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Zhang Z, Liu L, Li Y, Liu Z, Zhang C, Zhao Y, Zhu M, Wan B, Deng H, Xie X, Tian K, Guo Z, Yang H, Liao J, Zhu H, Liu L, Wang M, Ma X, Liu T, Huang N, Gao Y, Zhao J, Liao F, Li F, Wang X, Yuan R, Liu X, Chang L. Therapeutic experience of a pancreatic mixed serous neuroendocrine neoplasm invading peripancreatic vessels: A case report. Medicine (Baltimore) 2022; 101:e30323. [PMID: 36107509 PMCID: PMC9439807 DOI: 10.1097/md.0000000000030323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Pancreatic mixed serous neuroendocrine neoplasm (PMSNN) is an extremely rare disease. Only a few cases on the surgical treatment of PMSNN have been reported in the literature, and it is unclear whether there is invasion of important peripancreatic vessels. PATIENT CONCERNS We report the case of a 39-year-old female patient with PMSNN accompanied by invasion of important peripancreatic vessels. She underwent surgery and achieved satisfactory recovery. DIAGNOSIS Abdominal enhanced CT images showed an enhanced mass with a nonenhanced cyst involving the head and body of the pancreas, which invaded important peripancreatic vessels. The lesion had been misdiagnosed and mistreated as a metastatic carcinoma before admission. INTERVENTIONS CT 3-dimensional (3D) visualization reconstruction images showed intact peripancreatic vessels. Radical pancreatoduodenectomy was successfully performed and confirmed that the main blood vessels around the pancreas were only compressed or even wrapped by the mass, but not penetrated. OUTCOMES The patient recovered well and was discharged on the 19th day after surgery. Pathological examination reported the diagnosis of PMSNN with the collision type combination and the well-differentiated grade 2 pancreatic neuroendocrine tumor. She was followed up for 18 months without any abnormalities. LESSONS This case demonstrates that surgical treatment of PMSNN with invasion of peripancreatic vessels can be successful. Preoperative abdominal CT 3D visualization reconstruction is helpful in determining the degree of invasion of important peripancreatic vessels, and plays a key role in formulating an accurate surgical plan and improving patient outcome.
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Affiliation(s)
- Zongming Zhang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
- *Correspondence: Zongming Zhang, Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China (e-mail: )
| | - Limin Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Youwei Li
- Youwei Li, Department of Radiology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Zhuo Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Chong Zhang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Yue Zhao
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Mingwen Zhu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Baijiang Wan
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Hai Deng
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Xiyuan Xie
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Kun Tian
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Zhentian Guo
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Haiyan Yang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Jiahong Liao
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Hongyan Zhu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Lili Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Man Wang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Xiaoting Ma
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Tiantian Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Niuniu Huang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Yujiao Gao
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Jing Zhao
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Fang Liao
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Fengyuan Li
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Xueting Wang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Ruijiao Yuan
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Xinying Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Lidan Chang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
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Xu YM, Li ZW, Wu HY, Fan XS, Sun Q. Mixed serous-neuroendocrine neoplasm of the pancreas: A case report and review of the literature. World J Clin Cases 2019; 7:4119-4129. [PMID: 31832417 PMCID: PMC6906574 DOI: 10.12998/wjcc.v7.i23.4119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/14/2019] [Accepted: 11/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pancreatic mixed serous-neuroendocrine neoplasms (MSNNs) are mixed tumors containing two components with different pathologies, namely, pancreatic serous cystic neoplasm (PSCN) and pancreatic neuroendocrine tumor (PanNET). For MSNNs, diffuse PSCN involving the whole pancreas is extremely rare, with only eight previous case reports.
CASE SUMMARY A 45-year-old Chinese woman, with a free previous medical history and no obvious symptoms, was found to have a pancreatic neoplasm and admitted to our hospital for further diagnosis in March 2018. Abdominal palpation revealed a painless, mobile mass in the epigastrium, and no abnormalities were observed in an examination of the nervous system and ocular system. A computed tomography scan showed multiple cystic lesions involving the whole pancreas ranging in diameter from 0.4 to 2 cm and also revealed an enhanced mass, 2.2 cm in diameter, in the head of the pancreas. Moreover, multiple cysts were found in the kidneys bilaterally, and the right lobe of the liver contained a small cyst. A Whipple operation with total pancreatectomy and splenectomy was performed. A diagnosis of pancreatic MSNN was established, consisting of diffuse serous microcystic cystadenoma with a concomitant grade 2 PanNET. Of note, the patient had no personal or family history of Von Hippel-Lindau syndrome or other disease.
CONCLUSION We report the first case of MSNN with a diffuse PSCN component involving the entire pancreas in a Chinese woman. It is important to be aware of its relationship with VHL syndrome, and close clinical follow-up is recommended.
