Ohike Nobuyuki, Kosmahl Markus, Klöppel Günter
First Department of Pathology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, 42-8555 Tokyo, Japan.
Virchows Arch. 2004 Sep;445(3):231-5. doi: 10.1007/s00428-004-1037-x. Epub 2004 Jul 29.
We compared the clinicopathological features of acinar-cell carcinomas (ACCs) with those of mixed acinar-endocrine carcinomas (MAECs). Specimens from 37 patients with ACC and 6 patients with MAEC were examined histologically and immunohistochemically. The mean age of ACC and MAEC patients was similar (61.3 years versus 58.4 years), but the sex ratio differed (ACC, 29 males and 8 females; MAEC, 2 males and 4 females). The size of the tumor was large in both cases (ACC, 13.8 cm in diameter; MAEC, 8.2 cm). Immunohistochemically, more than half of the tumor cells in all tumors, whether ACC or MAEC, stained for trypsin. In 20 of the 37 ACCs (54%), scattered endocrine cells (SECs) were found, which stained positively for synaptophysin (SYN) and/or chromogranin A (CGA). Interestingly, there was also a difference in the sex ratio between ACC patients without SECs (16 males and 1 female) and ACC patients with SECs (13 males and 7 females). In MAECs, the cells staining for SYN were more common than those staining for CGA and made up more than one-third of the neoplastic-cell population. In all but one case (in which the endocrine component was arranged in islet-like cell clusters), the endocrine cells were intimately mixed with trypsin-positive tumor cells. The endocrine cells only rarely expressed one of the known pancreatic or gastrointestinal hormones. Both ACCs and MAECs had a high proliferation rate and lacked p53 overexpression or progesterone and estrogen receptors. This study revealed that ACCS and MAECs share most clinicopathological features and, therefore, may form a single tumor entity, though they differ in the number of endocrine cells. The frequent identification of endocrine cells in these tumors suggests the existence of a pluripotent cell of origin that is capable of differentiating into acinar and endocrine cells.
我们比较了腺泡细胞癌（ACCs）和腺泡-内分泌混合癌（MAECs）的临床病理特征。对37例ACC患者和6例MAEC患者的标本进行了组织学和免疫组织化学检查。ACC和MAEC患者的平均年龄相似（分别为61.3岁和58.4岁），但性别比例不同（ACC，29例男性和8例女性；MAEC，2例男性和4例女性）。两种情况下肿瘤大小均较大（ACC，直径13.8 cm；MAEC，直径8.2 cm）。免疫组织化学显示，无论是ACC还是MAEC，所有肿瘤中超过一半的肿瘤细胞胰蛋白酶染色阳性。在37例ACC中的20例（54%）中发现了散在的内分泌细胞（SECs），这些细胞突触素（SYN）和/或嗜铬粒蛋白A（CGA）染色呈阳性。有趣的是，无SECs的ACC患者（16例男性和1例女性）与有SECs的ACC患者（13例男性和7例女性）之间的性别比例也存在差异。在MAECs中，SYN染色的细胞比CGA染色的细胞更常见，且占肿瘤细胞总数的三分之一以上。除1例（内分泌成分呈胰岛样细胞簇排列）外，所有病例中内分泌细胞均与胰蛋白酶阳性肿瘤细胞紧密混合。内分泌细胞仅很少表达已知的胰腺或胃肠激素之一。ACCs和MAECs均具有高增殖率，且缺乏p53过表达以及孕激素和雌激素受体。本研究表明，ACCs和MAECs具有大多数临床病理特征，因此可能构成一个单一的肿瘤实体，尽管它们在内分泌细胞数量上有所不同。这些肿瘤中内分泌细胞的频繁发现提示存在一种能够分化为腺泡细胞和内分泌细胞的多能起源细胞。
