Síndrome de hipersecreción de lipasa y lesiones óseas en el cáncer de células acinares del páncreas / Lipase hypersecretion syndrome and bone lesions in acinar cell cancer of the pancreas. Report of one case

Lipase hypersecretion syndrome (LHS) is a rare paraneoplastic syndrome, associated with acinar cell carcinoma of the pancreas (ACCP) in 10% to 15% of patients. Clinically, LHS manifests itself with the appearance of subcutaneous fibrocystic nodules, associated with trophic changes in the overlying skin, such as ulcers or fistulas that are difficult to manage, mainly affecting the lower extremities. Additionally, lipolysis near the joints and in the intraosseous adipose tissue can cause bilateral arthralgias, especially of the knees and ankles. We report a 57-year-old man, with a history of insulin resistance and allergic rhinitis, who presented in June 2019 with multiple subcutaneous nodules in the lower extremities, predominantly in both ankles, associated with arthralgia in that region. Additionally, a CT scan of the abdomen revealed a significant abdominal mass, measuring approximately 17 cm and in contact with the body and tail of the pancreas, pathologically compatible with an ACCP. Treatment with capecitabine was started with a favorable progression. The patient currently presents a small left lateral retro malleolar fistula, which, given the analyzes, studies and reviewed literature is concluded to be a lesion in the context of LHS.

Prognostic utility of epidermal growth factor receptor (EGFR) expression in prostatic acinar adenocarcinoma

Background: Epidermal growth factor receptor (EGFR) is potential prognostic biomarker expressed in many human cancers. Prognostic significance of EGFR immunohistochemical expression has not been established in prostatic acinar adenocarcinoma, therefore we aimed to evaluate the frequency of expression of EGFR in prostatic adenocarcinoma and its association with other prognostic parameters. Methods: The study included 123 cases of biopsy proven prostatic acinar adenocarcinoma treated at Liaquat National hospital, Karachi from January 2013 till December 2017. Paraffin blocks of all cases were retrieved; sections were cut and stained with haematoxylin and eosin. Pathologic characteristics including tumor quantification, WHO grade group, gleason score, perineural and lymphovascular invasion were evaluated. EGFR immunohistochemistry (IHC) was performed on all tissue blocks. Results: Mean age of the patients included in the study was 69.05±8.68years. High gleason scores i.e. 8 & 9 were noted in 22% (27 cases) and 22.8% (28 cases) respectively. Similarly, 22.8% (28 cases) showed WHO grade group 5. 52.8% (65 cases) had > 50% tissue involvement by carcinoma and perineural invasion was seen in 37.4% (46 cases). Positive EGFR expression was noted in 18.7% (23 cases), while 81.3% (100 cases) showed negative EGFR expression. Significant association of EGFR expression was noted with gleason score (p-value = < 0.001), WHO grade (p = < 0.001), tumor quantification (p =0.007) and perineural invasion (p = < 0.001). Moreover, significant association of EGFR expression was also seen with disease recurrence and Her2neu over expression. Patients with low gleason scores (score 6 and 7) and lower grade group (1, 2 & 3) were less likely to have positive EGFR expression as compared to patients with high gleason score (score 9) and higher grade group (5). Similarly, patients with perineural invasion were more likely to have positive EGFR expression. Conclusion: We found a relatively low EGFR expression in our patients with prostatic adenocarcinoma; however, its association with poor prognostic parameters like high gleason score, higher grade group, perineural invasion, higher tissue involvement by cancer and disease recurrence signifies its importance as a prognostic parameter in prostatic acinar adenocarcinoma (AU)

Incidental Discovery of Acinic Cell Carcinoma of the Oral Mucosa with Metachronous Adenoid Cystic Carcinoma of the Upper Lip / Hallazgo Incidental de Carcinoma de Células Acinares de la Mucosa Oral con Carcinoma Adenoide Quístico Metacrónico del Labio Superior

ABSTRACT: Multiple salivary gland tumors represent an unusual event characterized by the development of composite lesions originated from minor or major salivary glands. These neoplasms can be categorized into three perspectives: Histologic type, time of appearance and topographic distribution. We report an unusual case of a 73-year-old black man with an acinic cell carcinoma (ACC) of the oral mucosa discovered incidentally during surgical removal of an adjacent mucocele. Approximately one year after the first consultation, the patient was seen at the local cancer reference center with a third lesion that was diagnosed as an adenoid cystic carcinoma (AdCC) of the upper lip. The patient underwent surgical reconstruction of the treated areas and has been free of the disease for the past year. To our knowledge, the combination of ACC and AdCC in intraoral sites has not been reported in the literature.

RESUMEN: Los tumores de glándulas salivales múltiples representan un evento inusual caracterizado por el desarrollo de lesiones compuestas, originadas en glándulas salivales menores o mayores. Estos neoplasmas se pueden categorizar en tres perspectivas: tipo histológico, tiempo de aparición y distribución topográfica. Reportamos un caso inusual de un hombre negro de 73 años con un carcinoma de célula acínica (ACC) de la mucosa oral descubierta incidentalmente durante la extirpación quirúrgica de un mucocele adyacente. Aproximadamente un año después de la primera consulta, el paciente se presentó en el centro de referencia del cáncer local con una tercera lesión que fue diagnosticada como carcinoma adenoide quístico (AdCC) del labio superior. El paciente se sometió a la reconstrucción quirúrgica de las áreas tratadas y durante el último año no ha presentado recurrencia de la enfermedad. De acuerdo a nuestro conocimiento la combinación de ACC y AdCC en sitios intraorales no se ha informado en la literatura.

Clinicopathological Features of Prostate Ductal Carcinoma: Matching Analysis and Comparison with Prostate Acinar Carcinoma

We evaluated the clinicopathological features and prognosis of 29 cases of prostate ductal carcinoma was considered to be an aggressive subtype of prostate acinar carcinoma. We selected 29 cases who were diagnosed prostate ductal carcinoma and had a radical prostatectomy (RP). The acinar group (n = 116) was selected among 3,980 patients who underwent a prostatectomy. The acinar group was matched to the ductal group for prostate specific antigen (PSA), clinical stage, Gleason score, and age. The mean (range) of the follow-up periods for the ductal and acinar group was 23.8 +/- 20.6 and 58 +/- 10.5 months, respectively. The mean age of the prostate ductal and acinar carcinoma patients was 67.3 and 67.0 yr and the mean PSA level was 14.7 and 16.2 ng/mL, respectively. No statistical differences were evident between groups in terms of the final pathologic stage or positive resection margin rate other than the postoperative Gleason score. A greater proportion of the ductal group demonstrated a postoperative Gleason score > or = 8 in comparison with the acinar group (P = 0.024). Additionally, we observed significant prognostic difference in our patient series in biochemical recurrence. The ductal group showed a poorer prognosis than the acinar group (P = 0.016). There were no differences significantly in terms of final pathology and rate of positive resection margin, but a greater proportion of the ductal group demonstrated a Gleason score > or = 8 than the acinar group after matching for PSA, Gleason score in biopsy and clinical stage. The ductal group also showed a poorer prognosis.

Carcinoma de células acinares del páncreas: reporte de un caso / Acinar cell carcinoma of the pancreas: a case report

Reportar el caso de una paciente con carcinoma de células acinares de pancreas como una entidad clínico-patológica infrecuente. Presentación del caso clínico y revisión de la literatura. Servicio de Cirugía General del Hospital Universitario de Los Andes Mérida Estado Mérida-Venezuela. Paciente femenino de 21 años de edad que refiere enfermedad actual de 12 meses de evolución, caraterizada por aumento de volumen en epigastrio e hipocondrio izquierdo y sensación de plenitud postprandial. Por estudios imagenológicos se evidencia una tumoración en cuerpo y cola pancreática. Se realiza laparotomía subcostal bilateral, encontrando tumoración de 20x15x10 cm en cuerpo y cola pancreática, encapsulada, con áreas sólidas y quísticas, no adherida a órganos vecinos y de 850 gr de peso; se realizó pancreatectomía córporocaudal, sin preservacion esplénica. El reporte histopatológico fue carcinoma acinar del pancreas. Actualmente sin complicaciones de la función endocrina, sin evidencias de recidiva y recibiendo quimioterapia adyuvante. El carcinoma de células acinares es una entidad poco frecuente que representa del 1 al 2% de los tumores pancreáticos exocrinos. Ocurre con mayor frecuencia en hombres de edad media o mayores. Clinicamente cursan con dolor difuso y aumento del volumen abdominal. Por lo general afectan al cuerpo y cola del pancreas, son tumores encapsulados, de gran tamaño, que presentan distintos patrones de crecimiento. La supervivencia es variable, entre 1 a 3 años, dependiendo de la presencia o no de metástasis.

