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Karamitopoulou-Diamantis E. [Exocrine meets neuroendocrine: mimickers of pancreatic neuroendocrine neoplasms]. PATHOLOGIE (HEIDELBERG, GERMANY) 2024; 45:42-49. [PMID: 38091082 DOI: 10.1007/s00292-023-01286-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 01/31/2024]
Abstract
Neuroendocrine neoplasms (NENs) originate from various epithelial or neuroectodermal tissues, can occur in any organ, including the pancreas, and are characterized by the expression of the neuroendocrine markers synaptophysin and chromogranin A. Pancreatic neuroendocrine tumors (PanNETs) are well-differentiated epithelial neoplasms with morphological and immunohistochemical features of neuroendocrine differentiation of low, intermediate, or high grade. Pancreatic neuroendocrine carcinomas (PanNECs) are clinically aggressive, high-grade (poorly differentiated) carcinomas with morphologic features suggesting neuroendocrine differentiation, a high proliferative rate (> 20 mitoses per 2 mm2 and Ki67 index > 20%), and immunohistochemical labeling for neuroendocrine markers. They include the small cell neuroendocrine carcinoma and the large cell neuroendocrine carcinoma categories.Neuroendocrine-like morphology coupled with immunohistochemical markers of neuroendocrine differentiation are highly specific. However, neuroendocrine markers may also be expressed in non-neuroendocrine neoplasms, which can therefore be confused with NENs. Mimickers of pancreatic NENs comprise a number of important pitfall tumors, including epithelial and non-epithelial neoplasms, such as acinar cell carcinomas, solid pseudopapillary neoplasms (SPNs), or even non-neoplastic lesions. All of these lesions have the expression of neuroendocrine markers in common, such as synaptophysin and chromogranin A, and although they are comparatively rare, they can cause considerable diagnostic problems. This review article deals with some of the most important mimickers of pancreatic neuroendocrine neoplasms and even non-neoplastic lesions, such as islet aggregation. The similarities and differences between these entities and pancreatic neuroendocrine neoplasms are highlighted, and key findings that facilitate the correct diagnosis are discussed.
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Affiliation(s)
- Eva Karamitopoulou-Diamantis
- Institut für Gewebemedizin und Pathologie, Universität Bern, Bern, Schweiz.
- PATHOLOGIE INSTITUT ENGE, Hardturmstr. 133, 8005, Zürich, Schweiz.
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2
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Chatterjee T, Reddy Y, Badshah M, Puli S. An Unusual Case of Dual Pancreatic Tumors. ACG Case Rep J 2023; 10:e01190. [PMID: 37860811 PMCID: PMC10584299 DOI: 10.14309/crj.0000000000001190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
We report a simultaneous occurrence of pancreatic adenocarcinoma and pancreatic neuroendocrine tumor. A 64-year-old woman presented with abdominal pain and weight loss. Abdominal computed tomography revealed a pancreatic head mass with a mesenteric artery encasement. Endoscopic ultrasound revealed a second mass in the tail of the pancreas. Pathology reported adenocarcinoma of the head of the pancreas and a neuroendocrine tumor in the tail of the pancreas. The neuroendocrine tumor was nonfunctional, with no symptoms or signs present on assessment. The patient had advanced unresectable carcinoma, so she was treated with chemotherapy.
