ASCAP is a malignant tumor with debatable histogenesis. We report the case of a year-old man, with a history of more than half of a year of right upper quadrant abdominal pain, jaundice, with no anamnestic data of acute or chronic pancreatitis, or substance abuse.
On gross examination the tumor was solid, white, poorly circumscribed, located in the head of the pancreas, with 4 cm diameter, and direct extension into ampulla of Vater, common bile duct, and peripancreatic soft tissue. Microscopically, the tumor was composed of squamous polygonal cells arranged in small glandular structures, with tightly packed pattern, and mild nuclear pleomorphism, along with small areas with Alcian blue positive intracellular mucin.
Therefore, the differential diagnosis between ASCAP and pancreatic collision tumor, metastasis of adenosquamous carcinoma or mucoepidermoid tumor was compulsory.
The immuno-histochemistry assay confirmed ASCAP as the final diagnosis, based on the intense positive reaction for cytokeratin 7 mainly in the glandular structures, whereas cytokeratin 5 and p63 were positive predominantly in the squamous component. The present report aimed to highlight the pathological characteristics of this rare subtype of pancreatic tumors and to point out pancreatic cancer diagnosis difficulty in differentiation between a pancreatic and an extra pancreatic biliary tract or ampulla of Vater tumor, due to the extensive tumor growth that interests, in advanced stages, the same anatomical space, pancreatic cancer diagnosis the different prognosis and therapeutic approach of these entities.
Adenosquamous carcinoma of the pancreas.
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