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Affiliation(s)
- Yue-Mei Xu
- Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Zhi-Wen Li
- Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Hong-Yan Wu
- Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Xiang-Shan Fan
- Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Qi Sun
- Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
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Rowan D, Pant M, Hagen C, Giorgadze T. Coexisting pancreatic serous cystadenoma and pancreatic ductal adenocarcinoma: A cytological-pathologic correlation with literature review. Ann Diagn Pathol 2019; 42:87-91. [PMID: 31382079 DOI: 10.1016/j.anndiagpath.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/26/2019] [Indexed: 12/12/2022]
Abstract
Pancreatic serous cystadenoma (SCA) is a benign neoplastic lesion with a distinctive gross and microscopic appearance consisting of numerous thin-walled cysts lined by uniform epithelial cells with clear cytoplasm and small nuclei. The vast majority of serous cystadenomas are benign. Pancreatic SCA has rarely been reported in association with other pancreatic lesions. We present a challenging case in which a cystic and solid pancreatic mass was identified on imaging studies. FNA was performed and showed clusters of atypical cells with significant nuclear pleomorphism (>4:1), disorganized, overlapping nuclei, and prominent nucleoli. The FNA diagnosis was positive for malignancy, consistent with adenocarcinoma. The patient underwent neoadjuvant therapy and pancreaticoduodenectomy. Final pathology showed a serous cystadenoma associated with small foci of high-grade PanIN. The lack of invasive adenocarcinoma in the resection specimen was most likely due to complete response of the tumor to neoadjuvant chemoradiation therapy, but it is also possible that only high-grade PanIN was present initially. To our knowledge, this is the first reported case of SCA and high grade PanIN/PDAC that was assessed by FNA. We discuss the cytologic differential diagnosis and how to avoid potential pitfalls highlighted by this case.
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Affiliation(s)
- Daniel Rowan
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mamta Pant
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Catherine Hagen
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tamara Giorgadze
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA.
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A case report of three synchronous tumors in the same pancreatic specimen. Ann Med Surg (Lond) 2019; 44:79-82. [PMID: 31341616 PMCID: PMC6629607 DOI: 10.1016/j.amsu.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/19/2019] [Accepted: 07/03/2019] [Indexed: 12/21/2022] Open
Abstract
It is known that Duodenal adenocarcinoma (DA) is a rare malignant solid tumor that cause occlusion symptoms with orthodox dysphagia when locally advanced. Pancreatic neuroendocrine tumors (PanNETs) account for about 2% of all pancreatic neoplasms. The combination of these two lesions, with the synchronous presence of ectopic pancreatic tissue (EPT) of the duodenum, has never been described in literature, to our knowledge. Here we report a case of combined DA, EPT and PanNET affecting a 71-year-old woman. Simultaneous presence of Duodenal adenocarcinoma pancreatic neuroendocrine tumor ectopic pancreatic tissue of duodenum. Biochemical tests did not reveal abnormalities: CA 19-9 was normal, CEA was 153 U/L. Ultrasonography confirmed a nodule dislocating pancreas investigated with contrast-enhanced CT and esophagogastroduodenoscopy. The association between duodenal adenocarcinomas, PanNET and ectopic pancreatic tissue (EPT) of the duodenum is really rare.
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Madelung AB, Detlefsen S. Synchronous Pancreatic Serous Cystic Neoplasm and Duodenal Neuroendocrine Tumor: Case Report and Review of the Literature. Int J Surg Pathol 2018; 26:551-557. [PMID: 29623746 DOI: 10.1177/1066896918766245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Simultaneous presence of pancreatic serous cystic neoplasms and neuroendocrine neoplasms is rare. We present a case with the incidental finding of a duodenal neuroendocrine tumor (NET) with 2 lymph node metastases in a Whipple resection specimen performed to remove a pancreatic cystic neoplasm that postoperatively turned out to represent a serous cystic neoplasm (SCN). The patient was a 75-year-old female. She presented with loss of appetite and weight. Preoperative contrast-enhanced computed tomography scan of the abdomen showed a multicystic lesion in the head of pancreas. On histologic examination of the resection specimen, a pancreatic SCN was found, and in addition in 2 peripancreatic lymph nodes, metastases from a NET. Further examination of the resected specimen revealed a duodenal NET. Review of the literature revealed only one prior study with 4 cases of pancreatic SCN associated with a duodenal NET. In 1 of the 4 cases, the patient had von Hippel-Lindau disease. Our report emphasizes the importance of careful examination of pancreatic resection specimens including the peripancreatic lymph nodes also when dealing with SCNs, as coexisting and more malignant tumors may otherwise be missed.
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Affiliation(s)
| | - Sönke Detlefsen
- 1 Department of Pathology, Odense University Hospital, Odense, Denmark
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6
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Kim SW, Song IH, An S, Kim SY, Kim HJ, Song KB, Hwang DW, Lee SS, Byun JH, Seo DW, Kim SC, Yu E, Hong SM. Pancreatic serous cystic neoplasms accompanying other pancreatic tumors. Hum Pathol 2016; 60:104-113. [PMID: 27816717 DOI: 10.1016/j.humpath.2016.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/22/2016] [Accepted: 10/14/2016] [Indexed: 02/07/2023]
Abstract
Serous cystic neoplasms (SCNs) are benign cystic neoplasms that predominantly occur in the tail of the pancreas in elderly women. It is well known that patients with von Hippel-Lindau syndrome can develop SCNs and neuroendocrine tumors in the pancreas. However, our understanding on SCNs accompanying other pancreatic tumors (SCNAOPTs) is limited. We compared the clinicopathological features of 15 surgically resected SCNAOPTs with 259 conventional SCNs. The prevalence of SCNAOPT was 5%. The SCNAOPTs were significantly smaller than conventional solitary SCNs, and they were more commonly observed in the head of the pancreas, whereas conventional solitary SCNs were more frequently noted in the body and tail. However, no differences were found in terms of sex, patient age, or the gross patterns of the SCNs. Accompanying neoplasms included 7 intraductal papillary mucinous neoplasms, 1 colloid carcinoma arising from intraductal papillary mucinous neoplasm, 6 neuroendocrine tumors, and 1 solid pseudopapillary neoplasm. Four neuroendocrine tumors associated with von Hippel-Lindau syndrome occurred as multiples, whereas 2 neuroendocrine tumors without von Hippel-Lindau syndrome were solitary. In summary, SCNAOPTs comprise 5% of all SCNs and tend to be smaller and located in the head of the pancreas. Common accompanying tumors include intraductal papillary mucinous neoplasms, neuroendocrine tumors, and other neoplasms such as colloid carcinoma and solid pseudopapillary neoplasm.
