Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Jul 3;1(4):285-288.
doi: 10.21873/cdp.10037. eCollection 2021 Sep-Oct.

Pancreatic-type Mixed Acinar-neuroendocrine Carcinoma of the Stomach: A Case Report and Literature Review

James Saller  1 , Brooke Hough  2 , Domenico Coppola  1   2
Affiliations
Case Reports

Pancreatic-type Mixed Acinar-neuroendocrine Carcinoma of the Stomach: A Case Report and Literature Review

James Saller et al. Cancer Diagn Progn. .

Abstract

Background: 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.

Case report: 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.

Conclusion: 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.

Keywords: Acinar cell carcinoma; immunohistochemistry; mixed acinar-neuroendocrine carcinoma; stomach.

PubMed Disclaimer

Conflict of interest statement

The Authors have no conflicts of interest to report.

Figures

Figure 1
Figure 1. The features of gastric pancreatic-type mixed acinarneuroendocrine carcinoma (hematoxylin and eosin). A: Low-power view showing the tumor’s overall high cellularity, with minimal stroma and no evidence of desmoplastic reaction (bar=200 μm). B: Intermediate-power view showing tumor areas exhibiting a trabecular pattern and acinar structures with small lumina and basally located nuclei (bar=50 μm). C: High-power view showing one of the solid tumor areas characterized by monotonous cells with amphophilic cytoplasm and round nuclei exhibiting prominent nucleoli (bar=20 μm). Several mitoses are present.
Figure 2
Figure 2. Immunohistochemical features of the gastric pancreatic-type mixed acinar-neuroendocrine carcinoma. The tumor stained strongly for chymotrypsin (A; bar=100 μm) and BCL10 immune signaling adaptor (B; bar=100 μm). The neuroendocrine component was strongly and diffusely positive for synaptophysin (C; bar=50 μm). The adjacent area of acinar cell carcinoma component showed focal and weak synaptophysin positivity (C).
See this image and copyright information in PMC

References

    1. Klimstra DS, Heffess CS, Oertel JE, Rosai J. Acinar cell carcinoma of the pancreas. A clinicopathologic study of 28 cases. Am J Surg Pathol. 1992;16(9):815–837. doi: 10.1097/00000478-199209000-00001. - DOI - PubMed
    1. Klimstra DS, Rosai J, Heffess CS. Mixed acinar-endocrine carcinomas of the pancreas. Am J Surg Pathol. 1994;18(8):765–778. doi: 10.1097/00000478-199408000-00002. - DOI - PubMed
    1. Lloyd R, Osamura R, Klöppel G, Rosai J. IARC Press, Lyon. 2017. WHO Classification of Tumours of Endocrine Organs, Vol. 10., Fourth Edition.
    1. Fujita Y, Uesugi N, Sugimoto R, Eizuka M, Matsumoto T, Sugai T. Gastric mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) with pancreatic acinar differentiation: a case report. Diagn Pathol. 2019;14(1):38. doi: 10.1186/s13000-019-0815-3. - DOI - PMC - PubMed
    1. Kim KM, Kim CY, Hong SM, Jang KY. A primary pure pancreatic-type acinar cell carcinoma of the stomach: a case report. Diagn Pathol. 2017;12(1):10. doi: 10.1186/s13000-017-0601-z. - DOI - PMC - PubMed

Publication types

LinkOut - more resources