Clinicopathologic study of 62 acinar cell carcinomas of the pancreas: Insights into the morphology and immunophenotype and search for prognostic markers

Stefano La Rosa, Volkan Adsay, Luca Albarello, Sofia Asioli, Selenia Casnedi, Francesca Franzi, Alessandro Marando, Kenji Notohara, Fausto Sessa, Alessandro Vanoli, Lizhi Zhang, Carlo Capella

Research output: Contribution to journalArticle

88 Scopus citations

Abstract

Acinar cell carcinoma (ACC) of the pancreas is a very rare tumor that has various morphologic features, which may give rise to diagnostic difficulties. Because of its rarity, many clinicopathologic characteristics remain to be further elucidated, and prognostic factors are yet to be well established. With the aim of better characterizing this carcinoma and searching for prognostic indicators, we collected 62 ACCs and investigated the following parameters: site, size, local infiltration, node and distant metastases, architectural pattern, nuclear atypia, presence of necrosis, lymphovascular and perineural invasion, proliferation, BCL10, trypsin, carboxyl ester lipase, amylase, lipase, PDX1, cytokeratin 19 (CK19), CK7, p53, and β-catenin expression. Twelve cases showing >30% of endocrine cells were reclassified as mixed acinar-neuroendocrine carcinomas, whereas 1 tumor was reclassified as a mixed ductal-acinar carcinoma and was excluded from the statistical prognostic evaluations. BCL10 and trypsin were the most reliable immunohistochemical markers, whereas amylase and lipase were not. Surgery was statistically correlated with a better prognosis (P=0.0008). Among resected tumors there was no difference in survival between ACCs and mixed acinar-neuroendocrine carcinomas, and factors that significantly correlated with poor prognosis were size >6.5 cm (P=0.004), lymph node (P=0.0039) and distant (P=0.008) metastases, and UICC stage (P=0.009). Stage was the only independent prognostic factor at multivariable analysis, and the best prognostic discrimination was observed on grouping together stages I and II and grouping together stages III and IV, suggesting a simplification of the UICC staging for such cancers. In addition, vascular and perineural invasion and CK19 and p53 expression showed a trend for poor prognosis, not reaching statistical significance.

Original languageEnglish (US)
Pages (from-to)1782-1795
Number of pages14
JournalAmerican Journal of Surgical Pathology
Volume36
Issue number12
DOIs
StatePublished - Dec 1 2012

Keywords

  • acinar cell carcinoma
  • morphology
  • pancreas
  • prognostic markers

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

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    La Rosa, S., Adsay, V., Albarello, L., Asioli, S., Casnedi, S., Franzi, F., Marando, A., Notohara, K., Sessa, F., Vanoli, A., Zhang, L., & Capella, C. (2012). Clinicopathologic study of 62 acinar cell carcinomas of the pancreas: Insights into the morphology and immunophenotype and search for prognostic markers. American Journal of Surgical Pathology, 36(12), 1782-1795. https://doi.org/10.1097/PAS.0b013e318263209d