Endocrine Carcinoma Research Articles

Early gastric mixed neuroendocrine–non-neuroendocrine neoplasms with endoscopic findings of neuroendocrine cell carcinoma components exposed on the mucosal surface: a case report

BackgroundGastric mixed neuroendocrine–non-neuroendocrine neoplasms are rare malignant tumors. The lack of specific findings makes it difficult to diagnose endoscopically. We report the case of early gastric mixed neuroendocrine–non-neuroendocrine neoplasms treated by endoscopic submucosal dissection.Case presentationAn 81-year-old Japanese female underwent esophagogastroduodenoscopy for screening and was treated with endoscopic submucosal dissection for the diagnosis of early gastric cancer. Histopathologically, the lesion was diagnosed as mixed neuroendocrine–non-neuroendocrine neoplasms (tubular adenocarcinoma 2 60%, endocrine cell carcinoma 40%), pT1b(submucosa (SM) 900 μm), pUL(−), Ly(+), v(−), pHM0, pVM0. After additional surgical resection without adjuvant chemotherapy, she has had no recurrences or metastases for 3 years.ConclusionsComparing narrow-band imaging magnified endoscopic findings with pathological findings, the depressed area with a lack of surface structure was consistent with the neuroendocrine cell carcinoma component, while narrow-band imaging magnification findings showed non-network vessels. In this case, we examined endoscopic findings of early stage mixed neuroendocrine—non-neuroendocrine neoplasms in detail and compared it with the pathological findings. We believe that these endoscopic findings contribute to the diagnosis of mixed neuroendocrine–non-neuroendocrine neoplasms and can lead to its early detection.

S2075 Mixed Adeno-Neuroendocrine Carcinoma (MANEC) of Colon: Rare Differential Diagnosis for Iron Deficiency Anemia

Introduction: Colonic Mixed adenoneuroendocrine carcinoma (MANEC) is a rare but highly aggressive tumor. In English Literature only 10 cases or less have been reported of this neoplasm, with the prognosis still unfavorable. Mixed adenoneuroendocrine carcinomas, by definition, are comprised of at least 30% of both a neuroendocrine and an adenocarcinomatous component. Cases are typically diagnosed at advanced stages, and the age of presentation is younger than the average age of colorectal adenocarcinoma (∼60 years old). Metastasis can occur anywhere but usually seen in the liver, regional lymph nodes and rarely peritoneum. The tumor neuroendocrine markers and immunophenotype are essential for the diagnosis, for example chromogranin, synaptophysin, CDX-2, and CD56. Case Description/Methods: A 53-year-old women with a history of abdominal pain was diagnosed with NET via histopathology of the cecum. The patient was referred to us by her hematologist which he ordered CT/pelvis due to her new onset of iron deficiency anemia and CT scan showed irregular bowel wall thickening of proximal ascending colon with infiltration and nodularity of surrounding fat suspicious of colon neoplasm. The patient has diabetes mellitus and hypertension other than that she had no significant history of past illness. A colonoscopy and biopsy were performed that showed poorly differentiated carcinoma with ulceration in large bowel mucosa, morphologically, high grade poorly differentiated malignant neoplasm was noted with ulceration. Histopathology and Immunohistochemical studies show the tumor cells are positive for AE1/3, CK7, synptophysin, CDX-2, while negative for CK20, chromogranin, CD56. Ki-67 shows a high labeling index (−95%). The negative stain of tumor cells for MLH-1 and PMS2 can be associated with microsatellite instability related germ line mutation. The differential diagnosis includes poorly differentiated adenocarcinoma, mixed adenoneuroendocrine carcinoma and large cell endocrine carcinoma. A definitive classification depends on the total resection specimen (Figure 1). Discussion: Mixed adenoneuroendocrine carcinoma of the colon is a neoplasm consisting of 2 components coexisting simultaneously within a tumor. It is a very rare carcinoma that presents at a younger age than colorectal adenocarcinoma. Unfortunately, it is diagnosed usually at late stages when metastasis has occurred. If detected at early stages curative surgery can be the treatment. The prognosis Is poor due to late diagnosis and dual nature of the tumor.Figure 1.: Histology and Immunohistochemical studies.

Potential Therapeutic Agents against Paclitaxel-And Sorafenib-Resistant Papillary Thyroid Carcinoma.

Thyroid carcinoma, a disease in which malignant cells form in the thyroid tissue, is the most common endocrine carcinoma, with papillary thyroid carcinoma (PTC) accounting for nearly 80% of total thyroid carcinoma cases. However, the management of metastatic or recurrent therapy-refractory PTC is challenging and requires complex carcinoma therapy. In this study, we proposed a new clinical approach for the treatment of therapy-refractory PTC. We identified sarco/endoplasmic reticulum calcium ATPase (SERCA) as an essential factor for the survival of PTC cells refractory to the treatment with paclitaxel or sorafenib. We validated its use as a potential target for developing drugs against resistant PTC, by using patient-derived paclitaxel- or sorafenib-resistant PTC cells. We further discovered novel SERCA inhibitors, candidates 7 and 13, using the evolutionary chemical binding similarity method. These novel SERCA inhibitors determined a substantial reduction of tumors in a patient-derived xenograft tumor model developed using paclitaxel- or sorafenib-resistant PTC cells. These results could provide a basis for clinically meaningful progress in the treatment of refractory PTC by identifying a novel therapeutic strategy: using a combination therapy between sorafenib or paclitaxel and specific SERCA inhibitors for effectively and selectively targeting extremely malignant cells such as antineoplastic-resistant and carcinoma stem-like cells.

Improving the diagnosis of thyroid cancer by machine learning and clinical data

Thyroid cancer is a common endocrine carcinoma that occurs in the thyroid gland. Much effort has been invested in improving its diagnosis, and thyroidectomy remains the primary treatment method. A successful operation without unnecessary side injuries relies on an accurate preoperative diagnosis. Current human assessment of thyroid nodule malignancy is prone to errors and may not guarantee an accurate preoperative diagnosis. This study proposed a machine learning framework to predict thyroid nodule malignancy based on our collected novel clinical dataset. The ten-fold cross-validation, bootstrap analysis, and permutation predictor importance were applied to estimate and interpret the model performance under uncertainty. The comparison between model prediction and expert assessment shows the advantage of our framework over human judgment in predicting thyroid nodule malignancy. Our method is accurate, interpretable, and thus useable as additional evidence in the preoperative diagnosis of thyroid cancer.

Analysis of survival and prognostic factors of thymic neuroendocrine tumors.

e20622 Background: To investigate the clinical characteristics of thymic neuroendocrine tumors and the relationship between treatment and survival prognosis. Methods: 69 patients, including 54 males and 15 females, who were diagnosed with NETT by puncture or surgical pathology in the First Affiliated Hospital of Zhengzhou University from September 2011 to October 2021 were retrospectively analyzed for initial symptoms, Pathological type, lesion size, treatment and prognosis of survival. Results: The median age of the 69 patients was 53 years old (28-83 years old), the median maximum diameter of the primary lesion was 6.85 cm (1.1-14.9 cm), and the clinical manifestations were not specific. The most common initial symptom was chest tightness and chest pain for 20 cases, 19 cases with hidden disease, found during physical examination. The manifestations of local invasion and metastasis included cough (6 cases), neck and face swelling (9 cases), retrosternal discomfort (3 cases), and low back pain (4 cases). There were 6 cases with systemic manifestations (anorexia, fatigue and fever). Only one case showed ectopic ACTH syndrome. The pathological types included 46 cases of well-differentiated neuroendocrine tumors (5 cases of typical carcinoid tumors, 41 cases of atypical carcinoid tumors), 23 cases of poorly differentiated neuroendocrine tumors (13 cases of small cell carcinomas, 3 cases of large cell neuroendocrine carcinomas, and high-grade neuroendocrine carcinomas). 7 cases of endocrine carcinoma). Masaoka-Koga staging: 2 cases of stage I, 10 cases of stage II, 20 cases of stage III, and 37 cases of stage IV. Thirty patients received surgical treatment, and 19 received postoperative adjuvant therapy. Long-term follow-up results showed a median overall survival time of 49.5 months. Univariate analysis showed that surgery could improve PFS (P = 0.009), while postoperative comprehensive treatment had no effect on PFS (P = 0.724). Pathological grade (P < 0.001), Masaoka-Koga stage (P = 0.004), and surgery (P = 0.014) were associated with OS. Multivariate analysis showed that pathological grade was an independent factor affecting OS (HR: 7.133; 95%CI: 2.183-23.306; P = 0.001). Conclusions: Thymic neuroendocrine tumor is a rare malignant tumor, and pathological grade is an independent risk factor for prognosis. Surgery can improve the patient's PFS.

Endocrine mucin-producing sweat gland carcinoma mimicking meibomian gland carcinoma

Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare adnexal tumor of the skin with immunoexpression and neuroendocrine differentiation. It can be easily misdiagnosed as a meibomian gland tumor due to its prevalence in the Indian subcontinent over EMPSGC. It has a predilection for the skin of the eyelid and elderly females. It is histologically and immunohistochemically analogous to solid papillary carcinoma of the breast/endocrine ductal carcinoma in situ with a nodular, solid, papillary, and/or cribriform architecture, neuroendocrine differentiation, and mucin production. We describe a case of EMPSGC clinically mimicking meibomian gland carcinoma which was confirmed on immunohistochemistry and histopathological diagnosis.

Endocrine mucin-producing sweat gland carcinoma: a systematic review and meta-analysis

Background Endocrine mucin-producing sweat gland carcinoma is a rare, under-reported cutaneous adnexal tumor that is often misdiagnosed and has an unknown incidence of metastasis. Objective To determine the incidence of metastasis and tumor recurrence, as well as diagnostic accuracy and current trends in treatment modality. Methods A search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Tumor pathology and clinical data concerning demographics, presentation, diagnosis, treatment and follow-up were assessed. Results A total of 36 publications with 110 cases were identified. Initial pathological diagnosis was incorrect in 45.5% of cases. One case of metastatic disease was reported. The incidence of locoregional recurrence was 10.6% over a mean follow-up period of 21.3 months. Of cases with known methods of resection, 34.6% were resected by excisional biopsy, 42.8% were resected by wide surgical excision, and 31.3% were cleared by Mohs micrographic surgery. Limitations The low reported incidence and level of evidence was suboptimal with only case reports and retrospective case studies being reported. Conclusion Reported cases of this pathology demonstrate poor diagnostic accuracy. High rates of misdiagnosis and inadequate definitive treatment suggest the need for more comprehensive work-up and management of lesions suspicious for this pathology.

A parathyroid carcinoma mimicking thyroid carcinoma; A case report.

Introduction and importanceParathyroid carcinoma is an extremely rare endocrine neoplasm. Most of the patients present with severe hyperparathyroidism with altered serum calcium levels.Case presentationWe describe a patient who presented with a neck mass and secondary hyperparathyroidism Ultrasound (USG) suggested a tumor located near the lower pole of the thyroid gland. USG guided FNAC suggested parathyroid neoplasm. CT scan showed tumor infiltration of the parathyroid gland. The patient underwent total resection of the tumor along with total thyroidectomy and right central compartment clearance. The biopsy of the mass confirmed the parathyroid carcinoma infiltrating the thyroid gland.Clinical discussionParathyroid carcinoma is a rare endocrine carcinoma. Due to its location, it is often misdiagnosed as thyroid carcinoma. It can present with problems related to bones, kidney stones, psychiatric problems and many others. Serum calcium, Parathormone level, Ultrasound neck, CT scan and MIBI scan are the imaging study for early diagnosis of Parathyroid carcinoma. Complete removal of tumor followed by regular follow up with serum calcium and Parathormone level will help to improve the survival of Patient.ConclusionDiagnosis of parathyroid carcinoma is very challenging due to the limited contribution of imaging. It mimics thyroid carcinoma due to the origin of the tumor from the lower pole of the thyroid area. It is extremely important for suspicion of parathyroid tumor in case of neck mass who have an abnormality in serum calcium and parathormone level. Total resection of the tumor with a negative margin is important to control hyperparathyroidism and increase the survival.

Endocrine Mucin-Producing Sweat Gland Carcinoma: Emerging Evidence of Multicentric Cutaneous Origin and Occasional Concurrence With Analogous Breast Tumors.

Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a low-grade carcinoma with predilection for the eyelid. It is analogous to solid papillary carcinoma of the breast with both expressing neuroendocrine markers and the potential to progress to invasive mucinous carcinoma (IMC). Although over 80 cases of EMPSGC have been reported, few multicentric cases have been described in the literature. In this article, we report 9 cases of EMPSGC including 3 with multicentric disease. A computerized search was performed for EMPSGC and IMC of the eyelid from January 2000 to February 2021. Records were reviewed for age, sex, tumor location, and clinical impression. Eight EMPSGC (7 associated with IMC) and 1 IMC of the eyelid were identified. Lesions were slightly more common in men (55%) than women. The mean age of presentation was 76 years (range, 59-98 years). Lesions ranged from 2.5 to 12 mm. Three cases had multicentric synchronous lesions on the skin. Histologically, these were well-circumscribed dermal tumors with solid or partially cystic nodules. Tested tumors expressed at least 1 neuroendocrine marker and were positive for CK7, ER/PR, 1 or more of GCDFP-15, mammaglobin, and GATA-3. One case had an associated IMC of the breast, and another case was associated with an intraductal papilloma of the breast in a man. There was no evidence of metastasis. EMPSGC is a low-grade adnexal neoplasm, commonly affecting the eyelid of the elderly. Lesions often progress to IMC, metastases being exceptionally rare. EMPSGC can be bilateral and multicentric. Concurrence with breast neoplasms has been observed and deserves investigation.

