Saller James, Hough Brooke, Coppola Domenico
Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, U.S.A.
Department of Pathology, Florida Digestive Health Specialists, Bradenton, FL, U.S.A.
Cancer Diagn Progn. 2021 Jul 3;1(4):285-288. doi: 10.21873/cdp.10037. eCollection 2021 Sep-Oct.
Pancreatic-type mixed acinar-neuroendocrine carcinoma (PMANEC) in the stomach is very rare. We report a case of PMANEC that was initially misdiagnosed as a gastric neuroendocrine tumor.
A 63-year-old female was found to have a gastric mass by histology and immunohistochemistry. The tumor had a heterogenous histology, with areas resembling pancreatic acinar cell carcinoma and other areas exhibiting neuroendocrine features. Only the neuroendocrine component was present in the initial biopsy, resulting in the erroneous diagnosis of gastric neuroendocrine tumor. Evaluation of the final resected tumor revealed cells expressing pancreatic exocrine markers, including trypsin and chymotrypsin and BCL10 immune signaling adaptor. Large areas of the tumor (>30%) were also positive for chromogranin A and synaptophysin. The final diagnosis was PMANEC.
This type of gastric cancer is rare and may cause diagnostic difficulty, especially if only the neuroendocrine component of the tumor is sampled in a biopsy.
胃胰腺型混合性腺泡-神经内分泌癌（PMANEC）非常罕见。我们报告一例最初被误诊为胃神经内分泌肿瘤的PMANEC病例。
一名63岁女性经组织学和免疫组化检查发现胃部有肿块。肿瘤组织学表现异质性，部分区域类似胰腺腺泡细胞癌，其他区域具有神经内分泌特征。最初的活检仅发现神经内分泌成分，导致误诊为胃神经内分泌肿瘤。对最终切除肿瘤的评估显示，细胞表达胰腺外分泌标志物，包括胰蛋白酶、糜蛋白酶和BCL10免疫信号衔接蛋白。肿瘤大片区域（>30%）嗜铬粒蛋白A和突触素也呈阳性。最终诊断为PMANEC。
这种类型的胃癌很罕见，可能导致诊断困难，尤其是在活检时仅取到肿瘤的神经内分泌成分。