To report a case of a patient with acinar cell carcinoma of the pancreas as no frequent clinical pathological entity. Presentatin of clinical case and literature review. General Surgery Service of the Hospital Universitario de Los Andes. Mérida State Merida-Venezuela. A 21-year-old female patient presented to out hospital with a 12 month history of a increasing tumor in epigastrium and left hipocondrio and complaining of early satiety. Image studies evidenced a tumor in head and tail of pancreas. Chevron's laparotomy was performed, finding a 20x15x10 cm tumor in head and tail of pancreas, capsuled, with cystic and solid areas, not adherent to other tissues, with a weight of 850 grams. Corpocaudal pancreatectomy with splenectomy was performed. Histological report showed an acinar cell carcinoma of the pancreas. Patient actually with no endocrine disfuntions, no tumor recidive evidence, in adyuvant chemotherapy. Acinar cell carcinoma of the páncreas is a rare tumor that constitutes 1-2 of exocrine neoplasms. Ocurrs most frequently in elder male patients. Clinically presented with diffuse abdominal pain and tumors. Head and tail of pancreas are the most involved, as large capsiled tumors with different grow partterns. Survival is variable, from 1 to 3 years depending on presence or absence of metastases.

Imaging Findings in a Case of Mixed Acinar-Endocrine Carcinoma of the Pancreas

Mixed acinar-endocrine carcinoma (MAEC) of the pancreas is extremely uncommon. We report here a rare case of MAEC of the pancreas presenting as watery diarrhea. This is the first report in the English-language literature that describes the imaging findings of MAEC of the pancreas, including computed tomography (CT), magnetic resonance (MR) imaging, and MR cholangiopancreatography features.

Carcinoma de células acinares del páncreas: reporte de un caso / Acinar cell carcinoma of the pancreas: case report

Objetivo: Reportar el caso de una paciente con carcinoma de células acinares de páncreas como una entidad clinico-patológica infrecuente. Método: Presentación del caso clínico y revisión de la literatura. Ambiente: Servicio de Cirugía General del Hospital Universitario de Los Andes. Mérida. Estado Mérida. Venezuela. Resultados: Paciente femenino de 21 años de edad, que refiere enfermedad actual de 12 meses de evolución, caracterizada por aumento de volumen en epigastrio e hipocondrio izquierdo y sensación de plenitud postprandial. Por estudios imagenológicos se evidencia tumoración en cuerpo y cola pancreática. Se realiza laparotomía subcostal bilateral, encontrando tumoración de 20 x 15 x 10 cm en cuerpo y cola pancreática, encapsulada, con áreas sólidas y quísticas, no adherida a órganos vecinos y de 850 gr de peso; se realizó pancreatectomía corporocaudal, sin preservación esplénica. El reporte histopatológico fue carcinoma acinar de páncreas. Actualmente sin complicaciones de la función endocrina y sin evidencias de recidiva. Discusión: El carcinoma de células acinares es una entidad poco frecuente que representa del 1 al 2 por ciento de los tumores pancreáticos exocrinos. Ocurre con mayor frecuencia en hombres de edad media o mayores. Clínicamente cursan con dolor difuso y aumento del volumen abdominal. Por lo general afectan al cuerpo y cola del páncreas, son tumores encapsulados, de gran tamaño, que presentan distintos patrones de crecimiento. La supervivencia es variable, entre 1 y 3 años, dependiendo de la presencia o no de metástasis.

We report a 21 years old female presenting with a history of 12 months of a lump located in the epigastrium. An abdominal CAT scan showed a tumor located in the pancreatic body and tail. The patient was operated, and during the laparotomy an encapsulated tumor of the pancreas measuring 20 x 15 x 10 cm was found. The body and tail of the pancreas were excised and the pathological study of the surgical piece disclosed an acinar cell carcinoma. In the postoperative period the patient received chemotherapy with gemcitabine and oxaliplatin. After three years of follow up, she is in good conditions and without evidences of tumor relapse.

Síndrome de Frey tratamiento con toxina botulínica tipo A botox®: reporte de dos casos / Frey syndrome treatment with botulinum toxin type A botox: report of two cases

Evaluar la efectividad del uso de la toxina botulínica tipo A Botox® en el síndrome aurículo-temporal (síndrome de Frey). Se realizó un estudio experimental en dos pacientes femeninas con síndrome de Frey a quienes se les realizó: parotidectomía superficial bilateral por sialodenitis crónica en una, y parotidectomía superficial derecha en la otra, por carcinoma de células acinares, para objetivar el síndrome se utilizó el test de Minor y se uso toxina botulínica tipo A Botox®, aplicándola por vía subcutánea, usando una dosis de 3.0 MU/0.1ml/cm2. Se realizó el test de Minor en dos pacientes con síndrome de Frey. El tiempo de aparición de los síntomas fue: de 6 meses del lado izquierdo y 12 meses en el lado derecho para la que presentaba síndrome bilateral y 12 meses para la segunda paciente, el test de Minor fue positivo en 100 por ciento. Se aplicó toxina botulínica, y con tres meses de seguimiento no se evidenció recidiva objetivizado por el test de Minor. No se presentaron efectos adversos tras la administración de la toxina botulínica tipo A Botox®. La toxina botulínica representa un tratamiento efectivo, seguro y fácil de reproducir en el tratamiento del síndrome de Frey, sin evidencia de efectos adversos, y mejora en la calidad de vida de los pacientes.