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Affiliation(s)
- Tulika Chatterjee
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL
| | - Yeshaswini Reddy
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL
| | - Maaz Badshah
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL
| | - Srinivas Puli
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL
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3
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Hirai R, Omae KI, Yodoya M, Fujie S, Fujii M, Iwata K, Imanishi K, Kurihara E, Yoshida K, Jida M, Kobayashi K, Kanaya Y, Maruyama S. A case report of a collision tumor composed of pancreatic ductal adenocarcinoma and peri-pancreatic mucosa-associated lymphoid tissue lymphoma. World J Surg Oncol 2023; 21:110. [PMID: 36973717 PMCID: PMC10045193 DOI: 10.1186/s12957-023-02981-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/08/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Collision tumors are composed of two distinct tumor components. Collision tumors composed of pancreatic ductal adenocarcinoma and malignant lymphoma occurring in the pancreas have not been previously described in the scientific literature. In this case report, we describe a unique patient with a collision tumor composed of pancreatic ductal adenocarcinoma and peri-pancreatic mucosa-associated lymphoid tissue (MALT) lymphoma occurring in the pancreas. CASE PRESENTATION An 82-year-old woman presented to our hospital complaining of dizziness. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large lymphoid lesion spreading from the peri-pancreatic tissue heading to the hepatic hilar plate, involving the hepatoduodenal ligament and the entire duodenum, also showing a hard tumor in the pancreas head. We performed echo-guided needle biopsies for each tumor and diagnosed a collision tumor composed of pancreatic ductal adenocarcinoma and low-grade B cell lymphoma. The patient underwent pancreaticoduodenectomy. The resected specimen showed an elastic hard tumor, 90 × 75 mm in size, located in the pancreatic head, and a whitish-yellow hard tumor involving the lower bile duct, 31 mm in size, located in the center of the pancreatic head. Pathological and immunohistochemical examination proved that pancreatic ductal adenocarcinoma and MALT lymphoma originating from the peri-pancreatic head collided in the pancreatic head. CONCLUSIONS To best of our knowledge, this is the first report of a surgically resected collision tumor of pancreatic ductal adenocarcinoma and MALT lymphoma originating from the peri-pancreatic head. A needle biopsy is useful when inconsistent findings are observed on diagnostic CT and MRI of tumor lesions since there is the possibility of a collision tumor.
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Affiliation(s)
- Ryuji Hirai
- Department of Surgery, Himeji St. Mary's Hospital, 650, Nibuno, Himeji, Hyogo, 670-0801, Japan.
| | - Ken-Ichi Omae
- Department of Radiology, Himeji St. Mary's Hospital, 650, Nibuno, Himeji, Hyogo, 670-0801, Japan
| | - Mitsuko Yodoya
- Department of Radiology, Himeji St. Mary's Hospital, 650, Nibuno, Himeji, Hyogo, 670-0801, Japan
| | - Syunji Fujie
- Department of Radiology, Himeji St. Mary's Hospital, 650, Nibuno, Himeji, Hyogo, 670-0801, Japan
| | - Masayoshi Fujii
- Department of Pathology, Himeji St. Mary's Hospital, 650, Nibuno, Himeji, Hyogo, 670-0801, Japan
| | - Kazuma Iwata
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama University, 2-5-1, Shikata-Cho, Kita-Ku, Okayama City, Okayama, 700-8558, Japan
| | - Kentaro Imanishi
- Department of Surgery, Himeji St. Mary's Hospital, 650, Nibuno, Himeji, Hyogo, 670-0801, Japan
| | - Eisuke Kurihara
- Department of Surgery, Himeji St. Mary's Hospital, 650, Nibuno, Himeji, Hyogo, 670-0801, Japan
| | - Kazuhiro Yoshida
- Department of Surgery, Himeji St. Mary's Hospital, 650, Nibuno, Himeji, Hyogo, 670-0801, Japan
| | - Masaru Jida
- Department of Surgery, Himeji St. Mary's Hospital, 650, Nibuno, Himeji, Hyogo, 670-0801, Japan
| | - Kazuyasu Kobayashi
- Department of Surgery, Himeji St. Mary's Hospital, 650, Nibuno, Himeji, Hyogo, 670-0801, Japan
| | - Yoshiaki Kanaya
- Department of Surgery, Himeji St. Mary's Hospital, 650, Nibuno, Himeji, Hyogo, 670-0801, Japan
| | - Syuichiro Maruyama
- Department of Surgery, Himeji St. Mary's Hospital, 650, Nibuno, Himeji, Hyogo, 670-0801, Japan
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Liang Z, Wei Y, Li P, Xu R, Zhou Q, Zhang S. Case report: First case of early adenoid cystic carcinoma and squamous cell carcinoma collision cancer treated by endoscopic submucosal dissection. Front Oncol 2023; 13:1072336. [PMID: 36816912 PMCID: PMC9934923 DOI: 10.3389/fonc.2023.1072336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Background Collision cancer, a rare tumor, rarely occurs in the esophagus. Most reported cases of esophageal collision cancers are advanced cancers that can only be treated with surgery or palliative chemoradiotherapy. Here, we report a rare case of collisional squamous cell carcinoma (SqCC) and adenoid cystic carcinoma (AdCC) that was detected in the early stages by endoscopy. Case summary A 66-year-old man presented with retrosternal pain after swallowing and underwent endoscopy. Pathological biopsy showed high-grade squamous intraepithelial neoplasia. The lesion was removed by endoscopic submucosal dissection (ESD) after magnification and endoscopic ultrasonography. Postoperative pathology proved that the lesion was collision cancer comprising SqCC and AdCC. After six months of postoperative follow-up, there was no recurrence of esophageal cancer. Conclusions We provided a case report related to the diagnosis and treatment of esophageal collision cancer, especially early collision cancer. More research is needed to provide insights into the management of collision cancers.