Adenoneuroendocrine (mixed) gastric carcinoma: Report of 2 cases of a rare condition

Background: Mixed Adenoneuroendocrine Carcinomas (MANEC) are rare neoplasms composed of both exocrine and endocrine carcinomas. Because of its extremely rarity no therapeutic strategies have been stablished. We report two cases of surgical resected MANEC.

Bilateral Concurrent Endocrine Mucin-Producing Sweat Gland Carcinoma and Mucinous Carcinoma of the Eyelids

Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is thought to be a precursor to mucinous carcinoma, both of which are rare. In this case report, the authors present a 55-year-old woman with concurrent EMPSGC and mucinous carcinoma manifesting with 2 distinct lesions on her left upper and lower eyelid and 1 lesion on her right lower eyelid. Biopsy and immunohistochemical staining supported primary cutaneous origin of the tumors. Systemic metastatic workup was initiated and thus far negative. The patient underwent staged slow Mohs micrographic surgery to remove one tumor at a time, with delayed reconstruction. This is the first reported case of EMPSGC and mucinous carcinoma presenting as distinct lesions both bilaterally and synchronously.

Endocrine Mucin-Producing Sweat Gland Carcinoma: A Case Report and Literature Review

Endocrine Mucin-Producing Sweat Gland Carcinoma (EMPSGC) is a rare, low-grade, malignant tumor derived from sweat glands, arising preferentially in skin from the periorbital region. EMPSGC tumors are more frequently found in elderly female patients. To date, only around 70 cases have been reported in the literature [1-3]. Therefore, thorough immunohistochemical characterization of EMPSGC tumors is of pivotal importance to confirm its diagnosis [4-6].

A Case of Gastric Large Cell Endocrine Carcinoma

A Case of Gastric Large Cell Endocrine Carcinoma

Endocrine Mucin-Producing Sweat Gland Carcinoma Treated With Mohs Micrographic Surgery.

Endocrine Mucin-Producing Sweat Gland Carcinoma Treated With Mohs Micrographic Surgery.

Carboxypeptidase A1 (CPA1) immunohistochemistry is highly sensitive and specific for acinar cell carcinoma (ACC) of the pancreas

Abstract Introduction/Objective Introduction: Carboxypeptidase A1 (CPA1) is a zinc metalloprotease which is produced in pancreatic acinar cells and plays a role in cleaving C-terminal branched-chain and aromatic amino acids from dietary proteins. This study assessed the utility of immunohistochemical CPA1 staining for diagnosing pancreatic acinar cell carcinoma. Methods/Case Report Methods: A total of 15,680 tumor samples from 132 different tumor types and subtypes as well as 8 samples each of 76 different normal tissue types were analyzed by immunohistochemistry in a tissue microarray format. Results (if a Case Study enter NA) Results: CPA1 was strongly expressed in acinar cells of all normal pancreas samples but not in any other normal tissues. CPA1 immunostaining was detected in 100% of 11 pancreatic acinar cell carcinomas and one mixed acinar endocrine carcinoma (MAEC), but absent in 449 pancreatic ductal adenocarcinomas, 75 adenocarcinomas of the ampulla of Vater, and 11,739 other evaluable cancers from 128 different tumor entities. A weak to moderate diffuse staining of epithelial and stromal cells of cancer tissues immediately adjacent to non-neoplastic pancreatic acinar cells often occurred and was considered to be caused by diffusion of the highly abundant CPA1 from normal acinar cells that may have suffered some autolytic cell damage. Conclusion Our data show that CPA1 is a highly sensitive and largely specific marker for normal and neoplastic pancreatic acinar cells. CPA1 immunohistochemistry greatly facilitates the otherwise often difficult diagnosis of pancreatic acinar cell carcinoma.

Carboxypeptidase A1 (CPA1) Immunohistochemistry Is Highly Sensitive and Specific for Acinar Cell Carcinoma (ACC) of the Pancreas.

