Virchows Archiv

, Volume 457, Issue 6, pp 643–649 | Cite as

Vacuolated cell pattern of pancreatobiliary adenocarcinoma: a clinicopathological analysis of 24 cases of a poorly recognized distinctive morphologic variant important in the differential diagnosis

  • Nevra Dursun
  • Jining Feng
  • Olca Basturk
  • Sudeshna Bandyopadhyay
  • Jeanette D. Cheng
  • Volkan N. Adsay
Original Article

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.

Keywords

Pancreas Pancreatobiliary Ductal Adenocarcinoma Vacuolated Lipoid Signet ring Cribriform 

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Nevra Dursun
    • 1
  • Jining Feng
    • 2
  • Olca Basturk
    • 3
  • Sudeshna Bandyopadhyay
    • 2
  • Jeanette D. Cheng
    • 4
  • Volkan N. Adsay
    • 5
  1. 1.Department of PathologyIstanbul Education and Research HospitalIstanbulTurkey
  2. 2.Department of PathologyKarmanos Cancer Institute and Wayne State UniversityDetroitUSA
  3. 3.Department of PathologyMemorial Sloan–Kettering Cancer CenterNew YorkUSA
  4. 4.Department of PathologyPiedmont HospitalAtlantaUSA
  5. 5.Department of Pathology and Laboratory MedicineEmory University HospitalAtlantaUSA

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