Pancreatic adenocarcinoma

From Dog
Solid area of clear cell carcinoma characterized by an acinar pattern supported by a thin fibrovascular stroma[1]

Pancreatic adenocarcinoma is a rare metastatic neuroendocrine neoplasia of the canine exocrine pancreas.

These tumors of the pancreas often metastasize early in the course of disease, often to the liver, regional lymph nodes, intestines, lungs and brain[2].

Clinical signs are often vague and can be confused with pancreatitis. Clinical signs may be subtle, such as intermittent vomiting, gradual weight loss and diarrhea associated with exocrine dysfunction, metabolic epidermal necrosis, jaundice (associated with metastatic bile duct obstruction) and lameness (bone metastases).

Diagnosis can be suggested by elevated circulating pancreatic lipase and ultrasonographic evidence of hyperechoic pancreatic mass.

Some adenocarcinomas have paraneoplastic overexpression of both insulin and glucagon, resulting in hyperinsulinaemia and hyperglucagonaemia[3].

Definitive diagnosis is based on histological sampling of pancreatic biopsy on exloratory laparotomy or via laparoscopy[4].

Histologically, many expression antigen against claudin-5, an endothelium-specific tight junction protein[5][1].

Variants include hyalinizing pancreatic adenocarcinoma[6] and tubular adenocarcinoma[7].

Included in a differential diagnosis would be pancreatitis, pancreatic adenoma, insulinoma, gastrinoma.

Treatment is usually difficult as most cases present late in the course of disease. Surgical resection by a partial pancreatectomy can be attempted as well as chemotherapy as a palliative modality.

The prognosis for most cases is poor.

References

  1. 1.0 1.1 Pavone S et al (2011) Canine pancreatic clear acinar cell carcinoma showing an unusual mucinous differentiation. J Comp Pathol 145(4):355-358
  2. Chang SC et al (2007) Pancreatic acinar cell carcinoma with intracranial metastasis in a dog. J Vet Med Sci 69(1):91-93
  3. Cave TA et al (2007) Metabolic epidermal necrosis in a dog associated with pancreatic adenocarcinoma, hyperglucagonaemia, hyperinsulinaemia and hypoaminoacidaemia. J Small Anim Pract 48(9):522-526
  4. Jakab CS et al (2011) Expression of claudin-4 molecule in canine exocrine pancreatic acinar cell carcinomas. Histol Histopathol 26(9):1121-1126
  5. Jakab C et al (2011) Expression of claudin-5 in canine pancreatic acinar cell carcinoma - An immunohistochemical study. Acta Vet Hung 59(1):87-98
  6. Dennis MM et al (2008) Hyalinizing pancreatic adenocarcinoma in six dogs. Vet Pathol 45(4):475-483
  7. Grieco V et al (2008) A case of two different tumors in the heart of a dog. J Vet Diagn Invest 20(3):365-368