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Affiliation(s)
- Zheng Liang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing, China
| | - Yongqiu Wei
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing, China
| | - Rui Xu
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qiaozhi Zhou
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing, China
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Vial I, Kausar A. A rare case of concomittant pancreatic adenosquamous and neuroendocrine tumours. J Surg Case Rep 2022; 2022:rjac377. [PMID: 35991843 PMCID: PMC9386458 DOI: 10.1093/jscr/rjac377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/27/2022] [Indexed: 11/25/2022] Open
Abstract
Only two cases of concomitantly occurring adenosquamous and neuroendocrine tumours (NET) have been reported in the literature. We report a case where both NET and adenosquamous are simultaneously occurring. A 42-year-old lady was hospitalized following painless jaundice and loss of weight. Computer tomography scan showed 3.0 x 2.9 cm hypo enhancing and hypovascular mass in the uncinate/head process. Another hypervascular mass was seen in the body of the pancreas. Pathological examination showed that the lesion in the uncinate process/neck of pancreas was an adenosquamous in the main pancreatic duct intraductal papillary mucinous neoplasm. The second tumour was a NET measuring 36 mm with no metastatic involvement. These findings suggested concurrently occurring but separated adenocarcinoma and NET tumours. This is the third case in the literature where both NET and adenosquamous are happening concomitantly, and the previous two other cases are also reviewed in the article.
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Affiliation(s)
- Izziddine Vial
- Correspondence address. Department of General Surgery, East Lancashire NHS Trust, Royal Blackburn Hospital, Haslingden Rd, Blackburn BB2 3HH, UK. Tel: +44 7709770702; E-mail:
| | - Ambareen Kausar
- Department of General Surgery, East Lancashire NHS Trust, Royal Blackburn Hospital, Blackburn, UK
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Elpek GO. Mixed neuroendocrine–nonneuroendocrine neoplasms of the gastrointestinal system: An update. World J Gastroenterol 2022; 28:794-810. [PMID: 35317101 PMCID: PMC8900574 DOI: 10.3748/wjg.v28.i8.794] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/15/2021] [Accepted: 01/22/2022] [Indexed: 02/06/2023] Open
Abstract
Mixed neuroendocrine-nonneuroendocrine neoplasms (MiNENs) of the digestive tract are a rare heterogeneous group of tumors that present many challenges in terms of diagnosis and treatment. Over the years, the diagnostic criteria, classification, and clinical behavior of these tumors have been the subjects of ongoing debate, and the various changes in their nomenclature have strengthened the challenges associated with MiNENs. This review is performed to provide an understanding of the key factors involved in the evolution of the designation of these tumors as MiNEN, highlight the current diagnostic criteria, summarize the latest data on pathogenesis and provide information on available treatments. Moreover, this work seeks to increase the awareness about these rare neoplasms by presenting the clinicopathological features and prognostic factors that play important roles in their behavior and discussing their different regions of origin in the gastrointestinal system (GIS). Currently, the MiNEN category also includes tumors in the GIS with a nonneuroendocrine component and epithelial tumors other than adenocarcinoma, depending on the organ of origin. Diagnosis is based on the presence of both morphological components in more than 30% of the tumor. However, this value needs to be reconfirmed with further studies and may be a limiting factor in the diagnosis of MiNEN by biopsy. Furthermore, available clinicopathological data suggest that the inclusion of amphicrine tumors in the definition of MiNEN is not supportive and warrants further investigation. The diagnosis of these tumors is not solely based on immunohistochemical findings. They are not hybrid tumors and both components can act independently; thus, careful grading of each component separately is required. In addition to parameters such as the metastatic state of the tumor at the time of diagnosis and the feasibility of surgical resection, the aggressive potential of both components has paramount importance in the choice of treatment. Regardless of the organ of origin within the GIS, almost MiNENs are tumors with poor prognosis and are frequently encountered in the elderly and men. They are most frequently reported in the colorectum, where data from molecular studies indicate a monoclonal origin; however, further studies are required to provide additional support for this origin.
