Gastric carcinoma resembling pancreatic mixed acinar-endocrine carcinoma

doi:10.1053/hupa.2002.126345

Human Pathology

Volume 33, Issue 5, May 2002, Pages 569-573

https://doi.org/10.1053/hupa.2002.126345 Get rights and content

Abstract

A case of gastric carcinoma resembling pancreatic mixed acinar-endocrine carcinoma of 77-year-old female is presented. This type of gastric tumor has not been previously reported. The endoscopic mucosal resection specimen of the fundus contained a 1.2 × 0.9 × 0.3 cm, well-circumscribed, tan, soft nodular tumor with protruded configuration with a central recess. Histologically, the tumor was confined to the mucosa and submucosa and was characterized by three growth patterns; acinar, solid, and glandular. The growth patterns were intermingled. The tumor cells in the acinar component had round nuclei with prominent nucleoli and diastase-resistant, periodic acid-Schiff–positive, eosinophilic cytoplasm. Immunohistochemically, the tumor cells were positive for CAM5.2, cytokeratin (CK) 7, CK 20, trypsin, lipase, α-1-antitrypsin, and α-1-antichymotrypsin. The tumor cells in the solid component were positive for Grimelius stain and chromogranin A. The findings indicated that the tumor showed acinar and endocrine differentiation. There was no heterotopic pancreas tissue in the specimen. The patient was well without tumor at the 7-month follow-up. It is important to know the existence of this type of gastric cancer and to not confuse it with a metastatic lesion of the pancreatic origin. HUM PATHOL 33:569-573. Copyright 2002, Elsevier Science (USA). All rights reserved.

Section snippets

Case report

A 77-year-old Japanese woman presented with a 2-month history of epigastralgia. Gastroenteroscopy revealed a 1.2 × 0.9 cm protruded lesion in the posterior wall of the gastric fundus. Under the clinical diagnosis of an early gastric cancer, an endoscopic mucosal resection was performed. Laboratory data showed no abnormality. Her past history was unremarkable except for cholecystectomy for cholelithiasis and appendectomy for acute appendicitis. Extensive systemic examination, including imaging

Discussion

Histologically, the present gastric tumor was very similar to mixed acinar-endocrine carcinomas of the pancreas.1, 2, 3, 4, 5 It showed acinar structures, cellular polarization in the basal localization of the nuclei, and abundant eosinophilic cytoplasm. Immunohistochemically, the tumor expressed pancreatic enzyme, trypsin, and lipase. The tumor also contained solid and glandular elements. It exhibited Grimelius-positive staining and chromogranin A positivity, indicating neuroendocrine

Acknowledgements

The author thanks Yokihiro Takeuchi, Naoko Yamada, Takashi Honma, and Kuniko Kobayashi for their technical assistance and Michiko Takaki for her preparation of the photographs.

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Our understanding about the family of acinar neoplasms of the pancreas has grown substantially over the past 25 years. The prototype is acinar cell carcinoma, an uncommon variant of pancreatic carcinoma that demonstrates production of pancreatic exocrine enzymes, verifiable using immunohistochemistry, and exhibits characteristic histologic features. Related neoplasms include mixed acinar carcinomas such as mixed acinar neuroendocrine carcinoma and mixed acinar ductal carcinoma. In the pediatric age group, pancreatoblastoma is also closely related. Cystic and extrapancreatic forms have been described. These neoplasms share molecular alterations that are distinct from the more common ductal and neuroendocrine neoplasms of the pancreas. Although there is a broad range of genetic findings, a number of potential therapeutic targets have emerged. This review explores the clinical and pathologic features of pancreatic acinar neoplasms along with their more common molecular phenotypes. The differential diagnosis with other pancreatic neoplasms is explored as well.
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4) The tumor derives from pluripotential stem cells in the GEJ region with multiple differentiation capabilities. This hypothesis seems likely and has been suggested by other investigators who observed a mixed pattern of pancreatic exocrine and endocrine differentiations in the same adenocarcinoma [23,24,27-30]. This hypothesis requires the support of solid experimental studies.
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^*: Address, correspondence, and reprint requests to Masaharu Fukunaga, Department of Pathology, The Jikei Dáisan Hospital, 4-11-1, Izumihoncho, Komaeshi, Tokyo, 201-8601, Japan.

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Case StudiesGastric carcinoma resembling pancreatic mixed acinar-endocrine carcinoma*

Abstract

Section snippets

Case report

Discussion

Acknowledgements

Mixed acinar-endocrine carcinomas of the pancreas

Am J Surg Pathol

Pancreatic carcinoma with duct, endocrine, and acinar differentiation. A histologic, immunocytochemical, and ultrastructural study

Cancer

Malignant mixed exocrine-endocrine tumor of the pancreas with unusual intracytoplasmic inclusions

Ultrastruct Pathol

Pathology of the Gallbladder, Biliary Tract and Pancreas

Tumors of the pancreas, in Atlas of Tumor Pathology, 3rd series, Fascicle 20

Acinar cell carcinoma of the pancreas. A clinicopathologic study of 28 cases

Am J Surg Pathol

Case Studies
Gastric carcinoma resembling pancreatic mixed acinar-endocrine carcinoma*