The prevalence of pancreatic acinar differentiation in gastric adenocarcinoma: Report of a case and immunohistochemical study of 111 additional cases

Hwajeong Lee, Laura H. Tang, Emanuela F. Veras, David S. Klimstra

Research output: Contribution to journalArticle

Abstract

Although pancreatic acinar metaplasia in the gastric mucosa is well recognized in chronic gastritis, gastric carcinoma with acinar differentiation is very rare. We encountered a case of gastric adenocarcinoma with prominent histologic and immunohistochemical features of pancreatic acinar differentiation in the absence of identifiable heterotopic pancreatic tissue. Distinct glandular and diffuse patterns of adenocarcinoma were also present, and there was focal mucin production. The tumor strongly expressed pancreatic exocrine enzymes trypsin and chymotrypsin, and focal neuroendocrine staining was also present. To investigate the prevalence of acinar differentiation in histologically typical gastric cancers, we performed immunohistochemical staining for trypsin and chymotrypsin on a tissue microarray containing 111 conventional gastric adenocarcinomas (60 intestinal, 28 mixed, 22 diffuse type, and 1 undifferentiated). No obvious morphologic evidence of acinar differentiation was identified in any of the 111 cases. Although some cases showed equivocal staining for at least 1 pancreatic exocrine enzyme on the initial tissue microarray sections, repeat immunohistochemical staining on representative whole-tissue sections failed to reproduce positive staining. Thus, acinar differentiation is rare in gastric adenocarcinomas, other than in histologically unusual cases such as the one we report, and in others from the literature, which are reviewed.

Original languageEnglish (US)
Pages (from-to)402-408
Number of pages7
JournalAmerican Journal of Surgical Pathology
Volume36
Issue number3
DOIs
StatePublished - Mar 2012
Externally publishedYes

Fingerprint

Stomach
Adenocarcinoma
Staining and Labeling
Acinar Cell Carcinoma
Choristoma
Metaplasia
Mucins
Gastritis
Enzymes
Gastric Mucosa
Stomach Neoplasms
Neoplasms
trypsin drug combination chymotrypsin

Keywords

  • acinar cell carcinoma
  • acinar differentiation
  • chymotrypsin
  • gastric cancer
  • immunohistochemistry
  • pancreatic metaplasia
  • trypsin

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine
  • Surgery

Cite this

The prevalence of pancreatic acinar differentiation in gastric adenocarcinoma : Report of a case and immunohistochemical study of 111 additional cases. / Lee, Hwajeong; Tang, Laura H.; Veras, Emanuela F.; Klimstra, David S.

In: American Journal of Surgical Pathology, Vol. 36, No. 3, 03.2012, p. 402-408.

Research output: Contribution to journalArticle

@article{8476d53c53394a9fa76d2b457e223f4c,
title = "The prevalence of pancreatic acinar differentiation in gastric adenocarcinoma: Report of a case and immunohistochemical study of 111 additional cases",
abstract = "Although pancreatic acinar metaplasia in the gastric mucosa is well recognized in chronic gastritis, gastric carcinoma with acinar differentiation is very rare. We encountered a case of gastric adenocarcinoma with prominent histologic and immunohistochemical features of pancreatic acinar differentiation in the absence of identifiable heterotopic pancreatic tissue. Distinct glandular and diffuse patterns of adenocarcinoma were also present, and there was focal mucin production. The tumor strongly expressed pancreatic exocrine enzymes trypsin and chymotrypsin, and focal neuroendocrine staining was also present. To investigate the prevalence of acinar differentiation in histologically typical gastric cancers, we performed immunohistochemical staining for trypsin and chymotrypsin on a tissue microarray containing 111 conventional gastric adenocarcinomas (60 intestinal, 28 mixed, 22 diffuse type, and 1 undifferentiated). No obvious morphologic evidence of acinar differentiation was identified in any of the 111 cases. Although some cases showed equivocal staining for at least 1 pancreatic exocrine enzyme on the initial tissue microarray sections, repeat immunohistochemical staining on representative whole-tissue sections failed to reproduce positive staining. Thus, acinar differentiation is rare in gastric adenocarcinomas, other than in histologically unusual cases such as the one we report, and in others from the literature, which are reviewed.",
keywords = "acinar cell carcinoma, acinar differentiation, chymotrypsin, gastric cancer, immunohistochemistry, pancreatic metaplasia, trypsin",
author = "Hwajeong Lee and Tang, {Laura H.} and Veras, {Emanuela F.} and Klimstra, {David S.}",
year = "2012",
month = "3",
doi = "10.1097/PAS.0b013e318238369e",
language = "English (US)",
volume = "36",
pages = "402--408",
journal = "American Journal of Surgical Pathology",
issn = "0147-5185",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - The prevalence of pancreatic acinar differentiation in gastric adenocarcinoma