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Aaquist T, Dembic M, Thomassen M, de Stricker K, Bertelsen M, Christensen LG, Mortensen MB, Detlefsen S. Synchronous detection of pancreatic adenocarcinoma and paraganglioma in a Whipple resection specimen. Pathol Res Pract 2021; 226:153590. [PMID: 34454393 DOI: 10.1016/j.prp.2021.153590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 08/14/2021] [Indexed: 01/17/2023]
Abstract
We report a case of a pancreatic ductal adenocarcinoma (PDAC) presenting synchronously with a paraganglioma (PGL) in a Whipple reaction specimen. The patient was a 72-year-old female with a history of breast and vulvar cancer. The simultaneous occurrence of two synchronous tumours in the pancreas was striking. Due to the presence of PGL and multiple meta- and synchronous tumours, the patient was referred to genetic counselling. Tumour tissue from the vulvar carcinoma, the PDAC and the PGL was analysed by targeted next-generation sequencing (NGS) of 161 cancer-related genes and by whole exome sequencing (WES). Peripheral blood was also examined by NGS and WES. These genetic analyses revealed germline polymorphisms in AXIN2 (NM_004655.4:c 0.2272 G>A; p.Ala758Thr), BRCA2 (NM_000059.3:c.9976 A>T; p.Lys3326Ter), NCOR1 (NM_006311.4:c 0.6544 G>A; p.Ala2182Thr) and SPTA1 (NM_003126.3:c 0.373 G>A; p.Ala125Thr) and somatic mutations of KRAS (NM_033360.3;c 0.35 G>A; p.Gly12Asp) and TP53 (NM_000546.5; c.602delT; p.Leu201CysfsTer46) in the PDAC and of TP53 (NM_000546.5; c 0.733 G>A; p.Gly245Ser) and TERT (NM_198253.2; c.-124 C>T; promotor region) in the vulvar carcinoma. Breast carcinoma tissue was not available for genetic analysis. The results of the genetic analyses did not explain the presence of multiple tumours in this patient, despite a slightly increased risk of breast cancer associated with the identified BRCA2 polymorphism. To our knowledge, this is the first report of the synchronous occurrence of PDAC and PGL. This case emphasizes the importance of thorough macroscopic examination of pancreatic resection specimens, as coexisting neoplasms may otherwise be missed.
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Affiliation(s)
- Trine Aaquist
- Department of Pathology, Odense University Hospital, Odense, Denmark; Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Maja Dembic
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark; Department of Mathematics and Computer Science (IMADA), University of Southern Denmark, Odense, Denmark
| | - Mads Thomassen
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Karin de Stricker
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Mette Bertelsen
- Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
| | | | - Michael Bau Mortensen
- Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Surgery, Odense University Hospital, Odense, Denmark
| | - Sönke Detlefsen
- Department of Pathology, Odense University Hospital, Odense, Denmark; Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
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8
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Zhao X, Zhang G, Li CH. Collision carcinoma of the rectum involving neuroendocrine carcinoma and adenocarcinoma: A case report. World J Clin Cases 2021; 9:4789-4796. [PMID: 34222449 PMCID: PMC8223825 DOI: 10.12998/wjcc.v9.i18.4789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/28/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Collision carcinoma is a rare histological pattern, and includes two or more different types of tumors coexisting in the same organ as one neoplasm. Different to the combined type, the two adjacent tumors of collision carcinoma are histologically distinct. Collision carcinoma may occur from any origin or organ, including the cecum, liver, cervix, thyroid, stomach, kidney, and esophagus. In the rectum, adenocarcinoma is the most common pathological type, the combined type is rare, and collision tumors are even rarer. To date, only a limited number of collision carcinoma cases originating from the rectum have been reported. Due to the scarcity of rectal collision carcinoma, more cases need to be reported to fully understand the clinico-pathological features and biological behavior of the tumor.
CASE SUMMARY Here we report a 40-year-old female who presented with the chief complaints of persistent changes in bowel habits and hematochezia for 10 d. She underwent Miles' operation which revealed a collision carcinoma of the rectum, showing a “side by side” pattern, composed of a high grade neuroendocrine carcinoma, (small cell carcinoma) and moderately differentiated adenocarcinoma, based on its clinico-pathological features and biological behavior. The patient remained disease-free at 12 mo follow-up. We also focused on the related literature and expert opinion.