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Affiliation(s)
- So-Woon Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - In Hye Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Soyeon An
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Hyoung Jung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Ki-Byung Song
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Dae Wook Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Sang Soo Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jae Ho Byun
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Dong-Wan Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Song Cheol Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Eunsil Yu
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea.
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Li Y, Dai M, Chang X, Hu W, Chen J, Guo J, Wu W, Zhang T, Liao Q, Liu Z, Hu Y, Zhao Y. Mixed serous neuroendocrine neoplasm of the pancreas: Case report and literature review. Medicine (Baltimore) 2016; 95:e4205. [PMID: 27559942 PMCID: PMC5400308 DOI: 10.1097/md.0000000000004205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION The aim of this study was to report a new case of mixed serous neuroendocrine neoplasm (MSNN) and review the literature concerning this type of lesion, which was added to the World Health Organization classification of pancreatic tumors in 2010. RESULTS A 73-year-old woman presented with a pancreatic mass. The lesion was an intriguing combination of serous cystic neoplasm (SCN) and pancreatic neuroendocrine tumor (PanNET), in which the PanNET component grew into the wall of the serous oligocystic adenoma. We searched different databases for studies that had investigated MSNN. A total of 15 patients (age, 28-78), including the patient in the present study, were evaluated. We discuss these cases in detail especially regarding morphology and pathology; our case was the only one involving a collision type combination. CONCLUSION Although MSNN is recognized as a variant of SCN, it is quite different from SCN or PanNET. A new morphological analysis of MSNN may help in elucidating its histogenesis and prognosis.
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Affiliation(s)
| | - Menghua Dai
- Department of General Surgery
- Correspondence: Menghua Dai, Department of General Surgery, Peking Union Medical College Hospital, 100730 Beijing, P.R. China (e-mail: ); Yupei Zhao, Department of General Surgery, Peking Union Medical College Hospital, 100730 Beijing, P.R. China (e-mail: )
| | - Xiaoyan Chang
- Department of Pathology, Peking Union Medical College Hospital, Beijing
| | - Wendi Hu
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, P.R. China
| | - Jie Chen
- Department of Pathology, Peking Union Medical College Hospital, Beijing
| | | | | | | | | | | | - Ya Hu
- Department of General Surgery
| | - Yupei Zhao
- Department of General Surgery
- Correspondence: Menghua Dai, Department of General Surgery, Peking Union Medical College Hospital, 100730 Beijing, P.R. China (e-mail: ); Yupei Zhao, Department of General Surgery, Peking Union Medical College Hospital, 100730 Beijing, P.R. China (e-mail: )
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8
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De Marchi G, Paiella S, Luchini C, Amodio A, Rusev B, Bassi C, Manfredi R, Frulloni L. A rare case of three different tumors in the same pancreatic specimen: a case report and brief review of the literature. J Gastrointest Oncol 2016; 7:E52-7. [PMID: 27284489 DOI: 10.21037/jgo.2016.01.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Solid pseudopapillary tumors (SPT) of the pancreas are rare neoplasms mainly affecting young women. Pancreatic serous cystadenomas (SCAs) and pancreatic neuroendocrine tumors (PanNETs) account for about 2% of all pancreatic neoplasms. The combination of these three lesions, to our knowledge, has never been described in literature. Here we report a case of combined SPT, SCA and PanNET affecting a 33-year-old woman.
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Affiliation(s)
- Giulia De Marchi
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Salvatore Paiella
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Claudio Luchini
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Antonio Amodio
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Borislav Rusev
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Claudio Bassi
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Riccardo Manfredi
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Frulloni
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
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9
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Kakkar A, Sharma MC, Yadav R, Panwar R, Mathur SR, Iyer VK, Sahni P. Pancreatic mixed serous neuroendocrine neoplasm with clear cells leading to diagnosis of von Hippel Lindau disease. Pathol Res Pract 2016; 212:747-50. [PMID: 27161305 DOI: 10.1016/j.prp.2016.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/22/2016] [Accepted: 04/26/2016] [Indexed: 02/08/2023]
Abstract
Mixed serous neuroendocrine neoplasms are extremely rare tumors that are usually seen in female patients and are often associated with von Hippel Lindau (VHL) disease. We describe the case of a 38-year-old male who presented with complaints of anorexia, weight loss, and abdominal pain. CT abdomen showed a mass in the head of the pancreas, multiple small nodules in the body of pancreas, and bilateral adrenal masses. Fine needle aspiration cytology (FNAC) from the mass showed features of a neuroendocrine tumor, with many of the cells demonstrating abundant clear cytoplasm. Histopathological examination of the pancreaticoduodenectomy specimen showed a mixed serous neuroendocrine neoplasm with two components viz. serous cystadenoma and neuroendocrine tumor (NET) World Health Organization (WHO) grade 2. In addition, he was diagnosed to have bilateral pheochromocytomas and a paraganglioma. The synchronicity of these tumors suggested the possibility of VHL disease. Thus, identification of a NET with clear cells or of a mixed serous neuroendocrine neoplasm should raise suspicion of VHL disease. In a mixed tumor, FNAC may identify only one of the two components. Thorough processing of all pancreatic serous tumors for pathological examination is recommended, as NET may occur as a small nodule within the serous cystadenoma.
