aggressive
lesion. In addition, the outcome is less favorable than in other
pancreatic neoplasms, in spite of aggressive surgical and
postoperative adjuvant therapy. DESIGN: A retrospective review of 6
patients treated during an 8-year period. SETTING: A major urban
university tertiary referral hospital. PATIENTS: There were 6 patients
with this unusual tumor seen between 1990 and 1998. There were 4 men
and 2 women, all white, with a mean+/-SD age of 63.5+/-14.7 years.
Symptoms were similar to those in patients with more common pancreatic
malignant neoplasms. RESULTS: Four patients with tumors in the head of
the pancreas had pancreatoduodenectomy, and 2 with body and or tail
lesions had distal pancreatectomy and splenectomy. Pathologically, all
the tumors were poorly differentiated and aneuploid, and 5 of the 6
were locally metastatic. All but 1 patient had postoperative
complications, but there were no operative deaths. One half of the
patients received postoperative adjuvant chemotherapy and radiation
therapy. Only 1 patient is still alive at 9 months after surgery, but
has known residual cancer around his portal vein noted during
palliative distal pancreatectomy. CONCLUSIONS: Adenosquamous carcinoma
of the pancreas is an uncommon variant of exocrine pancreatic
neoplasm. It is characterized by an admixture of adenomatous and
squamous cell elements and demonstrates aggressive biologic behavior.
This series of 6 patients is similar to the 134 cases reported since
1907, in that survival is short despite aggressive surgical therapy.
Few patients with this disease live more than 1 year. Aggressive
therapy should be tempered by the realization of the uniform poor
prognosis associated with this malignant neoplasm.
Adenosquamous
carcinoma of the pancreas: report of two cases.Am
J Gastroenterol. 1998 Jul;93(7):1167-70.
Adenosquamous
carcinoma of the pancreas is a rare variant of pancreatic exocrine
carcinoma. We herein report two patients with this entity. One patient
was a 60-yr-old Japanese man complaining of a palpable mass, 5.5 cm in
the greatest diameter, in the epigastrium. Serum CA 19-9 was increased
(2010 U/ml). Ultrasonography and computed tomography showed a mass in
the pancreatic tail with central necrosis and invading the posterior
wall of the stomach. Angiography showed an encasement of the splenic
artery and complete obstruction of the splenic vein. Distal
pancreatectomy, splenectomy, and partial resection of the stomach were
done. The patient died of uncontrolled bleeding from the duodenal
ulcer four months after operation. The other patient was a 73-yr-old
man who presented with jaundice. The CA 19-9 was also elevated (354.8
U/ml). Ultrasonography showed a pancreatic head mass of heterogeneous
echogeneity and computed tomography demonstrated a cystic mass with an
enhanced rim, indicating necrosis in the tumor center. Angiography
showed a hypervascular mass in the head of the pancreas.
Pylorus-preserving pancreatoduodenectomy was done, but the patient
died of multiple liver metastases 10 months after the operation. From
our experience with the two patients, the presence of central necrosis
in an infiltrative huge pancreatic tumor seems to be suggestive of the
diagnosis of adenosquamous carcinoma of the pancreas.
Adenosquamous
carcinoma of the pancreas.J
Gastroenterol. 1995 Dec;30(6):798-802.
A 58-year-old
Japanese man was admitted complaining of abdominal pain. An abdominal
computed tomography examination demonstrated a tumor in the head of
the pancreas and multiple calcifications. A laparotomy was performed
and the tumor was removed by Whipple's operation. Histologically, the
neoplasm that invaded the duodenal wall and the papilla of Vater was
composed of nests of malignant squamous cells with intercellular
bridges and showed the formation of keratinized pearls with a small
area of concurrently neoplastic glandular and squamous elements. On
the basis of these features, the diagnosis of adenosquamous carcinoma
of the pancreas was made. The patient died 18 months after the
operation. The neoplastic behavior of this rare primary pancreatic
carcinoma is similar to that of duct cell carcinoma as well as pure
squamous cell carcinoma of the pancreas. As the pancreas can be the
target of metastases of squamous carcinomas from other organs it is
wise to be aware of this rare entity.
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