CONCLUSION Collision carcinoma is a rare tumor with ambiguous biological behavior. Greater attention should be paid to its clinico-pathologic diagnosis. Regular and adequate follow-up is essential to help rule out metastasis and assess the prognosis.
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Affiliation(s)
- Xing Zhao
- Department of Pathology, The Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
| | - Gang Zhang
- Department of General Surgery IV, Baoding First Central Hospital, Baoding 071000, Hebei Province, China
| | - Chun-Hui Li
- Department of Pathology, The Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
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Ryu MJ, Kim JW, Lee SE, Choi JH. Pancreatic Collision Tumor of Desmoid-Type Fibromatosis and Mucinous Cystic Neoplasm: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:1297-1303. [PMID: 36238408 PMCID: PMC9432369 DOI: 10.3348/jksr.2020.0163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/05/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
Pancreatic collision tumors are rare neoplasm, and cases consisting of ductal adenocarcinoma with a neuroendocrine tumor, intraductal papillary mucinous neoplasm with a neuroendocrine tumor, and solid pseudopapillary neoplasm with a neuroendocrine tumor have been reported. We report a case of a rapidly growing pancreatic collision tumor consisting of desmoidtype fibromatosis and mucinous cystic neoplasm in a 30-year-old pregnant female. To the best of our knowledge, this is the first reported case of a pancreatic collision tumor consisting of desmoid-type fibromatosis and mucinous cystic neoplasm.
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Affiliation(s)
- Min Jung Ryu
- Department of Radiology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jae Woon Kim
- Department of Radiology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Seung Eun Lee
- Department of Radiology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Joon Hyuk Choi
- Department of Pathology, College of Medicine, Yeungnam University, Daegu, Korea
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10
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Gao G, Qorbani A, Zhou CH. A pancreatic mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN) (NET and undifferentiated carcinoma of the pancreas with osteoclast-like giant cells) with metastatic neuroendocrine component to the liver. AUTOPSY AND CASE REPORTS 2020; 11:e2020201. [PMID: 34277482 PMCID: PMC8101651 DOI: 10.4322/acr.2020.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 06/20/2020] [Indexed: 11/25/2022] Open
Abstract
Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells (UCOGCs) is an extremely rare morphologically and clinically distinct variant of pancreatic ductal adenocarcinoma (PDAC), exhibiting a characteristic component of reactive osteoclast-like giant cells admixed with neoplastic mononuclear cells. Sommers and Meissner first described it in 1954 as an “unusual carcinoma of the pancreas”. Later it acquired many different names. In 2010, the WHO classified these tumors as a variant of PDAC under the heading of “undifferentiated carcinoma with osteoclast-like giant cells”. Here we describe the first case of pancreatic mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN) composed of UCOGC and pancreatic neuroendocrine tumor (NET), which occurred in a 78-year-old man with biliary colic and pancreatitis. The mass did not respond to the chemotherapy, and he soon developed liver metastasis from the NET component, and unfortunately, the patient passed away 10 months later. Since UCOGC is extremely rare, and its association with NET has not been reported yet, our case expands the knowledge regarding its unusual presentation and poor prognosis.
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Affiliation(s)
- Guofeng Gao
- University of California, Davis Medical Center, Department of Pathology & Laboratory Medicine, Sacramento, CA, USA
| | - Amir Qorbani
- University of California, San Francisco Medical Center, Department of Pathology & Laboratory Medicine, San Francisco, CA, USA
| | - Chihong Heidi Zhou
- University of California, Davis Medical Center, Department of Pathology & Laboratory Medicine, Sacramento, CA, USA
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11
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Ohno A, Fujimori N, Miki M, Oono T, Igarashi H, Matsuda R, Koga Y, Oda Y, Ohtsuka T, Nakamura M, Ito T, Ogawa Y. Collision of a pancreatic ductal adenocarcinoma and a pancreatic neuroendocrine tumor associated with multiple endocrine neoplasm type 1. Clin J Gastroenterol 2020; 14:358-363. [PMID: 32951175 DOI: 10.1007/s12328-020-01234-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
A 54-year-old man with pancreatic head tumor had undergone pancreaticoduodenectomy and was diagnosed with pancreatic neuroendocrine tumor (P-NET) associated with sporadic multiple endocrine neoplasm type 1. Five years after the resection, P-NET recurred and liver metastases were observed. He was treated with a somatostatin analog. Eleven years after the resection, computed tomography revealed a new pancreatic hypodense and hypovascular mass adjacent to the P-NET that was diagnosed as pancreatic adenocarcinoma via endoscopic ultrasound-guided fine-needle aspiration. He underwent a total remnant pancreatectomy. Pathological examination showed that the lesion was constituted by a pancreatic ductal adenocarcinoma (PDAC) and a neuroendocrine tumor. Additionally, the invasive ductal carcinoma collided with the neuroendocrine tumor. Both PDAC and P-NET cells were observed in the collision area. We could observe the onset of PDAC during the treatment of P-NET. Moreover, we are the first to report the case of a collision of pancreatic endocrine and exocrine tumors diagnosed preoperatively.
