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Presented by Dr. Ashley Cimino-Mathews and prepared by Dr. Kevan Salimian
An 80 year-old male with a history of pancreatic cancer presents with abdominal masses
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Question 1 of 1
1. Question
An 80 year-old male with a history of pancreatic cancer presents with abdominal masses
Choose the correct diagnosis:
Correct
Diagnosis: B. Metastatic acinar cell carcinoma
Histology:
This section of the abdominal mass shows nests of cells arranged in acinar and trabecular patterns, with basal polarization of the nuclei and apical pink, granular cytoplasm. The nuclei are uniform with finely dispersed chromatin and occasional prominent nucleoli. There are frequent mitotic figures, but no atypical mitoses or necrosis. No normal structures/organs are identified in this section. The lesional cells are positive for cytokeratin, chymotrypsin, and BCL10.Discussion:
This patient has a known history of pancreatic acinar cell carcinoma of the pancreas, and his metastatic disease involving the abdominal cavity displays characteristic histologic features of this entity. Pancreatic acinar cell carcinomas arise from the pancreatic acinar cells, which produce exocrine enzymes. Acinar cell carcinomas may have either an acinar growth pattern or solid growth pattern. The acinar growth pattern is easier to recognize as “acinar” in origin, whereas the solid pattern consists of sheets of atypical cells. By immunohistochemistry, acinar cell carcinomas are positive for cytokeratin, chymotrypsin, trypsin, lipase, and BCL10. Scattered cells may be synaptophysin or chromogranin positive, but this labeling is typically not diffuse. The differential diagnosis of other pancreatic neoplasms includes pancreatic neuroendocrine tumor, solid-pseudopapillary neoplasm, and Pancreatoblastoma (however, the latter typically effect children and contain squamoid nests). In metastatic sites, the differential diagnosis would also include neuroendocrine tumors with rosette formation, adenocarcinomas with gland formation, and other “pink cell tumors” such as melanoma and hepatocellular, renal and adrenocortical carcinomas. In general, acinar cell carcinomas have a more favorable prognosis that pancreatic ductal adenocarcinomas; however, acinar cell carcinomas can still metastasize and behave aggressively.References:
1. Hackeng WM, Hruban RH, Offerhaus GJ, Brosens LA. Surgical and molecular pathology of pancreatic neoplasms. Diagn Pathol. 2016 Jun 7;11(1):47.Incorrect
Diagnosis: B. Metastatic acinar cell carcinoma
Histology:
This section of the abdominal mass shows nests of cells arranged in acinar and trabecular patterns, with basal polarization of the nuclei and apical pink, granular cytoplasm. The nuclei are uniform with finely dispersed chromatin and occasional prominent nucleoli. There are frequent mitotic figures, but no atypical mitoses or necrosis. No normal structures/organs are identified in this section. The lesional cells are positive for cytokeratin, chymotrypsin, and BCL10.Discussion:
This patient has a known history of pancreatic acinar cell carcinoma of the pancreas, and his metastatic disease involving the abdominal cavity displays characteristic histologic features of this entity. Pancreatic acinar cell carcinomas arise from the pancreatic acinar cells, which produce exocrine enzymes. Acinar cell carcinomas may have either an acinar growth pattern or solid growth pattern. The acinar growth pattern is easier to recognize as “acinar” in origin, whereas the solid pattern consists of sheets of atypical cells. By immunohistochemistry, acinar cell carcinomas are positive for cytokeratin, chymotrypsin, trypsin, lipase, and BCL10. Scattered cells may be synaptophysin or chromogranin positive, but this labeling is typically not diffuse. The differential diagnosis of other pancreatic neoplasms includes pancreatic neuroendocrine tumor, solid-pseudopapillary neoplasm, and Pancreatoblastoma (however, the latter typically effect children and contain squamoid nests). In metastatic sites, the differential diagnosis would also include neuroendocrine tumors with rosette formation, adenocarcinomas with gland formation, and other “pink cell tumors” such as melanoma and hepatocellular, renal and adrenocortical carcinomas. In general, acinar cell carcinomas have a more favorable prognosis that pancreatic ductal adenocarcinomas; however, acinar cell carcinomas can still metastasize and behave aggressively.References:
1. Hackeng WM, Hruban RH, Offerhaus GJ, Brosens LA. Surgical and molecular pathology of pancreatic neoplasms. Diagn Pathol. 2016 Jun 7;11(1):47.
