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Comprehensive characterisation of acinar cystic transformation of the pancreas: a systematic review.

Authors :
Mattiolo P
Wang H
Basturk O
Brosens LAA
Hong SM
Adsay V
Scarpa A
Luchini C
Source :
Journal of clinical pathology [J Clin Pathol] 2023 Nov; Vol. 76 (11), pp. 740-746. Date of Electronic Publication: 2023 Aug 29.
Publication Year :
2023

Abstract

Aims: Acinar cystic transformation (ACT) of the pancreas is a rare pancreatic cystic lesion. Owing to its rarity, comprehensive histomolecular characterisation of this entity is still lacking. We aim to perform a systematic review on this controversial entity.<br />Methods: We searched PubMed, SCOPUS and Embase through May 2023 to identify all studies on ACTs. Clinicopathological, immunohistochemical (IHC) and molecular data have been extracted and analysed.<br />Results: Overall, there were 121 cases of ACTs in the literature. ACT had a female predominance (65.3% of patients), and a mean size of 4.8 cm. ACT was more often unifocal (71.9%) and multiloculate (61.2%). Histologically, the cysts were lined by an acinar epithelium, sometimes harbouring ductal-like areas (18.2%). In five cases (4.1%), an intralesional pancreatic intraepithelial neoplasia (PanIN) was reported. Preoperative diagnosis is challenging. After surgical resection, all patients were alive and disease free during follow-up except one patient who developed a second ACT after resection. By IHC, all lesions were positive for acinar markers; cytokeratin 7 and 8/18/19 were usually positive, and Ki-67 was invariably ≤3%. At the molecular level, three cases demonstrated genetic alterations: one showed multiple chromosomal gains, and other two harboured somatic mutations of KRAS and SMO genes (one mutation per case).<br />Conclusions: Globally considered, our findings demonstrated that ACT is a benign entity, without the need of surgical resection with the exception of symptomatic lesions. The rare occurrence of intracystic PanINs and driver mutations suggest considering follow-up if a preoperative diagnosis of ACT can be made.<br />Competing Interests: Competing interests: None declared.<br /> (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Details

Language :
English
ISSN :
1472-4146
Volume :
76
Issue :
11
Database :
MEDLINE
Journal :
Journal of clinical pathology
Publication Type :
Academic Journal
Accession number :
37643836
Full Text :
https://doi.org/10.1136/jcp-2023-209103