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Affiliation(s)
- Akihisa Ohno
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka City, Fukuoka, Japan
| | - Nao Fujimori
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka City, Fukuoka, Japan.
| | - Masami Miki
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka City, Fukuoka, Japan
| | - Takamasa Oono
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka City, Fukuoka, Japan
| | - Hisato Igarashi
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka City, Fukuoka, Japan
| | - Ryota Matsuda
- Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yutaka Koga
- Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takao Ohtsuka
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuhide Ito
- Department of Gastroenterology and Hepatology, International University of Health and Welfare Graduate School of Medicine, Fukuoka, Japan.,Neuroendocrine Tumor Centre, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka City, Fukuoka, Japan
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12
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Uccella S, La Rosa S. Looking into digestive mixed neuroendocrine - nonneuroendocrine neoplasms: subtypes, prognosis, and predictive factors. Histopathology 2020; 77:700-717. [PMID: 32538468 DOI: 10.1111/his.14178] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Mixed neuroendocrine - nonneuroendocrine neoplasms (MiNENs) of the digestive system represent a challenge for both pathologists and clinicians. Their nomenclature has changed several times, and their diagnostic criteria, classification and clinical behaviour have been matter of debate over the years. Although several attempts have been made to elucidate the pathogenesis and biology of MiNENs, some issues remain open. This review will provide: a historical background that helps in understanding the evolution of the concept and nomenclature of mixed neoplasms; a revision of the knowledge on this topic, including molecular aspects, to give the reader a comprehensive and practical overview on this challenging field of pathology; a focus on the diagnostic criteria and on the determination of prognostic and predictive factors; and a description of the different tumour types in the different sites of origin.
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Affiliation(s)
- Silvia Uccella
- Pathology Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Stefano La Rosa
- Institute of Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
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Gibson D, Beck S, Gonzàlez‐Gasch E, Harper A. Collision tumour of two nodal metastases (adenocarcinoma and mast cell tumour) in a dog. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2020-001231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Liu Y, Wang C, Hu X, Wang M, Wang Y, Ye M, Liu Y. Concurrent ductal adenocarcinoma, pseudocyst, and neuroendocrine tumor of the pancreas: A case report. Medicine (Baltimore) 2020; 99:e21354. [PMID: 32791739 PMCID: PMC7387013 DOI: 10.1097/md.0000000000021354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Pancreatic pseudocyst is one of the most common cystic lesions. It always occurs following pancreatitis and is rarely found in combination with pancreatic adenocarcinoma. The coexistence of exocrine and neuroendocrine tumors of the pancreas is also infrequent. We herein report a case of simultaneous occurrence of a pancreatic ductal adenocarcinoma (PDAC), pseudocyst, and neuroendocrine tumor (NET), showing a "side-by-side pattern." PATIENT CONCERN A 74-year-old man was hospitalized for epigastric pain and poor appetite. He had no history of pancreatitis, alcohol consumption, or smoking. DIAGNOSIS AND INTERVENTION Abdominal enhanced computed tomography and magnetic resonance imaging revealed a 15 × 8 cm cystic lesion with poor enhancement located in the tail of the pancreas. The distal aspect of the main pancreatic duct was dilated. The pancreatic parenchyma adjacent to the cystic lesion showed slightly heterogeneous enhancement on computed tomography and magnetic resonance imaging. Laboratory examination showed an elevated carbohydrate antigen 19-9 serum level. The patient was preoperatively diagnosed with intraductal papillary mucinous neoplasm and subsequently underwent laparotomy. During the operation, a hard white tumor measuring about 4 × 3 cm was palpated adjacent to the cystic lesion on the duodenal side, and a 0.6-cm nodule was simultaneously found in the pancreatic tail. Therefore, total pancreatectomy and splenectomy were performed. Histopathological examination showed that the tumor was PDAC with an adjacent pseudocyst, and the small nodule was suggestive of a NET. OUTCOMES The patient survived without recurrence or metastasis in the follow-up visit 10 months after the operation and adjuvant chemotherapy. CONCLUSIONS The concomitant occurrence of a PDAC, pseudocyst, and NET has not been previously reported. We suggest that if a pancreatic cyst is found, the coincidental occurrence of a malignant tumor should be considered, especially if the carbohydrate antigen 19-9 level is increased. Additionally, dilation of the pancreatic duct may be a diagnostic clue. Furthermore, the simultaneous occurrence of pancreatic endocrine and exocrine tumors is very uncommon. Preoperative diagnosis becomes difficult because of the lack of specific symptoms and radiological features.
