Presence of alpha-1-antitrypsin in pancreatic carcinoma. Report of four cases in association with hepatic storage of the protease inhibitor.

Among 13 patients with accumulation of alpha-1-antitrypsin (AAT) globules in periportal hepatocytes, 4 were found to have a pancreatic malignant tumor. Three tumors presented features of well-differentiated adenocarcinoma, the fourth was a poorly differentiated carcinoma displaying a glandular differentiation in its lymph node metastases. AAT immunoreactivity was detected in tumor cells from all 4 cases in either the primary or metastatic site. Two tumors contained Grimelius-positive cells; most of them were also positive for AAT. In addition, AAT immunoreactivity was observed in cells from normal large excretory ducts of the pancreas. AAT-positive tumor cells were negative on staining for other normal plasma (e.g. albumin and fibrinogen) or tissue-associated proteins (e.g. alpha-fetoprotein and human chorionic gonadotrophin). The findings appear to suggest: the pancreas adenocarcinoma as an additional malignant tumor with AAT positivity; a possible malignant proliferation of AAT containing cells in the pancreas ducts; a possible association between AAT accumulation in the liver and pancreatic adenocarcinoma.