Toyonaga Yasuhiro, Yamazaki Kazuto, Yamada Masatoshi, Koyasu Takayoshi, Koyama Yoshinori, Ishida Yasuo
Department of Pathology, Teikyo University, Chiba Medical Center, Ichihara, Japan.
Diagn Cytopathol. 2014 Apr;42(4):321-4. doi: 10.1002/dc.23087. Epub 2013 Dec 20.
We describe a rare case of pancreatic acinar cell carcinoma (ACC) with intraductal growth in a 77-year-old man, which was diagnosed by endoscopic brush cytology. Preoperative imaging revealed an ill-defined mass involving the main pancreatic duct of the body, which was suspected to be an invasive ductal carcinoma. Endoscopic brush cytology showed several thick, small to large clusters of tumor cells. However, a loosely cohesive or individual cell arrangement was more prominent. Singly dispersed naked nuclei, occasionally with crush artifact, were frequently observed. The nuclear contour was smooth and chromatin was finely clumped. The cytoplasm contained many coarse D-PAS-positive granules. Histologically, the tumor expansively invaded to parenchyma and expanded to fill the pancreatic ducts. Ultrastructurally, the tumor cells were less cohesive with scarce tight junctions, and their cytoplasm contained numerous zymogen granules and filamentous inclusions. Although ACCs usually show expansive growth, the incidence of intraductal extension may be higher than previously considered. A few of the characteristic cytomorphological features described here may be useful for differential diagnosis of this tumor from malignant epithelioid neoplasms involving the large pancreatic ducts.
我们描述了一例77岁男性胰腺腺泡细胞癌（ACC）伴导管内生长的罕见病例，该病例通过内镜刷检细胞学得以诊断。术前影像学检查显示，体部主胰管有一界限不清的肿块，怀疑为浸润性导管癌。内镜刷检细胞学检查显示有几个大小不一的厚肿瘤细胞团簇。然而，松散黏附或单个细胞排列更为突出。经常观察到单个分散的裸核，偶尔伴有挤压假象。核轮廓光滑，染色质细颗粒状聚集。细胞质含有许多粗大的D-PAS阳性颗粒。组织学上，肿瘤呈膨胀性侵犯实质并扩展至充满胰管。超微结构上，肿瘤细胞黏附性较差，紧密连接稀少，其细胞质含有大量酶原颗粒和丝状包涵体。尽管ACC通常表现为膨胀性生长，但导管内延伸的发生率可能比之前认为的更高。这里描述的一些特征性细胞形态学特征可能有助于将该肿瘤与累及大胰管的恶性上皮样肿瘤进行鉴别诊断。