Carboxypeptidase A1 (CPA1) is a zinc metalloprotease that is produced in pancreatic acinar cells and plays a role in cleaving C-terminal branched-chain and aromatic amino acids from dietary proteins. This study assessed the utility of immunohistochemical CPA1 staining for diagnosing pancreatic acinar cell carcinoma (ACC). A total of 12,274 tumor samples from 132 different tumor types and subtypes as well as 8 samples each of 76 different normal tissue types were interpretable by immunohistochemistry in a tissue microarray format. CPA1 was strongly expressed in acinar cells of all normal pancreas samples but not in any other normal tissues. CPA1 immunostaining was detected in 100% of 11 pancreatic ACCs and 1 mixed acinar endocrine carcinoma, but absent in 449 pancreatic ductal adenocarcinomas, 75 adenocarcinomas of the ampulla Vateri, and 11,739 other evaluable cancers from 128 different tumor entities. A weak to moderate diffuse staining of epithelial and stromal cells of cancer tissues immediately adjacent to non-neoplastic pancreatic acinar cells often occurred and was considered to be caused by the diffusion of the highly abundant CPA1 from normal acinar cells that may have suffered some autolytic cell damage. In conclusion, our data show that CPA1 is a highly sensitive and largely specific marker for normal and neoplastic pancreatic acinar cells. CPA1 immunohistochemistry greatly facilitates the otherwise often difficult diagnosis of pancreatic ACC.

Evaluation of the Incidence of Thyroid Cancer among Patients with Thyroid Nodules Attending to Suez Canal University Hospital

Background: Thyroid cancer is the most common endocrine carcinoma, as it accounts for almost 90% of all endocrine malignancies. Our objective was to determine prevalence of thyroid cancer in patients underwent thyroidectomyin Suez Canal University Hospital. Patients and Methods: Cross-sectional descriptive study was conducted on 81 patients attending to our surgical oncology outpatient who were candidate for total thyroidectomy or hemithyroidectomy. Patients were subjected toclinical examination including multinodular goiter or solitary nodule, complaint of patient: pressure manifestations, cosmetic disfigurement and thyrotoxicosis and cervical lymphadenopathy. Neck ultrasonography was done for cervical lymphadenopathy, solitary nodule or multi nodular, assessment by TI-RADS and size of nodule. Specimens were sent to our pathology department. Results: Mean age of the patients was 48.83±11.01 years.75% were females. The chief complaint was neck lump (46.9%) and pressure symptoms (45.7%). Fifty percent of the patients had thyroid nodular size 1–4cm and 69.2% of were multi-nodular.69.2% of the patients had total thyroidectomy while 30.8% had hemi-thyroidectomy. Incidence of thyroid carcinoma was 26% as: papillary (18.5%), follicular carcinoma (3.7%), medullary carcinoma (2.5%) and anaplastic (1.2%). Thyroid carcinoma was associated with solitary nodule (55%), in the left lobe (42.8%), cervical lymph node (30%) and TIRADS 5 (42.8%). Conclusion: Incidence of thyroid carcinoma in Suez Canal University hospital is 26%. The most frequent histopathology type is papillary carcinoma. Females were the most affected. The pressure symptom was the most complaint in benign nodules while neck lump was the most common in malignant nodules. TIRADS 5 was the most frequent in all malignant nodules.

28154 Endocrine mucin-producing sweat gland carcinoma in a patient with metastatic melanoma

A 55-year-old male with metastatic melanoma recently off immunotherapy presented with a 1-year history of an asymptomatic, slow growing mass on his right eyelid. Examination revealed a 3-mm well-circumscribed flesh-colored papule on the right upper eyelid margin. Excision performed by oculoplastics showed a multinodular superficial cystic and deep solid dermal neoplasm. The cystic component was comprised of an epithelial lining two layers thick. The deep solid component had foci of papillary change. Lesional cells had nuclear contours with small nuceloli and sparse pale granular eosinophilic cytoplasm. Scattered mitoses were present and high-grade atypia was absent. The tumor was positive for chromogranin A, CK7, EMA, BerEp4, synaptophysin (patchy), ER, and PR. MelanA, CK20, and CD56 were negative. P63 highlighted myoepithelial cells around the tumor. Based on the histopathologic and immunohistochemical features, endocrine mucin-producing sweat gland carcinoma (EMPSGC) was diagnosed. EMPSGC is an uncommon low-grade carcinoma with histopathologic and immunohistochemical features of solid, papillary breast carcinoma. Diagnosis can be difficult given its rarity and broad clinical differential diagnosis. The key immunohistochemical feature is neuroendocrine expression; tumors also often co-express estrogen and progesterone receptors. Elaboration of a myoepithelial layer surrounding the tumor is prudent to evaluate for invasive tumor. Although EMPSGC is a low-grade carcinoma with no reported cases of metastases, complete surgical excision is recommended given local recurrence and concern for progression to invasive mucinous carcinoma. Our patient’s tumor was completely excised via Mohs micrographic surgery with closure by oculoplastics. To our knowledge, there is no known association between EMPSGC and melanoma.

