title: Mixed acinar-endocrine carcinoma of the pancreas: new clinical and pathological features in a contemporary series.
abstract: OBJECTIVE
  The objective of this study was to characterize the novel clinical and pathological features of mixed acinar-endocrine carcinoma of the pancreas.
  
  
  METHODS
  This was a retrospective review of medical records and surgical pathology specimens of patients with a diagnosis of mixed acinar-endocrine carcinoma of the pancreas at Cedars-Sinai Medical Center between 2005 and 2011. Additional immunohistochemistry was performed on the specimens of some patients.
  
  
  RESULTS
  Five patients were identified. The median age at presentation was 74 years (range, 59-89 years), and all patients were male. The presenting symptoms were all related to tumor mass effects. The median size of the tumor was 10 cm (range, 3.9-16 cm). Preoperative clinical diagnosis aided by fine-needle aspiration biopsy was incorrect in all 5 cases. Most tumors (3/5) exhibited predominantly endocrine differentiation without hormonal production. Only 10% to 30% of cells were truly amphicrine, whereas most were differentiated into either endocrine or acinar phenotype. The clinical behavior ranged from moderate to aggressive with postoperative survival from 2.5 months to more than 3 years. Four patients received neoadjuvant or adjuvant chemotherapy with variable responses.
  
  
  CONCLUSIONS
  Mixed acinar-endocrine carcinoma of the pancreas appears to be not uncommon in men, may harbor predominantly endocrine component, is often misdiagnosed by cytology, and exhibits variable clinical behavior. Mixed acinar-endocrine carcinoma of the pancreas should be considered in older patients with sizable pancreatic mass and may warrant aggressive surgical resection and chemotherapy.
authors: Division of Endocrinology, Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. run.yu@cshs.org
authors: Run
authors: R
authors: Yu
authors: Lily
authors: L
authors: Jih
authors: Jing
authors: J
authors: Zhai
authors: Nicholas N
authors: NN
authors: Nissen
authors: Steven
authors: S
authors: Colquhoun
authors: Edward
authors: E
authors: Wolin
authors: Deepti
authors: D
authors: Dhall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D018267:Carcinoma, Acinar Cell / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D018273:Carcinoma, Islet Cell / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000187:drug effects / Q000473:pathology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome