Neuroendocrine carcinoma of the pancreas with similar genetic alterations to invasive ductal adenocarcinoma.
Neuroendocrine carcinoma (NEC) of the pancreas is very rare, and its origin is not fully elucidated. Here, we present a case of a small-size NEC of the pancreas that is genetically similar to invasive ductal adenocarcinoma (IDA). A 65-year-old man was referred to our hospital due to obstructive jaundice and found to have a 12-mm solid tumor in the pancreas head. The tumor exhibited low vascularity on enhanced computed tomography, and endoscopic retrograde pancreatographic imaging revealed an irregular obstruction in a branch duct of the pancreas. The patient was thereby diagnosed with a pancreatic ductal cancer, and stomach-preserving pancreaticoduodenectomy with regional lymph node resection was performed. Histochemical analysis of the resected tumor showed that the neoplastic cells with scanty cytoplasm and hyperchromatic nuclei strongly expressed chromogranin A and synaptophysin. The Ki-67 index was 40 % in the most proliferative tumor regions, and the tumor was diagnosed as a NEC of the pancreas. However, in the analysis of genetic alterations of the tumor tissue, the neoplastic cells showed altered KRAS, TP53, and SMAD4/DPC4, suggesting that the NEC in our case is genetically related to IDA. Our data suggest that poorly differentiated IDAs may transform into NECs.
Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan.
Tetsuo
T
Kimura
Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan.
Hiroshi
H
Miyamoto
Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan.
Akira
A
Fukuya
Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan.
Shinji
S
Kitamura
Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan.
Koichi
K
Okamoto
Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan.
Masako
M
Kimura
Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan.
Naoki
N
Muguruma
Department of Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
Tetsuya
T
Ikemoto
Department of Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
Mitsuo
M
Shimada
Division of Pathology, Tokushima University Hospital, Tokushima, Japan.
Akiko
A
Yoneda
Division of Pathology, Tokushima University Hospital, Tokushima, Japan.
Yoshimi
Y
Bando
Anan Kyoei Hospital, Tokushima, Japan.
Makoto
M
Takishita
Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan. takayama@tokushima-u.ac.jp.
Tetsuji
T
Takayama
D000368:Aged; D018278:Carcinoma, Neuroendocrine / Q000000981:diagnostic imaging / Q000235:genetics* / Q000473:pathology; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000235:genetics*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D018450:Disease Progression; D016158:Genes, p53; D006801:Humans; D008297:Male; D009154:Mutation; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000235:genetics* / Q000473:pathology; D016283:Proto-Oncogene Proteins p21(ras) / Q000235:genetics; D051901:Smad4 Protein / Q000235:genetics; D014057:Tomography, X-Ray Computed
C117307:KRAS protein, human; C497796:SMAD4 protein, human; D051901:Smad4 Protein; D016283:Proto-Oncogene Proteins p21(ras)
KRAS; Neuroendocrine carcinoma; Pancreatic cancer; SMAD4; p53