Metastatic mixed acinar-neuroendocrine carcinoma of the pancreas to the liver: a cytopathology case report with review of the literature.
A case of metastatic mixed acinar-neuroendocrine carcinoma (MANEC) of the pancreas to the liver is reported. A diagnostic percutaneous US-guided FNA and core biopsy of a liver nodule was performed. The FNA smears were cellular and showed neoplastic cells in clusters with acinar formation, isolated single cells, and scattered naked nuclei. The cytoplasm was finely granular. The nuclei were relatively uniform, some with speckled chromatin and prominent nucleoli. The immunohistochemistry performed on the cell block showed strong positivity for cytokeratin AE1/AE3, chromogranin, and synaptophysin. Furthermore, the tumor cells were weakly positive for α1-antichymotrypsin. The Ki-67 mitotic index was up to 50%. Based on the morphology and supporting immunohistochemical stains, the final cytopathologic diagnosis rendered was "Positive for malignant cells. Carcinoma with mixed acinar and endocrine features." To our knowledge, this is the first report of a metastatic MANEC to the liver diagnosed based on cytology with confirmatory histology. The difficulties in the cytopathologic diagnosis and differential diagnosis of MANEC are discussed in this article.
Department of Pathology, Division of Cytopathology, New York University School of Medicine, NYU Langone Medical Center and Bellevue Hospital Center, New York, New York, USA. lili.lee@nyumc.org
Lili
L
Lee
Ewa B
EB
Bajor-Dattilo
Kasturi
K
Das
D000368:Aged; D018278:Carcinoma, Neuroendocrine / Q000175:diagnosis / Q000473:pathology* / Q000556:secondary; D002467:Cell Nucleus / Q000473:pathology; D002864:Chromogranins / Q000032:analysis; D003593:Cytoplasm / Q000473:pathology; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D006801:Humans; D007633:Keratins / Q000032:analysis; D008113:Liver Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000556:secondary; D008297:Male; D008940:Mitotic Index; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000556:secondary; D016708:Synaptophysin / Q000032:analysis
D002864:Chromogranins; D016708:Synaptophysin; D007633:Keratins