Acinic cell carcinoma of the parotid gland in children a case report and literature review / Carcinoma de células acinosas de la glándula parótida en niños reporte de un caso y revisión de la literatura

Parotid acinic cell carcinoma is a rare malignancy in childhood. We report the case of a 12-year old girl presenting with a palpable mass in the left maxillofacial area. The radiologic evaluation showed a parotid mass. Tumour resection revealed acinic cell carcinoma of the parotid gland. She underwent complementary total parotidectomy without any adjuvant treatment. The patient has been disease-free for the last five years. We review the literature on acinic cell carcinomas of parotid glands in childhood.

El carcinoma de células acinosas de la parótida es una malignidad rara en la niñez. Reportamos el caso de una niña de 12 años con una masa palpable en el área maxilofacial izquierda. La evaluación radiológica mostró una masa parótida. La resección del tumor reveló un carcinoma celular de la glándula parótida. Fue sometida a una parotidectomía total complementaria sin tratamiento adyuvante alguno. La paciente ha estado libre de enfermedad durante los últimos cinco años. Revisamos la literatura sobre carcinomas de células acinosas en las glándulas parótidas en niños.

Papillary cystic acinic cell carcinoma of the parotid gland diagnosed on fine needle aspiration cytology.

The Cytomorphological features of Papillary Cystic Acinic Cell Carcinoma a rare malignant tumor of the Parotid gland in a 77 years male is described. The differential diagnosis and prognostic features are discussed.

Adenocarcinoma gigante de células acinares de tipo quístico papilar en parótida / Giant acinic cell adenocarcinoma with papillary-cystic pattern of the parotid gland

Se presenta el caso de un hombre de 38 años de edad con un adenocarcinoma de células acinares de 22 cm de tipo quístico papilar, originado en la glándula parótida. El interés del caso radica en: 1) el tamaño del tumor que supera en 9 cm al adenocarcinoma de células acinares más grande hasta ahora informado; y 2) la rara variedad histológica quística y papilar demandó estudios de histoquímica, inmunohistoquímica y microscopía electrónica para su diagnóstico

Carcinoma gigante acinar de cuerpo de páncreas / Giant acinar carcinoma of the body of the pancreas

El cáncer de páncreas ha incrementado su incidencia, pero mantiene un pobre pronóstico oncológico y una tasa de resección menor al 10 por ciento. Se presenta un caso clínico de un paciente joven, con excelente estado general portador de un cáncer corpo-caudal, con infiltración de estómago, tercio izquierdo de colon transverso y ángulo duodeno-yeyunal, en el que se consideró la cirugía de excéresis regional como la única opción terapéutica aceptable. La cirugía transcurrió sin complicaciones, pero el enfermo falleció 42 días después, con metástasis hepáticas masivas, en caquexia neoplásica. Se discute el valor de la excéresis paliativa de este tipo de tumores, considerando la ineficacia actual de la terapéutica adyuvante

Insulin and prostaglandins as signals between tumor and the host immune system

The development of malignant tissue in vivo is partially favored by the immunosuppression that occurs in cancer patients. However, the signals between tumor and immune tissues remain to be identified. We present evidence that prostaglandins may act as one of these signals by a direct action on cells of the immune system, or by inhibition of insulin secretion which in turn suppresses immune function, or both

Estudo clínico e histológico dos carcinomas de células acinares de glândulas salivares menores / Clinical and histological study of the acinic cell carcinomas of minor salivary glands

Os carcinomas de células acinares (CCAs) de glândulas salivares säo tumores considerados raros, correspondendo em média a 3 por cento das neoplasias destes orgäos. Poucos säo os estudos a seu respeito, principalmente em se tratando de tumores ocorridos nas glândulas salivares menores. Por esta razäo nos propusemos a realizar este trabalho. Obteve-se dados clínicos de oito CCAs de glândulas salivares menores, para os quais foi demonstrada ocorrência maior nas glândulas palatinas em pacientes do sexo feminino com média de idade de 35.5 anos. As neoplasias exibiram tamanho médio de 2.15 cm, evoluçäo clínica lenta, causando apenas aumento volumétrico assintomático na maioria dos casos. As descriçöes histológicas revelaram ser as células tipo acinares mucosas eosinófilas as principais componentes destes tumores. Estas exibiram variável grau de diferenciaçäo, dispostas em padräo sólido de crescimento. Células vacuoladas, em "anel de sinete", e tipo ducto intercalar também foram descritas. Dois tumores exibiram padräo papilocístico de crescimento