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Varshney B, Bharti JN, Varshney VK, Yadav T. Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN) of pancreas: a rare entity-worth to note. BMJ Case Rep 2020; 13:13/4/e234855. [PMID: 32345587 DOI: 10.1136/bcr-2020-234855] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Mixed adenocarcinoma with neuroendocrine tumour of pancreas has been reported infrequently and consists of both epithelial and neuroendocrine component. We encountered an 81-year-old male patient who presented with clinical features of painful progressive jaundice for 1 month. Contrast-enhanced CT abdomen reported a mass in the pancreatic head with dilated common bile duct and pancreatic duct. He underwent pancreatoduodenectomy and histopathological examination revealed two different tumours: ductal adenocarcinoma admixed with neuroendocrine tumour of pancreas. He received adjuvant chemotherapy, and at the end of 1-year follow-up, he has no recurrence. Here, we reported this rare malignancy of pancreas for which pancreatoduodenectomy was done and diagnosed on histopathology with immunohistochemistry.
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Affiliation(s)
- Bharti Varshney
- Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Vaibhav Kumar Varshney
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Evaluation of KRAS Mutation Status in a Patient With Concomitant Pancreatic Neuroendocrine Neoplasm and Intraductal Papillary Mucinous Neoplasm. Pancreas 2019; 48:e34-e35. [PMID: 31090662 DOI: 10.1097/mpa.0000000000001286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Buchner D, Hieggelke L, Löser H, Bruns CJ, Quaas A, Ghadimi MPH. First reported case of a collision tumor composed of pancreatic adenocarcinoma and retroperitoneal liposarcoma: a case report. BMC Cancer 2018; 18:1243. [PMID: 30541485 PMCID: PMC6292103 DOI: 10.1186/s12885-018-5151-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 11/29/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Collision tumors are rare cases with two different tumor entities growing synchronously. While adenocarcinoma of the pancreas is the most common pancreatic tumor with an incidence of 10 per 100.000, retroperitoneal liposarcoma remains very rare. This is the first report of a collision tumor between these two tumor entities. CASE PRESENTATION Demographic details: The tumor was diagnosed in a 64 male Caucasian patient. Besides atrial fibrillation, arterial hypertension and a hypothyroidism there is no relevant medical history especially no history of cancer. Clinical details: During a routine check-up an unclassified tumor of the pancreatic tail was diagnosed. The lab showed no pathologies. Tumor markers were negative for carbohydrate antigen 19-9 and 72-4 (CA 19-9, CA 72-4) and carcinoembryonic antigen (CEA). Alpha-fetoprotein (AFP) and neuron specific enolase (NSE) were both elevated (AFP 97kU/l, (< 5,8kU/l) and NSE 30,0 μg/l (16,4 μg/l)). A computed tomography-guided core needle biopsy was performed which revealed a low-grade liposarcoma (G1). A CT scan showed no metastases. A surgical resection was recommended by the interdisciplinary tumor board. INTERVENTIONS A systematic left sided retroperitoneal compartment resection including en-bloc-left sided pancreatectomy, splenectomy, nephrectomy, hemicolectomy, adrenalectomy, partial gastrectomy and partial resection of the diaphragm was performed. Pathology revealed a collision tumor consisting of pancreatic adenocarcinoma that was classified pT3, pN2 (11/33 ece+) L1 V0 Pn0, R0; G2 [UICC Stage III] and a liposarcoma pT2, pN0 (0/33) L0 V0 Pn0, G1 [UICC Stage Ib]. The postoperative tumor board recommended an adjuvant chemotherapy with gemcitabine and capecitabine for the locally advanced pancreatic adenocarcinoma. OUTCOME At the latest follow-up (1 year after surgery) the patient was in good clinical condition and without evidence of tumor recurrence. CONCLUSION Collision tumors are rare and difficult to diagnose. This is the first description of a collision tumor composed of pancreatic adenocarcinoma and retroperitoneal liposarcoma. The reported case demonstrates that inconsistent diagnostic results (e.g. imaging and pathology) should raise suspicion concerning the diagnosis. Awareness of these rare cases might protect us from underdiagnosing patients and therefore leading to better patient care. There is evolving evidence that will lead to more personalized treatment options for somatic BRCA mutated pancreatic cancer.
