Medullary Carcinoma of the Pancreas
Definition
- Poorly differentiated carcinoma of the pancreas with syncitial growth pattern and pushing border
Diagnostic Criteria
- Poor differentiation
- Syncitial growth pattern
- Poorly defined cell borders
- Pushing tumor border
- Lack infiltrative borders
- Frequently extensive necrosis
- One case reported with adenosquamous pattern
- Variable reports of presence of associated lymphoid infiltrate
- Lack crohn-like lymphoid infiltrate seen in colonic medullary carcinoma
- Lack mucinous / colloid component seen with colonic medullary carcinoma
Supplemental Studies
- About half of reported cases show microsatellite instability and/or loss of mismatch repair proteins
Differential Diagnosis
| Medullary Carcinoma of the Pancreas | Poorly Differentiated Ductal Adenocarcinoma of the Pancreas |
|---|---|
| Pushing border | Infiltrative border |
| Syncitial pattern | Usually has more distinct cell borders |
| May show microsatellite instability and/or mismatch repair deficiency | Not associated with mismatch repair defects |
| Medullary Carcinoma of the Pancreas | Poorly Differentiated Acinar Carcinoma of the Pancreas |
|---|---|
| Pleomorphic nuclei with variable nucleoli | Prominent central nucleoli in most cases |
| Lipase and trypsin negative | Lipase and trypsin positive in most cases |
| May show microsatellite instability and/or mismatch repair deficiency | No mismatch repair defects |
Clinical
- Insufficient data to determine prognostic significance
- May have a family history of cancer of various sites
Classification / Lists
Pancreatic Carcinomas
- Acinar cell carcinoma
- Adenosquamous carcinoma
- Colloid carcinoma
- Ductal adenocarcinoma
- Neuroendocrine carcinoma, poorly differentiated
- Well differentiated neuroendocrine (islet cell) tumors
- Hepatoid carcinoma
- Medullary carcinoma
- Micropapillary carcinoma
- Pancreatoblastoma
- Serous cystadenocarcinoma
- Signet ring cell carcinoma
- Undifferentiated carcinoma
- Undifferentiated carcinoma with osteoclast-like giant cells
Bibliography
- Bosman FT, Carneiro F, Hruban RH, Thiese ND (Eds). WHO Classifiication of Tumors of the Digestive System, IARC, Lyon 2010.
- Solcia E, Capella C, Kloppel G . Tumors of the Pancreas, Atlas of Tumor Pathology, AFIP Third Series, Fascicle 20, 1997.
- Goggins M, Offerhaus GJ, Hilgers W, Griffin CA, Shekher M, Tang D, Sohn TA, Yeo CJ, Kern SE, Hruban RH. Pancreatic adenocarcinomas with DNA replication errors (RER+) are associated with wild-type K-ras and characteristic histopathology. Poor differentiation, a syncytial growth pattern, and pushing borders suggest RER+. Am J Pathol. 1998 Jun;152(6):1501-7.
- Wilentz RE, Goggins M, Redston M, Marcus VA, Adsay NV, Sohn TA, Kadkol SS, Yeo CJ, Choti M, Zahurak M, Johnson K, Tascilar M, Offerhaus GJ, Hruban RH, Kern SE. Genetic, immunohistochemical, and clinical features of medullary carcinoma of the pancreas: A newly described and characterized entity. Am J Pathol. 2000 May;156(5):1641-51.
- Banville N, Geraghty R, Fox E, Leahy DT, Green A, Keegan D, Geoghegan J, O'Donoghue D, Hyland J, Sheahan K. Medullary carcinoma of the pancreas in a man with hereditary nonpolyposis colorectal cancer due to a mutation of the MSH2 mismatch repair gene. Hum Pathol. 2006 Nov;37(11):1498-502.
Author / Update
Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342
Original posting/updates: 1/5/08, 1/5/12
