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Int J Clin Exp Pathol 2(6),602-607;2009
Case Report
Pancreatic Carcinoma with Multilineage (Acinar, Neuroendocrine, and Ductal)
Differentiation
Kia Newman, Jay Stahl-Herz, Oluyomi Kabiawu, Elliot Newman, Rosemary Wieczorek, Beverly Wang, Zhiheng Pei, Michael Bannan, Peng Lee
and Ruliang Xu
Departments of Pathology and Surgery, New York University School of Medicine, and New York Harbor Healthcare System, New York, NY, USA
Received 06 February 2009; Accepted in revision 28 May 2009; Available online 20 June 2009
Abstract: The preponderance of pancreatic tumors is adenocarcinoma of the ductal type; carcinomas with multiple lineage differentiation are
extremely rare. We report an unusual case of pancreatic carcinoma with combined acinar and neuroendocrine differentiation and minor ductal
component with concurrent acinar-ductal metaplasia (ADM), an early lesion implicated in ductal carcinogenesis. The patient is a 56-year-old
man with vague complaints of dull left upper quadrant pain with radiation across the mid-portion of his abdomen. A computer tomography scan
revealed an irregular enlargement of the distal 3.2 cm of the pancreatic body. A distal pancreatectomy was then performed. Histologic
examination revealed a pancreatic carcinoma with cellular features of eosinophilic granular cytoplasm and salt-pepper nuclei. The acinar
differentiation of the carcinoma was confirmed by positivity on periodic acid-Schiff stain resistant to diastase digestion (dPAS), positivity for
antitrypsin on immunohistochemistry (IHC), and presence of zymogen granules on electron microscopy (EM). The neuroendocrine
differentiation was evident by positive synaptophysin and chromogranin stain on IHC and neuroendocrine granules on EM. The ductal
component was only visible by PAS stain and immunostains for CEA and CK19A and accompanied by a number of the acinar-ductal
metaplasia lesions adjacent to the main tumor. Thus, the histological, histochemical, immunohistochemical and electron-microscopic
evidence all suggested that the pancreatic carcinoma underwent trilineage differentiation. (IJCEP902002).
Key Words: Adenocarcinoma, pancreas, neuroendocrine differentiation, metaplasia
Full text PDF
Address all correspondence to: Ruliang Xu, MD, PhD, Department of Pathology, New York University School of Medicine, 550 First Avenue,
TH491 , New York, NY 10016. Tel: 212-263-0728; Email: Ruliang.xu@nyumc.org
Case Report
Pancreatic Carcinoma with Multilineage (Acinar, Neuroendocrine, and Ductal)
Differentiation
Kia Newman, Jay Stahl-Herz, Oluyomi Kabiawu, Elliot Newman, Rosemary Wieczorek, Beverly Wang, Zhiheng Pei, Michael Bannan, Peng Lee
and Ruliang Xu
Departments of Pathology and Surgery, New York University School of Medicine, and New York Harbor Healthcare System, New York, NY, USA
Received 06 February 2009; Accepted in revision 28 May 2009; Available online 20 June 2009
Abstract: The preponderance of pancreatic tumors is adenocarcinoma of the ductal type; carcinomas with multiple lineage differentiation are
extremely rare. We report an unusual case of pancreatic carcinoma with combined acinar and neuroendocrine differentiation and minor ductal
component with concurrent acinar-ductal metaplasia (ADM), an early lesion implicated in ductal carcinogenesis. The patient is a 56-year-old
man with vague complaints of dull left upper quadrant pain with radiation across the mid-portion of his abdomen. A computer tomography scan
revealed an irregular enlargement of the distal 3.2 cm of the pancreatic body. A distal pancreatectomy was then performed. Histologic
examination revealed a pancreatic carcinoma with cellular features of eosinophilic granular cytoplasm and salt-pepper nuclei. The acinar
differentiation of the carcinoma was confirmed by positivity on periodic acid-Schiff stain resistant to diastase digestion (dPAS), positivity for
antitrypsin on immunohistochemistry (IHC), and presence of zymogen granules on electron microscopy (EM). The neuroendocrine
differentiation was evident by positive synaptophysin and chromogranin stain on IHC and neuroendocrine granules on EM. The ductal
component was only visible by PAS stain and immunostains for CEA and CK19A and accompanied by a number of the acinar-ductal
metaplasia lesions adjacent to the main tumor. Thus, the histological, histochemical, immunohistochemical and electron-microscopic
evidence all suggested that the pancreatic carcinoma underwent trilineage differentiation. (IJCEP902002).
Key Words: Adenocarcinoma, pancreas, neuroendocrine differentiation, metaplasia
Full text PDF
Address all correspondence to: Ruliang Xu, MD, PhD, Department of Pathology, New York University School of Medicine, 550 First Avenue,
TH491 , New York, NY 10016. Tel: 212-263-0728; Email: Ruliang.xu@nyumc.org
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