Cytology of pancreatic acinar cell carcinoma

Abstract

Acinar cell carcinoma (ACC) of the pancreas is extremely uncommon and its cytologic features have rarely been described. We describe the cytologic features of cases we have seen, review the literature regarding its cytologic features and discuss the pitfalls that may be encountered and the use of immunohistochemistry for its diagnosis. We searched our databases for all cases of histologically confirmed pancreatic ACC which had undergone prior fine needle aspiration (FNA) of the primary pancreatic lesion. The clinical histories, radiographic and sonographic findings, cytologic features, original cytologic diagnoses, and final histologic diagnoses were reviewed. Four cases of pancreatic ACC were found that had undergone FNA prior to histologic confirmation of the diagnoses. They were from 2 men and 2 women aged 50-75 yr. All masses were in the head of the pancreas, 2 had apparent peri-pancreatic adenopathy and 1 had an apparent liver metastasis. On review, all 4 had had diagnostic material on cytology samples. Original cytologic diagnoses included "acinar cell carcinoma," "pancreatic endocrine tumor," "favor neuroendocrine tumor, low-grade" and "non-diagnostic specimen." The cytologic features included small to moderate-sized loose groups with numerous single cells, prominent acinar formation, little anisonucleosis and prominent nucleoli. The cytologic features showed significant overlap with those of pancreatic endocrine tumors.

Hints to the Diagnosis of Mixed Acinar-Endocrine Carcinoma on Pancreatic Fine-Needle Aspiration: Avoiding a Potential Diagnostic Pitfall

“…In studies that have examined the cytologic features of pure ACC, greater than half the cases were erroneously diagnosed as PENs on FNA or touch preparation [9,10]. Of the MAEC cases reported with previous biopsy results, only 2 of 7 cases had correctly identified both acinar and endocrine components on FNA [11,12,13,14,15,16,17].…”

Pancreatic Metastasis from Papillary Thyroid Carcinoma Diagnosed by Endoscopic Ultrasound-Guided Fine Needle Aspiration

“…Neuroendocrine markers and vimentin are negative. 16,17 Pancreatic endocrine neoplasms are also uncommon and account for < 2% of pancreatic neoplasms. Though these tumors may occur at any age, they are most common in adults, and > 90% occur in patients over 30 years old.…”

Binucleated HeLa cells are formed by cytokinesis failure in starvation and keep the potential of proliferation

“…In normal tissues, such as liver parenchyma, a relationship between binucleated cells and cell survival was reported (Morizur et al 2010). Many cytological studies have found elevated numbers of binucleated cells in various tumors (Bollmann et al 2005;Kimura et al 2009;Minimo et al 2002;Morin et al 2000;Stelow et al 2006;Stoll et al 2011). However, binucleated cells are observed in not only malignant tumors but also normal tissues (Mizoguchi and Ishikawa 1994;Morizur et al 2010).…”

“…Many cytological studies have reported that the numbers of binucleated cells were elevated in various tumors, including malignant mesothelioma, pancreatic endocrine tumor, cervical squamous lesion, angiosarcoma, and acute myeloid leukemia (Bollmann et al 2005;Kimura et al 2009;Minimo et al 2002;Morin et al 2000;Stelow et al 2006;Stoll et al 2011). However, binucleated cells are observed in not only malignant tumors but also normal tissues such as those of the heart, muscle cells, platelet progenitor-megakaryocytes, liver parenchyma, and bladder (Mizoguchi and Ishikawa 1994;Morizur et al 2010).…”