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Affiliation(s)
- Denise Buchner
- Department of General, Visceral and Tumor Surgery, University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Lena Hieggelke
- University Hospital of Cologne, Institute of Pathology, Cologne, Germany
| | - Heike Löser
- University Hospital of Cologne, Institute of Pathology, Cologne, Germany
| | - Christiane Josephine Bruns
- Department of General, Visceral and Tumor Surgery, University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Alexander Quaas
- University Hospital of Cologne, Institute of Pathology, Cologne, Germany
| | - Markus Philipp Hussein Ghadimi
- Department of General, Visceral and Tumor Surgery, University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
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Huang H, Giorgadze T. Synchronous pancreatic tumors in a patient with history of Wilms tumor: A case of pancreatic adenocarcinoma and lipid-rich neuroendocrine tumor diagnosed by cytopathology. Diagn Cytopathol 2018; 46:864-869. [PMID: 30194916 DOI: 10.1002/dc.23978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/01/2018] [Accepted: 05/09/2018] [Indexed: 11/07/2022]
Abstract
Synchronous tumors represent a very small portion of pancreatic tumors. Although there is a higher incidence of secondary malignant neoplasms (SMN) in patients with history of Wilms tumor (WT), pancreatic tumors are very infrequent SMNs in this population. We report the first case of synchronous pancreatic tumors in a patient with history of WT. Two separated pancreatic lesions were identified by abdominal computerized tomography (CT) scan. Fine-needle aspiration of both lesions was performed for cytopathology examination. A pancreatic adenocarcinoma was diagnosed in the head of pancreas, and the pancreatic body lesion was found to be a neuroendocrine tumor (NET). The NET had characteristic vacuolated lipid-rich cytoplasm. Further molecular testing was done on both tumors, but no common cancer-associated mutation was found.
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Affiliation(s)
- Huiya Huang
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Tamara Giorgadze
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Pancreatic Collision Tumor of Ductal Adenocarcinoma and Neuroendocrine Tumor. ACG Case Rep J 2018; 5:e39. [PMID: 29850646 PMCID: PMC5968152 DOI: 10.14309/crj.2018.39] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/28/2018] [Indexed: 01/13/2023] Open
Abstract
A pancreatic collision tumor is a rare entity that can be challenging to diagnose. We present a very rare case of a pancreatic collision tumor composed of both a neuroendocrine tumor and a ductal adenocarcinoma. Preoperative diagnosis was clinically challenging because both the radiology and fine-needle biopsy were consistent with a typical neuroendocrine mass. However, gross examination of the mass postoperatively revealed neuroendocrine cells with rare foci of ductal adenocarcinoma without a transition zone. Awareness of this entity is important so that medical practitioners consider pursuing surgical management of pancreatic lesions that otherwise would be managed exclusively with surveillance.
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Abstract
There are a few entities that account for most solid and cystic masses of the pancreas. The pancreas harbors a wide array of diseases, including adenocarcinoma, and its variants, such as anaplastic and adenosquamous carcinoma. Other neoplasms include acinar cell carcinoma, solid pseudopapillary tumor, and sarcomas. Benign lesions include hamartomas, hemangiomas, lymphangioma, and plasmacytoma. Isolated metastases include renal cell carcinoma, melanoma, and other carcinomas. Benign inflammatory conditions, such as autoimmune pancreatitis and groove pancreatitis can also mimic solid neoplasms of the pancreas.
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Affiliation(s)
- John A Stauffer
- Department of Surgery, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224, USA
| | - Horacio J Asbun
- Department of Surgery, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224, USA.
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