[Papillary cystic tumor of the pancreas].
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Nonneoplastic tumor-like lesions ("pseudotumors") of the pancreas include cystic and noncystic varieties. We report on a solid and cystic tumor-like lesion of the pancreas that occurred in 2 adult patients. The lesions, located in the head and neck of the gland, respectively, were well demarcated and composed of cystic ductal structures embedded in focally inflamed stromal tissue. In addition, one of the lesions showed irregularly arranged but well-differentiated acini and small intralobular and interlobular ducts embedded in hypocellular, fibrotic tissue. Discrete islets were lacking, but immunohistochemical staining for chromogranin A revealed individual scattered endocrine cells evenly distributed between acinar and ductal cells. The surrounding pancreatic parenchyma did not show significant chronic pancreatitis. After tumor removal, the follow-up of the patients was uneventful. Because of the irregular arrangement of otherwise mature tissue components of the pancreas, the lesions were considered solid and cystic hamartomas. Their pathogenesis is so far unknown.
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Abstract Carcinoma of the pancreas is a common tumour. Histologically, the majority are adenocarcinomas of duct origin. Carcinomas of the pancreas containing giant cells are uncommon and those containing osteoclast-type tumour cells are very rare. We report a case of malignant giant cell tumour presenting as an extremely large, thin walled haemorrhagic cyst of the pancreas. This tumour is most unusual in that the wall is composed of multiple highly pleomorphic malignant-looking multinucleated giant cells as well as numerous osteoclast-like giant cells in a stroma of small spindle shaped mononuclear cells.
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Hepatoid carcinomas are tumors that display, at least focally, cytologic and/or architectural features of hepatocellular carcinoma. They have been described in several organs, most notably in the stomach and ovary. We report a case of hepatoid carcinoma of the pancreas that developed in a 41-year-old woman in association with a pancreatic endocrine carcinoma. The fine needle aspiration material was characterized by the presence of monotonous, small-to-medium sized tumor cells with round nuclei and finely granular chromatin, intermixed with more atypical tumor cells displaying larger nuclei with coarse clumped chromatin, prominent nucleoli, and moderate amounts of foamy cytoplasm. The excised specimen displayed a poorly differentiated pancreatic endocrine carcinoma associated with well-defined islands of larger tumor cells growing in a perisinusoidal pattern which, based on their immunohistochemical profile and the demonstration of bile, proved to represent a hepatoid component. This case and prior examples in the literature suggest that hepatoid carcinomas of the pancreas appear to be a heterogeneous group of tumors (pure or associated with another histologic component) that are often associated with early liver metastasis and a short survival, although those arising as a component of endocrine tumors seem to fare slightly better. Hepatoid carcinoma of the pancreas should be included in the differential diagnosis of pancreatic tumors composed of large eosinophilic cells.
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Purpose: To compare outcomes of patients with pancreatic adenocarcinoma >=75 years of age with those <75 years of age treated with non-palliative surgery using the population-based registry data of the Surveillance, Epidemiology and End Results (SEER) program. Materials and Methods: Patients with diagnosis of adenocarcinoma of the pancreas were identified in the SEER public-use database. Study criteria included patients with diagnosis of primary non-metastatic adenocarcinoma of the exocrine pancreas for which details of T and N staging, histologic grade, tumor location, description of the surgical procedure, and types of treatment (i.e. surgery with or without radiation treatment) were available. Of the 513 patients identified, 80 patients were >= 75 years of age and 433 patients were <75 years of age at diagnosis. Cox proportional hazard model and log-rank test were used in the multivariate and univariate analyses of factors including age, T stage, N stage, histologic grade, tumor location, types of surgery, and types of treatment. Chi-square test was used to compare distribution of the factors among the patients between the groups. Results: The median survival for all patients was 10 months. The distribution of T stage, N stage, tumor location, histologic grade, and types of surgery were similar for patients >=75 or <75 years of age (all p>0.20, chi-square). Fewer patients >=75 years of age received radiation therapy as adjunct to surgery compared with those in the younger group (22.5% vs. 45.7% respectively, p<0.01, chi-square). No statistically significant difference in the 3-year overall survival between patients >=75 and <75 years of age was observed, 17.4% and 19.4% (p=0.68, log-rank) respectively. On univariate analysis, lower histologic grade, lower T stage, N-0 stage, and surgery with radiation therapy were associated with increased overall survival (all p<0.01, log-rank). Age, tumor location, and types of surgery did not show statistically significant difference (all p>0.60, log-rank). The following variables were significant predictors of survival in multivariate analysis: histologic grade, T stage, N stage, and types of treatment (all p<0.01, Cox). However, age (p=0.63, Cox), tumor location (p=0.69, Cox), and types of surgery (p=0.17, Cox) were not independent predictors. Conclusion: Surgery appeared to be efficacious for patients who were >=75 years of age when compared with younger patients. Studies of co-morbid conditions are needed to select the best patients with pancreatic cancer for non-palliative resection. Improvement in local and systemic therapies is also needed for all subgroups of patients as the longterm survival rate remains low.
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The malignant rhabdoid tumor (MRT) is histologically characterized by the invasive proliferation of polygonal to ovoid cells with abundant eosinophilic cytoplasm and eccentric vesicular nuclei with a prominent nucleolus. MRT frequently occurs in the kidney, but may also arise in other organs. However, MRT should be strictly distinguished from carcinomas with rhabdoid features. A post‐mortem examination of a 68‐year‐old woman found an anaplastic carcinoma of the pancreas with rhabdoid features displaying extensive invasion into the neighboring tissues. To the best of our knowledge, this is the first case of a pancreatic tumor with rhabdoid features. Pathologists should consider that carcinomas showing rhabdoid features may also appear in the pancreas. As pancreatic tumors with rhabdoid features have characteristic histopathological features and poor prognosis compared to other pancreatic tumors, careful histopathological differential diagnosis is important.
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Abstract We report two cases of extramedullary plasmacytoma (EMP) of the pancreas, diagnosed by fine‐needle aspiration (FNA). Plasmacytoma of the pancreas is a rare neoplasm with only 12 cases recorded in the literature. Because of its scarcity and the cytomorphologic similarity between plasma cells and endocrine cells, EMP of the pancreas may be confused with neuroendocrine (islet cell) tumors of the pancreas. Immunohistochemical staining for light chain and/or neuroendocrine markers will prevent diagnostic error when interpreting plasmacytoid neoplasms of any site susceptible to endocrine tumors, including the pancreas. © 1994 Wiley‐Liss, Inc.
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