Abstract
Abstract Introduction: Primary squamous cell carcinoma (SCC) and adenosquamous carcinoma of the pancreas are rare malignancies for which diagnostic and treatment strategy are challenging. In this paper we present a literature review of these tumors based on two case reports. Case presentation: In the first case, a 55-year-old male presented with an inoperable pancreatic head/body junction tumor. Endoscopic ultrasound-guided fine needle aspiration was practiced, and histopathological examination revealed a squamous cell carcinoma of the pancreas. After exclusion of any another tumor, the diagnosis of cT4N0M0-staged primary pancreatic SCC was made. The patient is under treatment with gemcitabine and oxaliplatin. The second case is represented by a 73-year-old patient in which imagistic examinations highlighted a cystic mass of the pancreatic body. Following coporeo-caudal splenic-pancreatectomy and histopathological-proved diagnosis of adenosquamous carcinoma, the patient started chemotherapy but died at 11 months after surgery. Both tumor components displayed positivity for markers which prove ductal (cytokeratin19, maspin) and squamous differentiation (p63, cytokeratin5/6) same as vimentin, as indicator of epithelial mesenchymal transition (EMT). Conclusions: SCC and adenosquamous carcinoma of the pancreas are aggressive malignancies which prognosis remains highly reserved. These tumors might be variants of ductal adenocarcinomas which are dedifferentiated through EMT phenomenon.
Highlights
Primary squamous cell carcinoma (SCC) and adenosquamous carcinoma of the pancreas are rare malignancies for which diagnostic and treatment strategy are challenging
Most of the malignant tumors of the exocrine pancreas are ductal adenocarcinomas [1,2,3]. Rare variants such papillary of adenosquamous pancreatic carcinomas are encountered in daily diagnosis but pure primary squamous cell carcinoma (SCC) of the pancreas is an unusual tumor which differential diagnosis is difficult to be done [4,5]
* Correspondence to: Simona Gurzu E-mail: simonagurzu@yahoo.com we present two cases, one of primary SCC and one adenosquamous carcinoma along with a pertinent review of literature
Summary
Most of the malignant tumors of the exocrine pancreas are ductal adenocarcinomas [1,2,3]. Rare variants such papillary of adenosquamous pancreatic carcinomas are encountered in daily diagnosis but pure primary squamous cell carcinoma (SCC) of the pancreas is an unusual tumor which differential diagnosis is difficult to be done [4,5] For such diagnosis, metastatic lesions need to be excluded [1,6,7]. In the most recent study published in 2019, based on a representative cohort, which included 57804 patients who undergone surgery for pancreatic cancer diagnosis during 2004-2014, Pokrzywa CJ et al identified only 39 primary pure SCCs (0.07%) and 655 adenosquamous carcinomas (1.13%) [3]. The stereotype of patient diagnosed with primary pancreatic carcinomas with squamous component is, like our cases, a male in his 6th decade of life showing an infiltrative tumor of the head of the pancreas [9,10]. Large cohorts need to be examined to confirm or infirm our hypothesis
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