The radiologic differential diagnosis for these tumors is broad and includes a number of benign and malignant processes, such as mucinous cystic neoplasm, serous microcystic adenoma, ductal adenocarcinoma, pancreatic endocrine neoplasm, acinar cell carcinoma
, solid pseudopapillary tumor, and autoimmune pancreatitis.
The incidences of acinar cell carcinoma
and adenoma or carcinoma (combined) exceeded those within the historical control range (overall incidence of acinar cell adenoma, 1 of 207 or 0.
However, this PSA reactivity has also been described in acinar cell carcinoma
of the pancreas .
3) Other stains (such as trypsin and chymotrypsin for pancreatic acinar cell carcinoma
, chromogranin and synaptophysin for neuroendocrine neoplasms, and others) can be included in the panel, depending on the clinical information and the morphologic appearance.
Other differential diagnoses included acinar cell carcinoma
, solid pseudopapillary neoplasm, and, less likely, adenocarcinoma or lymphoma.
Acinar cell carcinoma
usually presents with a large, intra-abdominal mass, with or without jaundice.
The rare acinar cell carcinoma
of the pancreas can be confirmed with stains for pancreatic enzymes such as trypsin, chymotrypsin, lipase, and elastase.
Two other pancreatic neoplasms that can be included in the differential diagnosis are the uncommon pancreatoblastoma and acinar cell carcinoma
Nucleoli are inconspicuous or absent; rarely, they are prominent and incorrectly suggest an acinar cell carcinoma
(Figure 8, A).
Sensitivities for specific diagnostic entities were as follows: 79% for ductal adenocarcinoma, 100% for acinar cell carcinoma
, 75% for pancreatic endocrine tumor, 70% for intraductal papillary mucinous neoplasms (IPMN), and 42% for mucinous cystic neoplasms (MCN).
The cystic form of acinar cell carcinoma
(ACC) is well documented but is extremely uncommon; only a handful of cases have been documented in the literature.
Many of the major types of pancreatic neoplasms (ductal adenocarcinoma, pancreatic endocrine neoplasm, acinar cell carcinoma
, pancreatoblastoma) typically form solid masses (Figure 4, A and B).