Case Report
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World J Gastroenterol. Jun 7, 2010; 16(21): 2692-2697
Published online Jun 7, 2010. doi: 10.3748/wjg.v16.i21.2692
Solitary concomitant endocrine tumor and ductal adenocarcinoma of pancreas
Shu-Mei Chang, Shih-Tang Yan, Chang-Kuo Wei, Chih-Wen Lin, Chih-En Tseng
Shu-Mei Chang, Chih-En Tseng, Department of Anatomic Pathology, Buddhist Dalin Tzu Chi General Hospital, Chiayi 622, Taiwan, China
Shih-Tang Yan, Department of Endocrinology and Metabolism, Buddhist Dalin Tzu Chi General Hospital, Chiayi 622, Taiwan, China
Chang-Kuo Wei, Department of General Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi 622, Taiwan, China
Chih-Wen Lin, Department of Medical Imaging, Buddhist Dalin Tzu Chi General Hospital, Chiayi 622, Taiwan, China
Chih-En Tseng, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan, China
Author contributions: Chang SM and Tseng CE designed this study, drafted, revised the manuscript and made the final approval of the version; Yan ST, Wei CK and Lin CW collected, analyzed and interpreted the data.
Supported by Buddhist Dalin Tzu Chi General Hospital
Correspondence to: Chih-En Tseng, MD, Department of Anatomic Pathology, Buddhist Dalin Tzu Chi General Hospital, 2, Min-Sheng Road, Dalin, Chiayi 622, Taiwan, China. p121521@gmail.com
Telephone: +886-5-2648000 Fax: +886-5-2648999
Received: February 16, 2010
Revised: March 25, 2010
Accepted: April 1, 2010
Published online: June 7, 2010
Abstract

Pancreatic tumors with combined exocrine and endocrine features are rare. Most reported cases are classified as mixed exocrine and endocrine carcinoma of the pancreas. We report the first case of solitary concomitant endocrine tumor and ductal adenocarcinoma of the pancreas. A 58-year-old patient was admitted for uncontrolled diabetes mellitus and body weight loss. The tumor was fortuitously discovered in the pancreatic tail after a tumor survey panel. Grossly, the solitary tumor had a central fibrous band that clearly divided it into two parts. On microscopic examination, the tumor contained both endocrine and exocrine components distinctly separated by the central fibrous band. The exocrine part showed a poorly-differentiated adenocarcinoma. The endocrine part was strongly immunoreactive to chromogranin, synaptophysin and glucagon. We reviewed the literature on pancreatic tumors with combined exocrine and endocrine features. A simple classification for this group of neoplasms is suggested, including five types: amphicrine, mixed, collision, solitary concomitant and multiple concomitant.

Keywords: Pancreas; Concomitant tumor; Collision tumor; Mixed tumor; Glucagonoma