Pancreatic cancer incidence trends in the United States from 2000-2017: Analysis of Surveillance, Epidemiology and End Results (SEER) database

Background: Recent incidence trends of pancreatic cancers were reviewed by demographics and histologic type to observe any new findings.Methods: Data was used from the Surveillance, Epidemiology, and End Results (SEER) registry 18 (2000-2017) and it underwent temporal trend analysis. Pancreatic cancer incidence rates were reported based on histological subtype and demographics.Results: The incidence rate of white males increased significantly during 2000-2017 (annual percent change (APC) = 3.5%) compared to previously reported APCs. The incidence of white females grew from an APC of 1.29% to 2.9%. Rates among black ethnicity increased with an APC of 4.2%. Rates among Hispanics and other ethnicities also showed increment. The rates for ductal adenocarcinoma showed a positive trend in all races, with the APC ≥ 6 % for females and APC ≥ 6.5 % for males. The rates of non-secretory endocrine tumors showed a decline in both genders of all five races in recent years after showing an initial positive trend till 2010. Rates for pancreatic adenocarcinoma continued to rise in all ethnicities from 2000-2017. Interestingly, there was a rise in carcinoid type pancreatic neuroendocrine tumors (PNETs) in all ethnicities. Cumulatively, males had a higher incidence than females; male to female Incidence Risk Ratio (IRRs) was 1.32. The IRR was > 1 for age groups ≥ 35 years. The male to female IRRs was less than 1 for cystic adenocarcinoma, secretory endocrine, and solid pseudopapillary carcinomas (IRR = 0.5, 0.9, and 0.2 respectively, confidence intervals 0.4–0.6 and 0.9-1.3, 0.2–0.3, respectively).Conclusion: Pancreatic cancer incidence continued to rise in the years 2000-2017. However, incidence differed by demographics and histologic type. Interestingly, recent years discerned a rise in PNETs (carcinoid type) which has not been reported previously.

Pancreatic cancer incidence trends in the United States from 2000-2017: Analysis of Surveillance, Epidemiology and End Results (SEER) database.

Background:Recent incidence trends of pancreatic cancers were reviewed by demographics and histologic type to observe any new findings. Methods:Data was used from the Surveillance, Epidemiology, and End Results (SEER)registry 18 (2000-2017) anditunderwent temporal trend analysis. Pancreatic cancer incidence rates were reported based on histological subtype and demographics. Results:The incidence rate of white males increased significantly during 2000-2017 (annual percent change (APC) = 3.5%) compared to previously reported APCs. The incidence of white females grew from an APC of 1.29% to 2.9%. Rates among black ethnicity increased with an APC of 4.2%. Rates among Hispanics and other ethnicities also showed increment. The rates for ductal adenocarcinoma showed a positive trend in all races, with the APC ≥ 6 % for females and APC ≥ 6.5 % for males. The rates of non-secretory endocrine tumors showed a decline in both genders of all five races in recent years after showing an initial positive trend till 2010. Rates for pancreatic adenocarcinoma continued to rise in all ethnicities from 2000-2017. Interestingly, there was a rise in carcinoid type pancreatic neuroendocrine tumors (PNETs) in all ethnicities.Cumulatively, males had a higher incidence than females; male tofemale IncidenceRiskRatio (IRRs) was 1.32. The IRR was > 1 for age groups ≥ 35 years. Themale tofemale IRRs was less than 1 for cystic adenocarcinoma, secretory endocrine, and solid pseudopapillary carcinomas (IRR = 0.5, 0.9, and 0.2 respectively, confidence intervals 0.4-0.6 and 0.9-1.3, 0.2-0.3, respectively). Conclusion: Pancreatic cancer incidence continued to rise in the years 2000-2017. However, incidence differed by demographics and histologic type. Interestingly,recent years discerned a rise in PNETs (carcinoid type)whichhas not been reported previously.