18F-FDG PET/CT feature of pancreatic adenosquamous carcinoma with pathological correlation

Wnt-deficient and hypoxic environment orchestrates squamous reprogramming of human pancreatic ductal adenocarcinoma

Human pancreatic cancer is characterized by the molecular diversity encompassing native duct-like and squamous cell-like identities, but mechanisms underlying squamous transdifferentiation have remained elusive. To comprehensively capture the molecular diversity of human pancreatic cancer, we here profiled 65 patient-derived pancreatic cancer organoid lines, including six adenosquamous carcinoma lines. H3K27me3-mediated erasure of the ductal lineage specifiers and hijacking of the TP63-driven squamous-cell programme drove squamous-cell commitment, providing survival benefit in a Wnt-deficient environment and hypoxic conditions. Gene engineering of normal pancreatic duct organoids revealed that GATA6 loss and a Wnt-deficient environment, in concert with genetic or hypoxia-mediated inactivation of KDM6A, facilitate squamous reprogramming, which in turn enhances environmental fitness. EZH2 inhibition counterbalanced the epigenetic bias and curbed the growth of adenosquamous cancer organoids. Our results demonstrate how an adversarial microenvironment dictates the molecular and histological evolution of human pancreatic cancer and provide insights into the principles and significance of lineage conversion in human cancer.

Fully automated magnetic resonance imaging-based radiomics analysis for differentiating pancreatic adenosquamous carcinoma from pancreatic ductal adenocarcinoma

PURPOSE

To develop and validate an automated magnetic resonance imaging (MRI)-based model to preoperatively differentiate pancreatic adenosquamous carcinoma (PASC) from pancreatic ductal adenocarcinoma (PDAC).

METHODS

This retrospective study included patients with surgically resected, histopathologically confirmed PASC or PDAC who underwent MRI between January 2011 and December 2020. According to time of treatment, they were divided into training and validation sets. Automated deep-learning-based artificial intelligence was used for pancreatic tumor segmentation. Linear discriminant analysis was performed with conventional MRI and radiomic features to develop clinical, radiomics, and mixed models in the training set. The models' performances were determined from their discrimination and clinical utility. Kaplan-Meier and log-rank tests were used for survival analysis.

RESULTS

Overall, 389 and 123 patients with PDAC (age, 61.37 ± 9.47 years; 251 men) and PASC (age, 61.99 ± 9.82 years; 78 men) were included, respectively; they were split into the training (n = 358) and validation (n = 154) sets. The mixed model showed good performance in the training and validation sets (area under the curve: 0.94 and 0.96, respectively). The sensitivity, specificity, and accuracy were 76.74%, 93.38%, and 89.39% for the training set, respectively, and 67.57%, 97.44%, and 90.26% for the validation set, respectively. The mixed model outperformed the clinical (p = 0.001) and radiomics (p = 0.04) models in the validation set. Log-rank test revealed significantly longer survival in the predicted PDAC group than in the predicted PASC group (p = 0.003), according to the mixed model.

CONCLUSION

Our mixed model, which combined MRI and radiomic features, can be used to differentiate PASC from PDAC.

Research advances and treatment perspectives of pancreatic adenosquamous carcinoma

BACKGROUND

As a malignant tumor, pancreatic cancer has an extremely low overall 5-year survival rate. Pancreatic adenosquamous carcinoma (PASC), a rare pancreatic malignancy, owns clinical presentation similar to pancreatic ductal adenocarcinoma (PDAC), which is the most prevalent pancreatic cancer subtype. PASC is generally defined as a pancreatic tumor consisting mainly of adenocarcinoma tissue and squamous carcinoma tissue. Compared with PDAC, PASC has a higher metastatic potential and worse prognosis, and lacks of effective treatment options to date. However, the pathogenesis and treatment of PASC are not yet clear and are accompanied with difficulties.

CONCLUSION

The present paper systematically summarizes the possible pathogenesis, diagnosis methods, and further suggests potential new treatment directions through reviewing research results of PASC, including the clinical manifestations, pathological manifestation, the original hypothesis of squamous carcinoma and the potential regulatory mechanism. In short, the present paper provides a systematic review of the research progress and new ideas for the development mechanism and treatment of PASC.

Pancreatic Adenosquamous Carcinoma: A Rare Pathological Subtype of Pancreatic Cancer

Pancreatic adenosquamous carcinoma (PASC) is a rare pathological subtype of pancreatic cancer (PC), with a worse prognosis than pancreatic ductal adenocarcinoma (PDAC). Due to its rarity, our knowledge of PASC and its biological characteristics are limited. In this review, we provide an overview of the histogenesis, genetic features, diagnosis, treatment, and prognosis of PASC, as well as pancreatic squamous cell carcinoma (PSCC). The information provided here may help to clarify our understanding of PASC and provide useful avenues for further research on this disease.

Adenosquamous cancer of the pancreas: A multicenter retrospective study

INTRODUCTION

Adenosquamous cancer of the pancreas (ASCP) is an aggressive, infrequent subtype of pancreatic cancer that combines a glandular and squamous component and is associated with poor survival.

METHODS

Multicenter retrospective observational study carried out at three Spanish hospitals. The study period was: January 2010- August 2020. A descriptive analysis of the data was performed, as well as an analysis of global and disease-free survival using the Kaplan-Meier statistic.

RESULTS

Of a total of 668 pancreatic cancers treated surgically, twelve were ASCP (1.8%). Patient mean age was 69.2±7.4 years. Male/female ratio was 1:1. The main symptom was jaundice (seven patients). Correct preoperative diagnosis was obtained in only two patients. Nine pancreatoduodenectomies and three distal pancreatectosplenectomies were performed. 25% had major complications. Mean tumor size was 48.6±19.4 mm. Nine patients received adjuvant chemotherapy. Median survival time was 5.9 months, and median disease-free survival was 4.6 months. 90% of patients presented recurrence. Ten of the twelve patients in the study (83.3%) died, with disease progression being the cause in eight. Of the two surviving patients, one is disease-free and the other has liver metastases.

CONCLUSION

ASCP is a very rare pancreatic tumor with aggressive behavior. It is rarely diagnosed preoperatively. The best treatment, if feasible, is surgery followed by the standard chemotherapy regimens for pancreatic adenocarcinoma.