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      Anaplastic Carcinoma of the Pancreas: A Rare Clinical Entity

      case-report
      1 , 1 , 1 , , 2 , 1
      ,
      Cureus
      Cureus
      anaplastic carcinoma, pancreas, surgery

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          Abstract

          Anaplastic carcinoma of the pancreas (ACP) is a very rare histologic subtype of pancreatic cancer and associated with more aggressive and poor prognosis than pancreatic ductal adenocarcinoma. We aimed to review this rare entity and discuss its clinical features, diagnosis and therapy. We presented a case of a 63-year-old male patient that diagnosed as ACP with cyst formation at a tertiary medical center with a detailed review of the current medical literature. We performed pancreaticoduodenectomy operation with lymph node dissection after diagnosis. Any complication after surgery was not observed. Anaplastic pancreas carcinomas are associated with poor survival when compared to invasive ductal adenocarcinomas. Clinical, radiological, laboratory and histological features may be helpful in making differential diagnosis and should be kept in mind in the diagnosis of this rare pancreatic malignancy.

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          Most cited references8

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          A clinicopathologic and immunohistochemical study of 35 anaplastic carcinomas of the pancreas with a review of the literature.

          Anaplastic pancreatic carcinomas are rare tumors, frequently displaying a variety of growth patterns. The literature lacks a comprehensive study of this tumor. Thirty-five cases of anaplastic carcinoma of the pancreas diagnosed between 1955 and 1997 were retrieved from the Endocrine Registry at the Armed Forces Institute of Pathology. Histology, immunophenotype, molecular analysis, and patient follow-up were analyzed. The tumors of 10 women and 25 men, aged 34 to 85 years (mean age at presentation, 62.5 years), were studied. Patients had vague symptoms (weight loss, pain, and fatigue, nausea, or vomiting), lasting an average of 13.2 weeks. The tumors, of an average size of 9.2 cm, were usually in the head or tail of the pancreas. The tumors were widely infiltrative, histomorphologically separated into predominantly large, pleomorphic cell, or spindle cell groups. Tumor phagocytosis and necrosis were noted. Immunohistochemical studies confirmed an epithelial origin with at least one epithelial marker in 78% of the tumors. K-ras mutations by sequence analysis were found in eight of 12 cases tested. Surgical biopsy/excision was used in all patients. Twenty-nine of 35 patients died of disease (average, 5.2 months), three died with no evidence of disease (average, 56.9 months), and three patients were alive at last follow-up (average, 94.0 months), one with residual disease. There was no statistically significant difference in survival between patients with and without a K-ras mutation. Anaplastic carcinoma of the pancreas usually occurs in the head of the pancreas in older men. The epithelial nature of the pleomorphic cells (giant or spindled) can usually be documented. Patients with K-ras mutations have a shorter survival time, even though the overall prognosis for all anaplastic carcinomas is fatal (93% fatality; average survival, 448 days). Ann Diagn Pathol 5: 129-140, 2001. This is a US government work. There are no restriction on its use.
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            Clinical outcomes for anaplastic pancreatic cancer: a population-based study.

            Anaplastic pancreatic cancer (APC) is a rare subtype of pancreatic ductal adenocarcinoma (PDA) that can carry a worse overall survival (OS) when compared with other variants. However, the presence of osteoclast-like giant cells (OCGCs) in APC specimens can predict improved OS. The aim of this study was to evaluate the OS of patients with APC (with and without OCGCs) compared with patients with other subtypes of PDA using a population-based registry.
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              Morphological study of 391 cases of exocrine pancreatic tumours with special reference to the classification of exocrine pancreatic carcinoma.

              Three hundred and ninety-one cases of primary pancreatic tumours, excluding endocrine tumours, were studied histologically. Carcinoma of the exocrine pancreas formed the largest group (98.5 per cent), benign tumours (1.25 per cent) and other malignant tumours (0.25 per cent) formed the remainder. Ductal adenocarcinoma was the commonest type and was divided into four sub-types, papillary, well, moderately and poorly differentiated duct adenocarcinoma. The moderately and poorly differentiated tumours were the commonest types. Papillary carcinoma was separated from the well differentiated tumours by its different morphological appearances and was found to exhibit different behaviour. Other special morphological types of pancreatic carcinoma, pleomorphic, mucinous, adenosquamous, acinar, microadenocarcinoma, cystadenocarcinoma and oncocytic carcinoma were also represented. Benign microcystadenomata (four cases) were considered because of their interesting morphological features and their significance in the differential diagnosis of carcinoma. Based on the morphology and behaviour of these 391 tumours, the classification of pancreatic carcinoma is discussed and some rare types are compared with previously reported cases and discussed.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                18 October 2017
                October 2017
                : 9
                : 10
                : e1782
                Affiliations
                [1 ] Department of Surgery, University of Health Sciences,izmir Bozyaka Education and Research Hospital,
                [2 ] Department of Pathology, University of Health Sciences,izmir Bozyaka Education and Research Hospital,
                Author notes
                Article
                10.7759/cureus.1782
                5736168
                9ec5f3d4-785c-4bce-a3c1-066020558f37
                Copyright © 2017, Oymaci et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 15 September 2017
                : 18 October 2017
                Categories
                Oncology
                Pathology
                General Surgery
                Oncology

                anaplastic carcinoma,pancreas,surgery
                anaplastic carcinoma, pancreas, surgery

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