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Affiliation(s)
- Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Mehar C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Rajni Yadav
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rajesh Panwar
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sandeep R Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Venkateswaran K Iyer
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Peush Sahni
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
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10
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Hsieh MS, Liu KL, Tien YW, Shun CT. Combined pancreatic endocrine tumor and serous cystadenoma. J Formos Med Assoc 2010; 108:739-45. [PMID: 19773214 DOI: 10.1016/s0929-6646(09)60399-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Pancreatic serous cystadenomas account for 1-2% of all exocrine pancreatic tumors, and endocrine tumors account for 1-2% of all pancreatic neoplasms. The combination of pancreatic serous cystadenoma and endocrine tumor is even rarer. Here, we report two cases of combined pancreatic serous adenoma and endocrine tumor. One was a 64-year-old woman with serous cystadenoma and pancreatic endocrine tumor. The other case was a 28-year-old woman with von Hippel-Lindau disease with combined pancreatic serous oligocystic adenoma and well-differentiated malignant endocrine carcinoma. Reviewing the literature, we found 15 similar cases that showed two different age distributions and clinical presentations. Careful examination of benign serous cystadenoma should be kept in mind during clinical practice, to rule out the possibility of combined malignant endocrine tumor. In addition, von Hippel-Lindau disease should also be suspected when a young adult presents with combination of pancreatic serous cystadenoma and endocrine tumor.
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Affiliation(s)
- Min-Shu Hsieh
- Department of Pathology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
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11
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Cystic pancreatic endocrine neoplasms: a distinct tumor type? J Am Coll Surg 2008; 206:1154-8. [PMID: 18501813 DOI: 10.1016/j.jamcollsurg.2007.12.040] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Revised: 10/31/2007] [Accepted: 12/03/2007] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cystic pancreatic endocrine neoplasms (CPENs) are considered rare, and their behavior is thought to be similar to that of solid pancreatic endocrine neoplasms (PENs). This study aims to describe the characteristics of CPENs in a large patient cohort. STUDY DESIGN We performed a retrospective review of 170 patients who underwent resections for PENs at Massachusetts General Hospital from 1977 to 2006. Twenty-nine patients (51% men, mean age 53) with CPENs were compared with 141 patients with solid PENs. Differences in clinical presentation, pathologic and radiographic features, and survival were described. RESULTS CPENs comprised 17% of all PENs (29 of 170) and 5.4% of all resected cystic pancreatic neoplasms(29 of 535). Ten (34%) were purely cystic and 19 (66%) were partially cystic. Compared with solid PENs, CPENs were larger (49 mm versus 23.5 mm, p < 0.05), more likely symptomatic (73% versus 45%, p < 0.05), and more likely nonfunctional (80% versus 50%, p < 0.05). They expressed synaptophysin (100%), chromogranin (82%), and cytokeratin (CK)-19 (24%). Multiple endocrine neoplasia type 1 (MEN-1) was 3.5 times more common in CPENs than in solid tumors (21% versus 6%, p < 0.05). No significant difference was found in location, propensity for metastasis, invasion, or 5-year survival (87% versus 77%, p=0.38). CONCLUSIONS This series, the largest report of CPENs in the literature, shows that CPENs are more common than previously thought, so they should be included in the differential of the cystic lesions of the pancreas. CPENs are larger and more likely to be symptomatic then solid PENs. They are also more likely to be associated with MEN-1 and to be nonfunctional, suggesting they may be a distinct tumor type.
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12
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Colonna J, Plaza JA, Frankel WL, Yearsley M, Bloomston M, Marsh WL. Serous cystadenoma of the pancreas: clinical and pathological features in 33 patients. Pancreatology 2008; 8:135-41. [PMID: 18382099 DOI: 10.1159/000123606] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 09/24/2007] [Indexed: 12/11/2022]
Abstract
AIM To report the clinicopathological features of patients with serous cystadenomas of the pancreas. METHODS Thirty-three cases of serous cystadenoma diagnosed between 1977 and 2006 were retrieved from the files of the Ohio State University Medical Center. Clinical data and microscopic slides were reviewed. RESULTS The patients included 27 women and 6 men with an age range of 38-83 (mean 64.3) years. The clinical presentation included 13 patients with abdominal pain and 8 patients with abdominal mass; 9 tumors were found incidentally. Abdominal CT scans in 25 patients were interpreted as suspicious for carcinoma in 8 (32%), suspicious for serous cystadenoma in 8, neoplasm not otherwise specified in 8, and suspicious for a pseudocyst in 1. Only 7 patients underwent a preoperative biopsy, and 5 of these were diagnosed as having a serous cystadenoma. All but 2 of the patients underwent surgical resection of the tumor. The serous cystadenomas varied in size from 1.0 to up to 13 cm in maximum dimension, and all but one had a multicystic appearance. Of the 33 serous cystadenomas, 20 (61%) were located in the pancreatic tail, 4 (12%) in the pancreatic body, 4 in the pancreatic body and tail, and 5 (15%) in the head of the pancreas. Follow-up in 17 patients (median 3 years, range from 1 month to 11 years) showed no recurrence of serous cystadenomas. One patient had von Hippel-Lindau syndrome, 4 patients had diabetes mellitus, 3 patients had metastatic cancer, and 2 patients had ovarian tumors. CONCLUSIONS Serous cystadenoma is an uncommon neoplasm that can be confused with malignancy both clinically and radiologically; a correct diagnosis is important in order to provide an accurate prognosis.
