Pancreatic Acinar-Like Adenocarcinoma of the Proximal Stomach Involving the Esophagus in Chinese Patients: A Clinicopathological Study of 41 Cases from a Single High-Volume Hospital in China.
Qin Huang, Jason K Gold, Hong Yan Wu, Xiang Shan Fan, An Ning Feng, Jiong Shi. Nanjing Drum Tower Hospital, China; VA Boston Healthcare System, West Roxbury, MA; VA Boston Healthcare System, West Roxbury, MS
Background: We recently reported that some adenocarcinomas of the proximal stomach involving the esophagus (APSE) mimicked pancreatic acinar carcinoma. In the present study, we aimed to systematically investigate clinicopathological characteristics and survival of pancreatic acinar-like adenocarcinoma (PALA) of APSE and to compare these with non-PALA tumors of APSE.
Design: We retrospectively reviewed 137 consecutive APSE resections over the period from May 2004 through October 2009 at a high-volume center in China. PALA tumors were defined by a pancreatic acinar-like morphology with α1-chymotrypsin immunoreactivity. Clinicopathological features of PALA (n=41) and non-PALA (n=96) groups were compared. Differences were tested using the Student's t, Fisher's exact, and Chi-square tests. Survival was compared using the log-rank test.
Results: In the PALA group, the median age was 65 (range: 51-90). The male:female ratio was 5.8. Grossly, tumors were non-encapsulated with a median size of 5.25 cm (range 2-10.5). There were 7%, 10%, 71%, and 12% Borrmann's I-IV tumors, respectively. Frank necrosis and hemorrhage were rare or absent. Lymphovascular invasion (83%) was more common in PALA tumors (p<0.001). Microscopically, PALA tumors showed adenocarcinoma (61%), micropapillary (10%), and mixed (29%) patterns. The mixed pattern consisted of neuroendocrine (17%), signet-ring (75%), and adenocarcinoma (100%). No mucinous or adenosquamous differentiation was noted. Nuclei were round-oval with single prominent nucleoli. Mitotic figures were variable. The cytoplasm was dark eosinophilic, granular, and immunoreactive to the α1-chymotrypsin antibody to various degrees. Tumor stroma was non-desmoplastic and fibrovascular. The overall AJCC stage of PALA tumors (pI, 0%; pII, 22%; pIII, 73%; pIV, 5%) was more advanced than that of non-PALA tumors (p=0.001), as were pT (p=0.02) and pN (p=0.04) stages. The median follow-up of survivors was 36 months after surgery. Advanced overall pT stage (p < 0.001), pN (p = 0.005), pM (p = 0.01), and the age >75 (p = 0.04) were associated with worse survival. However, the difference in overall survival rates between PALA and non-PALA groups was not statistically significant (p=0.69).
Conclusions: PALA of APSE shows distinct clinicopathological features and is associated with advanced pathological stages. PALA should be qualified as a unique type of APSE.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 149, Tuesday Morning