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James A. Madura, MD; Benjamin T. Jarman; Michael G. Doherty; Moo-Nahm Yum, MD; Thomas J. Howard, MD

Arch Surg. 1999;134:599-603.

Hypothesis  Adenosquamous carcinoma of the pancreas is a rare but particularly virulent variant of invasive ductal carcinoma. This review will demonstrate the aggressive biologic activity, histopathologic features, and DNA flow cytometric characteristics of this aggressive lesion. In addition, the outcome is less favorable than in other pancreatic neoplasms, in spite of aggressive surgical and postoperative adjuvant therapy.

Design  A retrospective review of 6 patients treated during an 8-year period.

Setting  A major urban university tertiary referral hospital.

Patients  There were 6 patients with this unusual tumor seen between 1990 and 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 pancreatoduodenectomy, and 2 with body and or tail lesions had distal pancreatectomy and splenectomy. Pathologically, all the tumors were poorly differentiated and aneuploid, and 5 of the 6 were locally metastatic. All but 1 patient had postoperative complications, but there were no operative deaths. One half of the patients received postoperative adjuvant chemotherapy and radiation therapy. Only 1 patient is still alive at 9 months after surgery, but has known residual cancer around his portal vein noted during palliative distal pancreatectomy.

Conclusions  Adenosquamous carcinoma of the pancreas is an uncommon variant of exocrine pancreatic neoplasm. It is characterized by an admixture of adenomatous and squamous cell elements and demonstrates aggressive biologic behavior. This series of 6 patients is similar to the 134 cases reported since 1907, in that survival is short despite aggressive surgical therapy. Few patients with this disease live more than 1 year. Aggressive therapy should be tempered by the realization of the uniform poor prognosis associated with this malignant neoplasm.

From the Departments of Surgery (Drs Madura and Howard and Messrs Jarman and Doherty) and Pathology (Dr Yum), Indiana University School of Medicine, Indianapolis.

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