OBJECTIVETo study the clinicopathologic features of 30 cases of pseudohyperplastic prostatic adenocarcinoma (PHPA).

METHODSEight hundred and sixty cases of ultrasound-guided prostatic needle biopsy and 46 cases of radical prostatectomy specimens collected during the period from January 1, 2005 to December 31, 2006 were retrieved from the archival files. The incidence, morphology, pathologic differential diagnosis, tumor volume, preferred location and Gleason's score were studied. The tissue sections suspicious for PHPA were immunohistochemically stained with high-molecular weight cytokeratin (34betaE12) or CK5/6, p63, AMACR, and cocktail antibody of 34betaE12/p63/AMACR. Cases with PHPA component more than 60% in at least one single slide were selected and pathologically analyzed.

RESULTSPHPA was present in 7% of needle biopsy and 15.2% of prostatectomy specimens. Histologically, 66.7% of PHPA demonstrated direct transition with conventional acinar adenocarcinoma; and 76.7% of cases had coexisting conventional acinar adenocarcinoma in the remaining tissue blocks. The tumor volume accounted for 5% to 100% of total carcinoma among core needle biopsy and 1% to 30% of total carcinoma among radical prostatectomy. PHPA resembled benign prostate glands, in which the hyperplastic malignant acini were predominantly of medium to large size. The neoplastic cells were well-differentiated, with basally located nuclei and luminal corpora amylacea. However, amongst the 20 pathologic indices of prostatic malignancy studied, occurrence of 10 or more indices exceeded 66.7%. Although PHPA looked benign morphologically, 66.7% cases had stromal invasion, 6.7% had perineural invasion and 3.3% had bone metastasis. The tumor was primarily located in the peripheral zone.

CONCLUSIONSPHPA is not a rare phenomenon in prostatic adenocarcinoma. Majority of cases have concurrent conventional acinar adenocarcinoma. It is different from well-differentiated (with Gleason's score 1 or 2) adenocarcinoma with a relatively indolent clinical course. In contrast, PHPA corresponds to moderately differentiated adenocarcinoma with Gleason's score of 3.

Adenocarcinoma ; metabolism ; pathology ; surgery ; Biopsy, Needle ; Carcinoma, Acinar Cell ; metabolism ; pathology ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Male ; Prostatectomy ; Prostatic Hyperplasia ; metabolism ; pathology ; surgery ; Prostatic Neoplasms ; metabolism ; pathology ; surgery ; Racemases and Epimerases ; metabolism

BACKGROUND/AIMS: Acinar cell carcinoma (ACC) of the pancreas is a rare malignancy. ACC has been considered a cancer with poor prognosis due to frequent metastasis, a high recurrence rate, and low resectability. The aim of this study was to examine the clinical, radiologic and pathologic features of ACC in Korean patients, and surgical outcome was also investigated. METHODS: We reviewed the clinical records of two patients with ACC who had undergone operation in January 1996 and December 2005 at Hanyang University Medical Center. Through searching of medical journal from 1983 to 2009, 27 patients reported on literatures as Korean ACC patients were reviewed together. The clinical, pathohistologic, and radiologic features, treatment, and prognosis were investigated for all 29 patients. RESULTS: ACC was more common in male, and age at diagnosis ranged from 25 to 68 years (median 54). Symptoms were, mostly abdominal pain and mass. Liver was most common organ of metastasis at diagnosis and recurrence after operation. The mean tumor size was 7.0 cm, and most common location was tail. Of the 29 patients, 22 underwent surgical resection. Excluding 7 cases of not-reported survival, the median survival with operation was 22.4 months compared to 1.5 months with non-operation. CONCLUSIONS: In Korea, the clinical features of ACC include young age, large size, tail location, and nonspecific tumor markers. Surgery should be actively performed in the treatment of ACC regardless of size.
Adult ; Age Factors ; Aged ; Carcinoma, Acinar Cell/*diagnosis/pathology/surgery ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms/*diagnosis/pathology/surgery ; Prognosis ; Republic of Korea ; Survival Analysis ; Tumor Markers, Biological/analysis

Pancreas acinar cell carcinoma (ACC) accounts for only 1-2% of pancreatic exocrine malignant tumor. The symptoms of patients with ACC are usually non-specific, for example the anorexia and weight loss. Patients may develop Schmid's triad including subcutaneous fat necrosis, polyarthritis, and eosinophilia. We reported a case of ACC which was manifested by subcutaneous nodule as initial clinical symptom. To our knowledge, this is the first reported case of ACC presenting as subcutaneous fat necrosis in Korea.
Carcinoma, Acinar Cell/*diagnosis/surgery/ultrasonography ; Fat Necrosis/pathology ; Humans ; Keratins/metabolism ; Male ; Middle Aged ; Pancreatic Neoplasms/*diagnosis/surgery/ultrasonography ; Subcutaneous Fat/*pathology ; Synaptophysin/metabolism ; Tomography, X-Ray Computed

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, Acinar Cell/*pathology/*radiography/surgery ; Cholangiopancreatography, Magnetic Resonance/methods ; Diagnosis, Differential ; Diarrhea ; Endocrine Gland Neoplasms/*pathology/*radiography/surgery ; Female ; Humans ; Magnetic Resonance Imaging/methods ; Middle Aged ; Pancreas/pathology/radiography/surgery ; Pancreatectomy ; Pancreatic Neoplasms/*pathology/*radiography/surgery ; Splenectomy ; Tomography, X-Ray Computed/methods