Abstract
Background: Anaplastic pancreatic carcinomas (APCs) are among the least frequently encountered pancreatic malignancies, ranging from 0.5% to 7% of all nonendocrine pancreatic malignancies. Furthermore, few cases of APCs have been described arising within a pancreatic mucinous cystic neoplasm (MCN).Case Presentation: A 36-year-old female presented with left upper quadrant pain and a 10 × 8 cm complex cystic mass in the pancreatic tail. Fine needle aspiration of the cyst showed papillary clusters of cells with mild cytological atypia, cyst fluid carcinoembryonic antigen >4000 ng/mL, and amylase of 25 U/L. After an open distal pancreatectomy and splenectomy, the specimen revealed an MCN with multifocal microscopic foci of invasive well-differentiated adenocarcinoma. After additional sampling, foci of undifferentiated malignancy—morphologically resembling sarcomas but with immunohistochemical staining consistent with anaplastic carcinoma—were identified. The patient had an uneventful recovery and is currently undergoing a regimen of gemcitabine-based adjuvant chemotherapy; she remains disease-free at 5 months after initial diagnosis.Conclusions: In this study, we describe a rare case of APC originating from a large pancreatic MCN lesion. This case underlines the importance of scrupulous pathological evaluation of the entire MCN epithelium and adds to the limited world literature of APC originating from pancreatic MCN lesions.
Highlights
In this study, we describe a rare case of Anaplastic pancreatic carcinomas (APCs) originating from a large pancreatic mucinous cystic neoplasm (MCN) lesion with final histological analysis revealing areas of adenocarcinoma, as well as foci of APC amid mucinous cystadenoma epithelium
APCs are defined as epithelial malignancies, which are composed largely of neoplastic cells with no identifiable line of differentiation
To the best of our knowledge, only 12 cases of anaplastic carcinoma arising from MCNs are reported in the English language literature (Table 2).[5,6,7,8,9,10,11,12,13]
Summary
Anaplastic Pancreatic Carcinoma Arising Within a Mucinous Cystic Neoplasm of the Pancreas: A Case Report and a Brief Review of the Literature. Alessandro Paniccia,[1] Robert Torphy,[1] Kalpana Devaraj,[2] and Richard D.
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