Adenosquamous carcinoma of the pancreas

Abstract

A 65 year old male with a past history of heavy alcohol consumption, presented complaining of a six month history of worsening back pain, anorexia and weight loss of 12 kg. Computerised tomography showed an enlarged poorly defined pancreas with multiple foci of low attenuation. Further low attenuation foci were noted in liver, spleen and peritoneum. Malignant cells were not found in a peritoneal tap. Fine needle aspiration biopsy of the pancreas showed the features of squamous cell carcinoma on smears and was confirmed on paraffin sections of clot. A glandular component was not identified and mucin stains were negative. The patient died two weeks later after a massive melaena. Postmortem examination revealed a 10 cm. tumour arising in the head and neck of the pancreas. Histology of the tumour showed a poorly differentiated adenosquamous carcinoma with the glandular component forming less than 5 per cent of the tumour. This case is presented to highlight the difficulty when squamous cell carcinoma of the pancreas is diagnosed cytologically as to whether it represents primary or secondary malignancy.