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Affiliation(s)
- Jorge Colonna
- Department of Pathology, Ohio State University Medical Center, Columbus, Ohio 43210, USA
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13
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Abstract
The increasing use of radiological imaging has led to greater detection of small and asymptomatic cystic lesions of the pancreas. Most are resectable, but not all are neoplastic. This review provides an update on the histopathology, immunohistochemistry, molecular biology, pathogenesis and management of cystic neoplasms of the exocrine pancreas. These include the serous, the mucinous cystic, the intraductal papillary mucinous and the solid pseudopapillary neoplasms. Recently reported variants are described and very rare cystic variants of other pancreatic epithelial and mesenchymal neoplasms are briefly mentioned.
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MESH Headings
- Biomarkers, Tumor/analysis
- Carcinoma, Pancreatic Ductal/chemistry
- Carcinoma, Pancreatic Ductal/pathology
- Carcinoma, Pancreatic Ductal/therapy
- Cystadenocarcinoma/chemistry
- Cystadenocarcinoma/pathology
- Cystadenocarcinoma/therapy
- Cystadenocarcinoma, Mucinous/chemistry
- Cystadenocarcinoma, Mucinous/pathology
- Cystadenocarcinoma, Mucinous/therapy
- Cystadenocarcinoma, Papillary/chemistry
- Cystadenocarcinoma, Papillary/pathology
- Cystadenocarcinoma, Papillary/therapy
- Cystadenocarcinoma, Serous/chemistry
- Cystadenocarcinoma, Serous/pathology
- Cystadenocarcinoma, Serous/therapy
- Humans
- Immunohistochemistry
- Pancreas, Exocrine/chemistry
- Pancreas, Exocrine/pathology
- Pancreatic Ducts/chemistry
- Pancreatic Ducts/pathology
- Pancreatic Neoplasms/chemistry
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/therapy
- Precancerous Conditions/chemistry
- Precancerous Conditions/pathology
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Affiliation(s)
- F Campbell
- Department of Pathology, Royal Liverpool University Hospital, Liverpool, UK.
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14
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Alzaraa A, Udom V, Mousa H, Alzein A, Benhamida A, Dalal N. Combined endocrine and exocrine tumours of the pancreas. World J Surg Oncol 2007; 5:103. [PMID: 17868437 PMCID: PMC2034388 DOI: 10.1186/1477-7819-5-103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Accepted: 09/14/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cystic neoplasms of the pancreas comprise 10%-15% of pancreatic cystic lesions, with the serous cystadenoms being the commonest. The association of exocrine and endocrine tumours of the pancreas unrelated to Von Hipple Lindau disease is very rare. Very few cases have been reported in the literature. We present another case of both these tumours in one patient. CASE PRESENTATION A female patient was seen in the surgical clinic for a pain in the right groin. Clinical examination and investigations confirmed a diagnosis of combined endocrine and exocrine tumours of the pancreas. She underwent surgery and is under regular follow-up in the surgical clinic. CONCLUSION Biphasic differentiation of pancreatic stem cell during embryological development could happen and may result in combined endocrine and exocrine tumours of the pancreas. Imaging studies are excellent in diagnosing theses lesions. Surgery has a central role and could be curative.
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Affiliation(s)
- Ahmed Alzaraa
- Department of General Surgery, Tameside General Hospital, Manchester, UK
| | - Valeri Udom
- Department of Radiology, Tameside General Hospital, Manchester, UK
| | - Husam Mousa
- Department of General Surgery, Tameside General Hospital, Manchester, UK
| | - Abdulhalem Alzein
- Department of General Surgery, Tameside General Hospital, Manchester, UK
| | | | - Neha Dalal
- Department of Histopathology, Tameside General Hospital, Manchester, UK
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15
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Abstract
Although cystic tumors of the pancreas are relatively rare, they constitute an increasingly important category. Advances in imaging and interventional techniques and the sharp drop in the mortality rate of pancreatic surgery have rendered pancreatic biopsies and resections commonplace specimens. Consequently, in the past two decades, the nature of many cystic tumors in this organ has been better characterized. The names of some existing entities were revised; for example, what was known as papillary-cystic tumor is now regarded as solid-pseudopapillary tumor. New entities, in particular, intraductal papillary mucinous neoplasm and its variants, such as oncocytic and intestinal subtypes were recognized. The importance of clinical and pathologic correlation in the evaluation of these lesions was appreciated, in particular, with regards to the multifocality of these lesions, their association with invasive carcinomas, and thus their 'preinvasive' nature. Consensus criteria for the distinction of these from the ordinary precursors of adenocarcinoma, the pancreatic intraepithelial neoplasia, were established. The definition of mucinous cystic neoplasms was refined; ovarian-like stroma has now become almost a requirement for the diagnosis of mucinous cystic neoplasia, and defined as such, the propensity of these tumors to occur in perimenopausal women became even more striking. The validity and clinical value of classifying the pancreatic cysts of mucinous type as adenoma, borderline, CIS and invasive have been established. Related to this, the importance of thorough sampling in accurate classification of these mucinous lesions was recognized. Greater accessibility of the pancreas afforded by improved invasive as well as noninvasive modalities has also increased the detection of otherwise clinically silent cystic tumors, which has led to the recognition of more innocuous entities such as acinar cell cystadenoma and squamoid cyst of pancreatic ducts. As the significance of the cystic lesions emerged, cystic forms of otherwise typically solid tumors were also better characterized. Thus, significant developments have taken place in the classification and our understanding of pancreatic cystic tumors in the past few years, and experience with these lesions is likely to grow exponentially in the coming years.
