Pancreas
Acinar cell tumors
Mixed tumors

Author: Deepali Jain, M.D. (see Authors page)

Revised: 12 December 2017, last major update August 2012

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Mixed tumors pancreas[TI]

Cite this page: Jain, D. Mixed tumors. PathologyOutlines.com website. http://pathologyoutlines.com/topic/pancreasmixed.html. Accessed December 13th, 2017.
Definition / general
  • Significant amount (some authors - 25%) of each component
  • "Collision tumors" have 2 topographically separate neoplasms and are not considered "mixed"
Diagrams / tables

Images hosted on other servers:

Proposed classification system for mixed tumors

Mixed acinar - ductal
Definition / general
  • Either (a) acinar component with extensive cytoplasmic or extracellular mucin pools, with positive mucin (mucicarmine, Alcian blue) and acinar (trypsin, chymotrypsin) staining or (b) ductal pattern of individual gland infiltration with desmoplasia but acinar differentiation by IHC
  • Highly aggressive (Am J Surg Pathol 2010;34:510)


Microscopic (histologic) images

Images hosted on other servers:

Top - ductal elements (right) are glandular and contain
intracellular mucin; acinar elements (left) are arranged in large nests
Bottom - acinar cells stain with trypsin, mucin associated
with ductal cells stain with Alcian blue

Mixed acinar - endocrine tumor
Definition / general

Case reports

Microscopic (histologic) images

Images hosted on other servers:

74 year old man

Mixed ductal - endocrine
Definition / general
  • Either (a) intermingled neoplastic ductal and neuroendocrine cells forming glandular / squamoid and solid structures or (b) moderately differentiated neoplastic ductal structures embedded in solid neuroendocrine component
  • Must rule out trapped benign ducts within an endocrine tumor
  • By definition, does not include ductal adenocarcinoma with scattered endocrine cells (see images below)


Case reports

Gross images

Images hosted on other servers:

65 year old woman
with 12 cm tumor
that infiltrated spleen
and splenic vessels

Separation of tumor types by fibrous band



Microscopic (histologic) images

Images hosted on PathOut server:

Poorly differentiated carcinoma

Endocrine component stains with somatostain

PAS diastase (purple)
highlights mucin,
somatostain highlights
endocrine component

Not a mixed tumor - well differentiated adenocarcinomas with scattered endocrine cells: left - synaptophysin+, right - tail tumor has numerous PP+ endocrine cells



Images hosted on other servers:

65 year old woman with 12 cm tumor that infiltrated spleen and splenic vessels:

Ductal component is well differentiated and CA19-9 positive

Endocrine component has irregular islands with central necrosis, is chromogranin+, synaptophysin+



Separation of tumor types by fibrous band

Various images - mixture of tumor types

Mixed acinar, ductal, endocrine tumor
Definition / general

Case reports

Microscopic (histologic) images

Images hosted on other servers:
   

56 year old man