Adenosquamous carcinoma of the pancreas

Hypothesis: Adenosquamous carcinoma of the pancreas is a rare but particula rly virulent variant of invasive ductal carcinoma. This review will demonst rate the aggressive biologic activity, histopathologic features, and DNA fl ow cytometric characteristics of this aggressive lesion. In addition, the o utcome is less favorable than in other pancreatic neoplasms, in spite of ag gressive surgical and postoperative adjuvant therapy. Design: A retrospective review of 6 patients treated during an 8-year perio d. Setting: A major urban university tertiary referral hospital. Patients: There were 6 patients with this unusual tumor seen between 1990 a nd 1998. There were 4 men and 2 women, all white, with a mean +/- SD age of 63.5 +/- 14.7 years. Symptoms were similar to those in patients with more common pancreatic malignant neoplasms. Results: Four patients with tumors in the head of the pancreas had pancreat oduodenectomy, and 2 with body and or tail lesions had distal pancreatectom y and splenectomy. Pathologically, all the tumors were poorly differentiate d and aneuploid, and 5 of the 6 were locally metastatic. All but 1 patient had postoperative complications, but there were no operative deaths. One ha lf of the patients received postoperative adjuvant chemotherapy and radiati on therapy. Only 1 patient is still alive at 9 months after surgery, but ha s known residual cancer around his portal vein noted during palliative dist al pancreatectomy. Conclusions: Adenosquamous carcinoma of the pancreas is an uncommon variant of exocrine pancreatic neoplasm. It is characterized by an admixture of ad enomatous and squamous cell elements and demonstrates aggressive biologic b ehavior. This series of 6 patients is similar to the 134 cases reported sin ce 1907, in that survival is short despite aggressive surgical therapy. Few patients with this disease live more than 1 year. Aggressive therapy shoul d be tempered by the realization of the uniform poor prognosis associated w ith this malignant neoplasm.