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Affiliation(s)
- N Volkan Adsay
- Department of Pathology, Harper Hospital and Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA.
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16
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Pautrat K, Chevalier Y, Barbey C, De Calan L. [A case of compressing serous cystadenoma with renal carcinoma]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2006; 30:1090-2. [PMID: 17075457 DOI: 10.1016/s0399-8320(06)73482-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Pancreas cystadenoma tumors represent 10 to 15% of all cystic lesions of the pancreas. These tumors are asymptomatic in around 30% of patients, serous adenoma being the most common. Malignancy should be suspected when cystadenoma is compressive. We report the case of a 72-year-old man with a compressive serous cystadenoma associated to renal carcinoma.
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Affiliation(s)
- Karine Pautrat
- Service de Chirurgie Digestive et Endocrinienne, CHU Trousseau, 37044 Tours Cedex 1.
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17
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Blandamura S, Parenti A, Famengo B, Canesso A, Moschino P, Pasquali C, Pizzi S, Guzzardo V, Ninfo V. Three cases of pancreatic serous cystadenoma and endocrine tumour. J Clin Pathol 2006; 60:278-82. [PMID: 16644876 PMCID: PMC1860571 DOI: 10.1136/jcp.2006.036954] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIMS To report three cases of serous cystadenoma and endocrine tumour in the same pancreas, to review the literature and to evaluate the clinicopathological features of the tumours. CASES Three women (71, 57 and 31 years old) were admitted to hospital, two for diseases unrelated to the pancreas and the third for increasing obstructive jaundice in von Hippel-Lindau disease. Preoperative examination showed two distinct lesions in the first patient and only cystic lesions in the other two. RESULTS Histological examination of the pancreas showed one serous oligocystic adenoma associated with a benign, well-differentiated endocrine tumour, one serous oligocystic adenoma associated with an endocrine microadenoma, and a von Hippel-Lindau-related cystic neoplasm with a well-differentiated endocrine carcinoma. CONCLUSIONS Serous cystadenoma associated with endocrine tumour shows some clinicopathological differences with respect to the two tumours considered separately, and with respect to von Hippel-Lindau-related cases, although there is no convincing evidence at present to justify considering this association as a separate entity.
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Affiliation(s)
- Stella Blandamura
- Department of Oncological and Surgical Sciences, Section of Pathological Anatomy, University of Padova, Padova, Italy.
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18
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Tampi C, Mullerpatan P, Shah R, Jagannath P, Zimmermann A. Microcystic serous cystadenoma of the pancreas: a report of two cases with one of diffuse presentation. Pancreatology 2006; 6:248-53. [PMID: 16543776 DOI: 10.1159/000092028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Microcystic adenoma or serous cystadenoma is an uncommon tumor and accounts for 1-2% of the exocrine neoplasms of the pancreas. Usually unifocal, they present as single, large, well-demarcated multiloculated cystic tumors, ranging in size from 1 to 25 cm. Multifocal variants or diffuse serous cystadenomas are extremely rare. We present 2 cases of which 1 is a diffuse variant affecting the body, tail and part of the neck of the pancreas. In both the patients the tumors were detected incidentally. We highlight on the diffuse variant in view of its rarity and present a review of literature. In this case the entire body and tail of the pancreas was spongy replaced by multicystic lobules and hyalinized fibrocollagenous stroma. The cysts were lined by low cuboidal glycogen containing bland cells. Such a unique presentation wherein the entire body and tail of the pancreas is replaced with multiple cysts is a diffuse presentation of microcystic adenoma and a search through literature revealed only 7 such cases among the 15 cases with multifocal presentation reported.
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Affiliation(s)
- Chandralekha Tampi
- Department of Pathology, Lilavati Hospital and Research Centre, Mumbai, India
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19
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Goh BKP, Tan YM, Kumarasinghe MP, Ooi LLPJ. Synchronous serous cystadenoma and pancreatic endocrine tumor: a case report and literature review. Dig Dis Sci 2006; 51:422-6. [PMID: 16534691 DOI: 10.1007/s10620-006-3147-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2005] [Accepted: 02/03/2005] [Indexed: 01/12/2023]
Affiliation(s)
- Brian K P Goh
- Department of Surgery, Singapore General Hospital, Outram Road, Singapore
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20
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Alasio TM, Vine A, Sanchez MA, Dardik H. Pancreatic endocrine tumor coexistent with serous microcystic adenoma: report of a case and review of the literature. Ann Diagn Pathol 2005; 9:234-8. [PMID: 16084460 DOI: 10.1016/j.anndiagpath.2005.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Serous cystadenomas of the pancreas have been classified as benign exocrine tumors. There have been rare cases of malignant behavior, and in exceptional cases, coexisting neoplasms have been reported. We report a case of a coexistent neuroendocrine tumor identified within a serous cystadenoma in a 78-year-old woman, which was discovered incidentally after complete resection of the tumor. Given the unpredictable metastatic potential of neuroendocrine tumors of the pancreas, we advocate complete resection of all pancreatic cystic tumors, combined with careful sampling of the pathological specimen to rule out a coexistent potentially malignant neoplasm.
