Abstract
BackgroundAcinar cell carcinoma of the pancreas is a rare neoplasm. Although this tumor has been well characterized histologically, the morphological patterns in Fine Needle Aspiration Cytology have not been well defined. Unlike ductal adenocarcinomas, endocrine tumors, and solid pseudopapillary tumors of the pancreas with their characteristic FNA cytological features, acinar cell carcinomas pose a particular diagnostic challenge by sharing many cytomorphologic features with endocrine tumors of the pancreas.Case presentationA 37-year-old man presented with lower chest and left upper quadrant abdominal pain. Computed tomography revealed a 7.8 × 7.3 cm irregular, partially cystic mass in the body and tail of the pancreas, and two lesions in the liver compatible with metastases. Subsequently, the patient underwent endoscopic ultrasound-guided fine needle aspiration on one of the two metastatic liver masses.FNA cytology revealed abundant, loosely cohesive clusters of malignant epithelial cells with vaguely acinar and trabecular formations. The pleomorphic nuclei had fine granular chromatin and occasionally small nucleoli. There were scant to moderate amounts of cytoplasm. Scattered, strikingly large tumor cells with giant nuclei, prominent mitoses and associated necrosis were evident. A pancreatic endocrine tumor was suspected initially, but acinar cell carcinoma of the pancreas was confirmed by immunohistochemistry, cytochemical and ultrastructural studies.ConclusionWe describe a case of pancreatic acinar cell carcinoma with unusual cytomorphologic features mimicking an endocrine tumor of pancreas, encountered in endoscopic ultrasound-guided fine needle aspiration of a metastatic liver mass and discuss the diagnostic approach for this unusual pancreatic tumor in fine needle aspiration cytology.
Highlights
Acinar cell carcinoma of the pancreas is a rare neoplasm
We describe a case of pancreatic acinar cell carcinoma with unusual cytomorphologic features mimicking an endocrine tumor of pancreas, encountered in endoscopic ultrasound-guided fine needle aspiration of a metastatic liver mass and discuss the diagnostic approach for this unusual pancreatic tumor in fine needle aspiration cytology
Rare neoplasms like acinar cell carcinomas of the pancreas (PACC), which only account for about 1% of pancreatic exocrine tumors, become a diagnostic challenge when fine needle aspiration (FNA) cytology is the sole diagnostic modality
Summary
A rare neoplasm like PACC often becomes challenging diagnostically when FNA cytology is the sole diagnostic modality. Due to many morphologic similarities at the microscopic level between PACC and PET, ancillary studies such as immunohistochemistry, cytochemistry and electron microscopy are often needed. Many studies have shown that regardless of the imaging modality used, the presence of a pathologist on site improves sampling and sensitivity by ensuring adequate tissue collection and sample preparation [18,19,20,21], and our present case supports this conclusion. When we encountered an unusual pancreatic tumor during the on-site evaluation, we ensured an additional pass for the cell block preparation necessary for ancillary studies, an essential element in making the final definitive diagnosis based only on FNA cytology
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