Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New YorK, USA.
Cancer Cytopathol. 2013 Aug;121(8):459-70. doi: 10.1002/cncy.21279. Epub 2013 Feb 13.
Acinar cell neoplasms of the pancreas are rare but when encountered, the diagnosis is often established based on cytology specimens. Diagnostic accuracy is important because acinar cell carcinomas are aggressive yet may mimic tumors with different outcomes and management.
The authors identified all patients with a diagnosis of acinar cell neoplasm in the institutional database; assessed cytomorphology and immunocytochemistry for trypsin, chymotrypsin, synaptophysin, chromogranin A, and MIB-1; and compared all cytology and final histological diagnoses for diagnostic discrepancies.
Cytological features were described for 16 histologically proven malignant acinar cell neoplasms: acinar cell carcinoma (8 cases), mixed acinar-neuroendocrine carcinoma (6 cases), mixed acinar-ductal carcinoma (1 case), and pancreatoblastoma (1 case).The majority of aspirates from acinar cell cystadenomas were nondiagnostic or negative (5 of 6 cases; 83%). Acinar and neuroendocrine differentiation that was detected by immunocytochemistry in >20% of tumor cells was found to be correlated with mixed acinar-neuroendocrine carcinoma histology. Cytohistological correlation included 32 patients with 17 discordant diagnoses (53%). The following preoperative cytology diagnoses proved to be acinar cell neoplasms on resection: neuroendocrine tumor (5 cases), adenocarcinoma (5 cases), atypical ductal cells (2 cases), solid pseudopapillary neoplasm, and hepatocellular carcinoma. Three aspirates diagnosed as acinar cell carcinoma by cytology proved to be chronic pancreatitis (2 cases) and ductal adenocarcinoma (1 case).
Acinar cell carcinoma has a distinctive cytological appearance but is frequently misdiagnosed on cytology. Immunocytochemistry is useful for identifying acinar differentiation.
胰腺腺泡细胞肿瘤较为罕见，但在遇到时，其诊断通常基于细胞学标本。诊断准确性很重要，因为腺泡细胞癌具有侵袭性，但可能模仿具有不同结果和处理方式的肿瘤。
作者在机构数据库中确定了所有诊断为腺泡细胞肿瘤的患者；评估了细胞学形态和免疫细胞化学中的胰蛋白酶、糜蛋白酶、突触素、嗜铬粒蛋白 A 和 MIB-1；并比较了所有细胞学和最终组织学诊断的诊断差异。
对 16 例经组织学证实的恶性腺泡细胞肿瘤的细胞学特征进行了描述：腺泡细胞癌（8 例）、混合性腺泡-神经内分泌癌（6 例）、混合性腺泡-导管癌（1 例）和胰母细胞瘤（1 例）。大多数腺泡细胞囊腺瘤的抽吸物为非诊断性或阴性（6 例中的 5 例；83%）。在>20%的肿瘤细胞中检测到的腺泡和神经内分泌分化与混合性腺泡-神经内分泌癌的组织学相关。细胞组织学相关性包括 32 例患者中有 17 例存在不一致的诊断（53%）。术前细胞学诊断为神经内分泌肿瘤（5 例）、腺癌（5 例）、非典型导管细胞（2 例）、实性假乳头状肿瘤和肝细胞癌的患者，在切除后被证实为腺泡细胞肿瘤。3 例细胞学诊断为腺泡细胞癌的抽吸物被证实为慢性胰腺炎（2 例）和导管腺癌（1 例）。
腺泡细胞癌具有独特的细胞学表现，但在细胞学上经常被误诊。免疫细胞化学对于识别腺泡分化很有用。
