Vacuolated cell pattern of pancreatobiliary adenocarcinoma: a clinicopathological analysis of 24 cases of a poorly recognized distinctive morphologic variant important in the differential diagnosis |
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Authors: | Nevra Dursun Jining Feng Olca Basturk Sudeshna Bandyopadhyay Jeanette D Cheng Volkan N Adsay |
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Institution: | (1) Department of Pathology, Istanbul Education and Research Hospital, Istanbul, Turkey;(2) Department of Pathology, Karmanos Cancer Institute and Wayne State University, Detroit, MI, USA;(3) Department of Pathology, Memorial Sloan–Kettering Cancer Center, New York, NY, USA;(4) Department of Pathology, Piedmont Hospital, Atlanta, GA, USA;(5) Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Road NE, Room H-180B, Atlanta, GA 30322, USA; |
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Abstract: | Pancreatic ductal adenocarcinoma (PDCA) is characterized by well-defined tubular units in the vast majority of the cases;
however, variations in this theme do occur. It is important to recognize the morphologic spectrum of PDCA to avoid misdiagnosis
especially in small specimens and also in metastatic foci. Here, we document a morphologic variant of PDCA that is characterized
by a distinctive pattern of infiltrating cribriform nests in a distinctive “microcystic” or “secretory” pattern. Twenty-four
cases of PDCA have been identified in a review of 505 cases diagnosed with PDCA. Histologically, this pattern was characterized
by infiltrating nests of tumor cells with large vacuoles and “signet-ring” like appearance imparting a cribriform growth pattern.
The vacuoles were one to five cells in size, often merging to form multilocular spaces separated by a thin rim of cell membrane.
Many of these spaces contained CA19.9 positive granular secretory material. The nuclei were often pushed to the periphery
and compressed in a pattern resembling adipocytes, although the nuclei were often densely hyperchromatic and displayed significant
atypia. Especially in biopsies from the peripancreatic fat and peritoneum, these neoplastic cells had been misdiagnosed as
degenerating adipocytes, and in the lymph nodes, they had been misinterpreted as lipogranulomas. Clinical findings of the
patients were similar to that of conventional PDCA, except higher incidence of history of smoking (83% vs. 60%; p = 0.034). In conclusion, vacuolated cell adenocarcinoma is a distinct morphologic variant of PDCA, and the presence of this
peculiar pattern in a metastatic site, although not specific, should raise the suspicion of a PDCA. |
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