Clinical and Histological Basis of Adenosquamous Carcinoma of the Pancreas: A 30-year Experience

Background: Adenosquamous carcinoma (ASC) of the pancreas is a rare form of malignancy with a poor prognosis. We herein report our case series with review of the contemporary literature. Methods: With institutional review board approval, we identified 23 patients with pancreatic ASC. Results: ASC was more common in women (61%), with a median age of 73 y at presentation. The tumor was in the head of the pancreas in 65% of cases. Six cases (26%) had resectable disease, three (13%) were borderline resectable, and eight (34.7%) were locally advanced or metastatic. First-line treatment included pancreatic resection in eight cases (34.8%), concurrent neoadjuvant chemoradiation in three (13%), and neoadjuvant chemotherapy in two (8.7%). Most resected tumors had pathological T3 stage (80%). Pathological nodal disease was demonstrated in 60%, and margins were positive in three cases. Complete pathological response was not observed, although fibrosis presented in only one case (10%). Eventually, twenty patients developed metastatic disease. Overall survival is 11.5 [95% confidence interval 6, 14.5] months. Conclusions: ASC demonstrates a more aggressive malignant phenotype and carries a worse prognosis. Oncological resection is the mainstay of treatment. Neoadjuvant chemoradiation is an emerging approach in the management of ASC that has been extrapolated from the adenocarcinoma neoadjuvant trials. (C) 2020 Elsevier Inc. All rights reserved.

Automated summary

Adenosquamous carcinoma (ASC) of the pancreas is a rare and aggressive malignancy that mainly affects women with a median age of 73 years. Most cases present with tumors in the head of the pancreas, show a wide range of clinical manifestations, and are primarily treated with oncological resection.