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Presented by Pedram Argani, M.D. and prepared by Dengfeng Cao, M.D. Ph.D.
Case 2: 60-year-old male with a pancreatic mass.
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Question 1 of 1
1. Question
Week 191: Case 2
60-year-old male with a pancreatic mass.images/cao_091304_case 2a.jpg
images/cao_091304_case 2b.jpg
images/cao_091304_case 2c.jpg
images/cao_091304_case 2d.jpgCorrect
Answer: Acinar cell carcinoma
Histology: The tumor has a predominantly solid pattern. The tumor cells are polygonal with a single prominent nucleolus and granular, eosinophilic to amphophilic cytoplasm. Tumor cells show strong granular cytoplasmic staining for trypsin, and lack staining for chromogranin or synaptophysin, supporting the diagnosis.
Discussion: Islet cell tumor would feature more uniform,“salt and pepper” chromatin without prominent nucleoli. The solid pseudopapillary tumor, as previously discussed, also typically has a finer chromatin, and would label for CD10. Medullary Carcinoma of the Pancreas is a recently described entity characterized by sheets of malignant epithelial cells with a prominent lymphoid reaction. These tumors show ductal differentiation but not acinar differentiation.
Acinar Cell Carcinoma of the pancreas typically affects adult males. Most patients present with an abdominal mass, though approximately 1/6 present with symptoms related to serum release of lipase, such as subcutaneous fat necrosis, polyarthralgias, and peripheral eosinophilia. Approximately 40% may have a minor endocrine component, but a true Mixed Endocrine-Acinar Tumor should have at least 25% of each component. The prognosis for acinar cell carcinoma is generally poor with only a 26% 3-year survival.
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Incorrect
Answer: Acinar cell carcinoma
Histology: The tumor has a predominantly solid pattern. The tumor cells are polygonal with a single prominent nucleolus and granular, eosinophilic to amphophilic cytoplasm. Tumor cells show strong granular cytoplasmic staining for trypsin, and lack staining for chromogranin or synaptophysin, supporting the diagnosis.
Discussion: Islet cell tumor would feature more uniform,“salt and pepper” chromatin without prominent nucleoli. The solid pseudopapillary tumor, as previously discussed, also typically has a finer chromatin, and would label for CD10. Medullary Carcinoma of the Pancreas is a recently described entity characterized by sheets of malignant epithelial cells with a prominent lymphoid reaction. These tumors show ductal differentiation but not acinar differentiation.
Acinar Cell Carcinoma of the pancreas typically affects adult males. Most patients present with an abdominal mass, though approximately 1/6 present with symptoms related to serum release of lipase, such as subcutaneous fat necrosis, polyarthralgias, and peripheral eosinophilia. Approximately 40% may have a minor endocrine component, but a true Mixed Endocrine-Acinar Tumor should have at least 25% of each component. The prognosis for acinar cell carcinoma is generally poor with only a 26% 3-year survival.
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