Pancreas - Foamy gland pattern of pancreatic adenocarcinoma

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Foamy gland pattern of pancreatic adenocarcinoma

Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 14 December 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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● Deceptively benign-appearing pattern with prominent microvesicular (foamy) cytoplasm, first described in 2000 in pancreas (Am J Surg Pathol 2000;24:493)
● Also described in prostate
● Considered a ductal pattern, not a WHO variant

Clinical features
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● Tumors are malignant architecturally and metastasize
● Clinical course, p53 and Kras mutations similar to usual ductal adenocarcinoma
● Foamy PanIN is considered as precursor (Ann Diagn Pathol 2008;12:252)

Micro description
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● Well formed glands with bland cells but subtle infiltration
● Cells have abundant microvesicular (white and crisply foamy) cytoplasm with distinct pink brush border-like zone at apical/luminal portion of the cell
● Nuclei are basal oriented, dense or wrinkled (raisinoid)
● May be misinterpreted as benign mucinous ducts; apical cytoplasmic folds in benign mucinous ducts should be differentiated from brush border-like zone
● Foamy material is due to evenly sized mucigen granules that are mucin negative

Micro images
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Invasive glands lined by foamy cells

PanIN3 lesion (left) is Alcian blue+, as is invasive foamy gland adenocarcinoma (right)

PanIN3 lesion (left) is MUC1+, as is invasive foamy gland adenocarcinoma (right)

Cytology description
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● Nuclear overlap, foamy cytoplasm, loss of cohesiveness, anisonucleosis, irregular nuclear contours (Am J Clin Pathol 2004;121:893, Diagn Cytopathol 2012 Sep 25 [Epub ahead of print])

Cytology images
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Cells with abundant foamy cytoplasm

Positive stains
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● Mucicarmine, Alcian blue and high iron diamine
● CEA, CK8, p53

Negative stains
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● Brush border-like zone: PAS, MUC2

End of Pancreas > Exocrine tumors > Foamy gland pattern of pancreatic adenocarcinoma

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