Adenosquamous carcinoma is a rare subtype of pancreatic adenocarcinoma, accounting
for less than 4 % of all exocrine pancreatic malignancies and representing a ductal
adenocarcinoma mixed with at least 30 % of malignant squamous cells [1]
[2]
[3]. Herein, we report a patient with a retroperitoneal mass in whom endoscopic ultrasound-guided
fine-needle aspiration (EUS-FNA) and immunohistochemical evaluation confirmed a pancreatic
adenosquamous carcinoma ([Video 1]).
Video 1 Adenosquamous carcinoma is an aggressive subtype of adenocarcinoma, accounting for
less than 4 % of all exocrine pancreatic malignancies. Endoscopic ultrasound-guided
fine-needle aspiration can guarantee the diagnosis in the presence of a ductal adenocarcinoma
mixed with malignant squamous cell carcinoma and specific immunohistochemical markers.
A 65-year-old white man with epigastric pain and weight loss was referred for investigation
of a pancreatic mass detected on abdominal computed tomography. Results of clinical
laboratory examinations were unremarkable. Sectorial endoscopic ultrasound (Olympus
GF-UCT140-AL5 [Olympus America Inc., New York, USA], coupled to an ultrasound unit
Aloka ProSound alpha-5 SX) detected a solid lesion with irregular borders measuring
4.9 × 3.5 cm in the pancreatic body. EUS-FNA was performed via a transgastric approach
using a 19-gauge needle (EchoTip Ultra Echo-19; Cook Medical, Winston-Salem, North
Carolina, USA) for a total of three passes. There was no on-site cytopathologist.
Histopathology on cell blocks demonstrated a mixture of adenocarcinoma cells with
malignant squamous epithelium. Immunohistochemistry panel was positive for S100 p,
cytokeratin 7 (both markers of glandular differentiation), p63, and cytokeratin 5/6
(both markers of squamous epithelium), but negative for chromogranin A and mucin 5AC.
Optimal treatment remains undefined for the disease. The patient was offered chemotherapy
with gemcitabine. After two cycles, liver metastases were detected. A new chemotherapy
protocol was begun with oxaliplatin, folinic acid, and fluorouracil. There was no
response and the patient died 6 months later.
Endoscopy_UCTN_Code_CCL_1AF_2AZ_3AB
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques
in gastroenterological endoscopy. All papers include a high quality video and all
contributions are freely accessible online.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos