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Affiliation(s)
- Teresa M Alasio
- Department of Pathology, Englewood Hospital and Medical Center, Englewood, NJ 07065, USA.
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21
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Slukvin II, Hafez GR, Niederhuber JE, Warner TF. Combined serous microcystic adenoma and well-differentiated endocrine pancreatic neoplasm: a case report and review of the literature. Arch Pathol Lab Med 2003; 127:1369-72. [PMID: 14521452 DOI: 10.5858/2003-127-1369-csmaaw] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report a case of combined microcystic adenoma and pancreatic endocrine neoplasm of the pancreas in a 53-year-old male patient. The pancreatic tumor was an incidental computed tomography scan finding and was not accompanied by gastrointestinal symptoms. The tumor was located in the head of the pancreas and was composed of numerous small cysts lined by uniform clear cells with a centrally located solid endocrine component. Four cases of similar neoplasm have recently been reported, exclusively in women. Literature review and case analysis indicate that combined microcystic adenoma and pancreatic endocrine neoplasm is characterized by the presence of pancreatic endocrine neoplasm within microcystic adenoma in the head of the pancreas, affects women more often than men, and presents at a younger age when compared to microcystic adenoma.
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Affiliation(s)
- Igor I Slukvin
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison 53792, USA
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22
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Abstract
The cystic tumors of the pancreas constitute a considerable diagnostic challenge because of their overlapping clinical, radiologic, and pathologic features. They may be difficult to differentiate from one another and from benign lesions such as pseudocysts. Because many of the tumors in this group are potentially curable, correct diagnosis is essential for proper patient management. Even when correctly diagnosed, thorough microscopic evaluation is required for the mucin-producing tumors to correctly determine their degree of malignant progression in any given case. Most recently, molecular analysis of these tumors has demonstrated definitively that the serous and mucinous types of cystic neoplasms of the pancreas are unrelated pathogenetically. Conversely, molecular data indicate similarities between the mucinous types of cystic tumors and ductal adenocarcinoma of the pancreas, but the essential molecular differences that underlie the differences in biological behavior are as yet undetermined.
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MESH Headings
- Cyst Fluid/cytology
- Cystadenoma, Mucinous/classification
- Cystadenoma, Mucinous/epidemiology
- Cystadenoma, Mucinous/pathology
- Cystadenoma, Serous/classification
- Cystadenoma, Serous/epidemiology
- Cystadenoma, Serous/pathology
- DNA, Neoplasm/genetics
- Diagnosis, Differential
- Histological Techniques/methods
- Humans
- Immunohistochemistry/methods
- Incidence
- Molecular Diagnostic Techniques/methods
- Mutation/genetics
- Pancreatic Cyst/classification
- Pancreatic Cyst/epidemiology
- Pancreatic Cyst/pathology
- Pancreatic Neoplasms/classification
- Pancreatic Neoplasms/epidemiology
- Pancreatic Neoplasms/pathology
- Papilloma, Intraductal/classification
- Papilloma, Intraductal/epidemiology
- Papilloma, Intraductal/pathology
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Affiliation(s)
- Carolyn C Compton
- Department of Pathology, McGill University, Office of the Chairman, 3775 University Street, Montreal, Quebec H3A 2B4, Canada.
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23
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Jung HK, Son HY, Lee HC, Yi SY. Microcytic adenoma coexistent with low-grade malignant islet cell tumor of the pancreas. J Clin Gastroenterol 2001; 32:441-3. [PMID: 11319320 DOI: 10.1097/00004836-200105000-00018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We report a case of microcystic (glycogen-rich) adenoma of the whole pancreas with coexistent pancreatic low-grade malignant islet cell tumor in a 29-year-old woman. She complained of nausea, vomiting, and growing abdominal mass. Abdominal computed tomography showed multiple cysts in the whole pancreas and a calcified solid mass in the pancreatic head. A Whipple's operation and total pancreatectomy with splenectomy was performed to treat pancreatic cystic neoplasm. The pancreas was entirely replaced by variable-sized, multilocular cysts, which were lined by a flattened-to-cuboidal glycogen-rich epithelium. Furthermore, in the head of the pancreas, a focal yellowish solid mass showed a positive reaction for chromogranin A and neuron-specific enolase. Careful examination of the pancreas is warranted in cases of microcystic adenoma to rule out a possible coexistent pancreatic malignancy.