T2 - Report of a case and immunohistochemical study of 111 additional cases

AU - Lee, Hwajeong

AU - Tang, Laura H.

AU - Veras, Emanuela F.

AU - Klimstra, David S.

PY - 2012/3

Y1 - 2012/3

N2 - Although pancreatic acinar metaplasia in the gastric mucosa is well recognized in chronic gastritis, gastric carcinoma with acinar differentiation is very rare. We encountered a case of gastric adenocarcinoma with prominent histologic and immunohistochemical features of pancreatic acinar differentiation in the absence of identifiable heterotopic pancreatic tissue. Distinct glandular and diffuse patterns of adenocarcinoma were also present, and there was focal mucin production. The tumor strongly expressed pancreatic exocrine enzymes trypsin and chymotrypsin, and focal neuroendocrine staining was also present. To investigate the prevalence of acinar differentiation in histologically typical gastric cancers, we performed immunohistochemical staining for trypsin and chymotrypsin on a tissue microarray containing 111 conventional gastric adenocarcinomas (60 intestinal, 28 mixed, 22 diffuse type, and 1 undifferentiated). No obvious morphologic evidence of acinar differentiation was identified in any of the 111 cases. Although some cases showed equivocal staining for at least 1 pancreatic exocrine enzyme on the initial tissue microarray sections, repeat immunohistochemical staining on representative whole-tissue sections failed to reproduce positive staining. Thus, acinar differentiation is rare in gastric adenocarcinomas, other than in histologically unusual cases such as the one we report, and in others from the literature, which are reviewed.

AB - Although pancreatic acinar metaplasia in the gastric mucosa is well recognized in chronic gastritis, gastric carcinoma with acinar differentiation is very rare. We encountered a case of gastric adenocarcinoma with prominent histologic and immunohistochemical features of pancreatic acinar differentiation in the absence of identifiable heterotopic pancreatic tissue. Distinct glandular and diffuse patterns of adenocarcinoma were also present, and there was focal mucin production. The tumor strongly expressed pancreatic exocrine enzymes trypsin and chymotrypsin, and focal neuroendocrine staining was also present. To investigate the prevalence of acinar differentiation in histologically typical gastric cancers, we performed immunohistochemical staining for trypsin and chymotrypsin on a tissue microarray containing 111 conventional gastric adenocarcinomas (60 intestinal, 28 mixed, 22 diffuse type, and 1 undifferentiated). No obvious morphologic evidence of acinar differentiation was identified in any of the 111 cases. Although some cases showed equivocal staining for at least 1 pancreatic exocrine enzyme on the initial tissue microarray sections, repeat immunohistochemical staining on representative whole-tissue sections failed to reproduce positive staining. Thus, acinar differentiation is rare in gastric adenocarcinomas, other than in histologically unusual cases such as the one we report, and in others from the literature, which are reviewed.

KW - acinar cell carcinoma

KW - acinar differentiation

KW - chymotrypsin

KW - gastric cancer

KW - immunohistochemistry

KW - pancreatic metaplasia

KW - trypsin

UR - http://www.scopus.com/inward/record.url?scp=84857649501&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84857649501&partnerID=8YFLogxK

U2 - 10.1097/PAS.0b013e318238369e

DO - 10.1097/PAS.0b013e318238369e

M3 - Article

C2 - 22082608

AN - SCOPUS:84857649501

VL - 36

SP - 402

EP - 408

JO - American Journal of Surgical Pathology

JF - American Journal of Surgical Pathology

SN - 0147-5185

IS - 3

ER -