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Affiliation(s)
- H K Jung
- Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
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24
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Hoang MP, Hruban RH, Albores-Saavedra J. Clear cell endocrine pancreatic tumor mimicking renal cell carcinoma: a distinctive neoplasm of von Hippel-Lindau disease. Am J Surg Pathol 2001; 25:602-9. [PMID: 11342771 DOI: 10.1097/00000478-200105000-00006] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The dominantly inherited von Hippel-Lindau disease is characterized by clear cell neoplasms in various organs including the kidney and pancreas. Determination of primary versus metastatic lesion in this setting can be a diagnostic dilemma. The authors present five cases of clear cell endocrine pancreatic tumor (EPT) closely mimicking renal cell carcinomas in five patients with a family history or histologic evidence of von Hippel-Lindau disease. In fact, two of these tumors were confused with metastatic renal cell carcinoma by fine-needle aspiration. All five tumors had a component of clear cells arranged in nests, cords, and tubules with central hemorrhage separated by thin-wall vessels resembling renal cell carcinoma. However, these tumors also exhibited cords and festoons and a gyriform pattern suggestive of an endocrine neoplasm, and expressed chromogranin and synaptophysin. Vascular invasion was identified in four tumors, one of which metastasized. The concurrent primary renal cell carcinomas and the multicentric microcystic adenomas found in three patients did not show reactivity for the neuroendocrine markers. Focal clear cell change was noted in only one of 29 endocrine pancreatic tumors arising in patients without von Hippel-Lindau disease. Eleven metastatic renal cell carcinomas in the pancreas did not show immunoreactivity with the endocrine markers. Clear cell EPTs closely mimicking renal cell carcinoma are distinctive neoplasms of von Hippel-Lindau disease. In contrast to clear cell EPT, metastatic renal cell carcinoma does not express neuroendocrine markers and lacks neurosecretory granules by electron microscopy. Von Hippel-Lindau disease should be strongly suspected in patients with renal cell carcinoma, clear cell EPT, and multifocal microcystic serous adenomas.
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MESH Headings
- Adenocarcinoma, Clear Cell/chemistry
- Adenocarcinoma, Clear Cell/diagnosis
- Adenocarcinoma, Clear Cell/etiology
- Adult
- Biomarkers, Tumor/analysis
- Carcinoma, Islet Cell/chemistry
- Carcinoma, Islet Cell/diagnosis
- Carcinoma, Islet Cell/etiology
- Carcinoma, Renal Cell/diagnosis
- Carcinoma, Renal Cell/secondary
- Cystadenoma, Serous/chemistry
- Cystadenoma, Serous/diagnosis
- Cystadenoma, Serous/etiology
- Cytoplasm/ultrastructure
- Diagnosis, Differential
- Female
- Humans
- Immunoenzyme Techniques
- Kidney Neoplasms/diagnosis
- Kidney Neoplasms/secondary
- Middle Aged
- Neoplasm Proteins/analysis
- Neoplasms, Multiple Primary/chemistry
- Neoplasms, Multiple Primary/pathology
- Pancreatic Neoplasms/chemistry
- Pancreatic Neoplasms/diagnosis
- Pancreatic Neoplasms/etiology
- Retrospective Studies
- von Hippel-Lindau Disease/complications
- von Hippel-Lindau Disease/metabolism
- von Hippel-Lindau Disease/pathology
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Affiliation(s)
- M P Hoang
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas 75390-9073, USA
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25
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Ustün MO, Tuğyan N, Tunakan M. Coexistence of an endocrine tumour in a serous cystadenoma (microcystic adenoma) of the pancreas, an unusual association. J Clin Pathol 2000; 53:800-2. [PMID: 11064680 PMCID: PMC1731099 DOI: 10.1136/jcp.53.10.800] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
A pancreatic endocrine tumour arising within a serous cystadenoma is reported. A 49 year old woman was admitted with a history of epigastric pain, nausea, vomiting, and weight loss of two months duration. She had been diabetic for 12 years. An epigastric mass was palpated in the physical examination, and computed tomography revealed a multiloculated cystic lesion in the pancreas. Pathological examination of the pancreatic tumour revealed the coexistence of a serous cystadenoma and an endocrine tumour. The endocrine tumour, which was located inside the serous cystadenoma, was 1 cm in diameter. The first case of a serous cystadenoma of the pancreas containing a pancreatic endocrine tumour was reported in the literature recently. This paper reports another incidentally found pancreatic endocrine tumour arising within a serous cystadenoma.
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Affiliation(s)
- M O Ustün
- Department of Pathology, Atatürk Teaching Hospital, Izmir, Turkey.
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26
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Tanno S, Obara T, Sohma M, Tanaka T, Izawa T, Fujii T, Nishino N, Ura H, Kohgo Y. Multifocal serous cystadenoma of the pancreas. A case report and review of the literature. INTERNATIONAL JOURNAL OF PANCREATOLOGY : OFFICIAL JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PANCREATOLOGY 1998; 24:129-32. [PMID: 9816547 DOI: 10.1007/bf02788571] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Serous cystadenoma of the pancreas is usually unifocal; multifocal tumors are rare. We report a case of multifocal serous cystadenoma of the pancreas in a 48-yr-old female complaining of general malaise. Serum tumor markers, such as CA 19-9, DUPAN-2, and Span-1, were elevated. Abdominal ultrasound (US) and computed tomography (CT) scans revealed two distinct cystic masses in the head and body of the pancreas, respectively. The patient underwent total pancreatectomy. The resected pancreas contained two discrete cystic masses in the head and body; no solid components were observed. Microscopically, the inner surfaces of the cysts were evenly lined by a single layer of low cuboidal or significantly attenuated epithelial cells containing clear cytoplasm and abundant glycogen without other morphological alterations. The histogenesis of serous cystadenoma is not clear; multicentric tumors may be helpful in understanding histogenesis.
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Affiliation(s)
- S Tanno
- Third Department of Internal Medicine, Asahikawa Medical College, Japan
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