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Invasive ductal carcinoma of the pancreas (view source)
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# | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | |||
| Image = Pancreas_adenocarcinoma_(2)_Case_01.jpg | |||
| Width = | |||
| Caption = Pancreatic adenocarcinoma. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = | |||
| Subtypes = | |||
| LMDDx = [[chronic pancreatitis]], [[cholangiocarcinoma]] | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = +/-[[BRCA2]] carrier | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[pancreas]], typically head of pancreas | |||
| Assdx = [[pancreatic intraepithelial neoplasia]], +/-[[diabetes mellitus]] | |||
| Syndromes = | |||
| Clinicalhx = +/-[[smoking]] | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = common for site | |||
| Bloodwork = elevated CA19-9 | |||
| Rads = pancreatic mass | |||
| Endoscopy = | |||
| Prognosis = very poor | |||
| Other = | |||
| ClinDDx = [[chronic pancreatitis]], other pancreatic tumours | |||
| Tx = surgery if possible | |||
}} | |||
'''Invasive ductal carcinoma of the pancreas''' is the most common type of [[pancreatic cancer]]. | |||
It is typically gland forming and thus also referred to as '''pancreatic ductal adenocarcinoma''' and '''pancreatic adenocarcinoma'''. | |||
Less specific terms that are used when the context is clear include '''[[ductal adenocarcinoma]]''' and '''[[invasive ductal carcinoma]]'''. | |||
==General== | |||
*Most common type of pancreatic cancer.<ref name=Ref_WMSP>{{Ref WMSP|237}}</ref> | |||
*Location: usually in the head ~60%. | |||
**15% in the body, 5% tail, 20% diffuse (head, body & tail).<ref name=Ref_PBoD950>{{Ref PBoD|950}}</ref> | |||
**The vast majority of pancreatic cancers are solitary, but multifocal disease can occur. | |||
*Abysmal prognosis. | |||
Risk factors:<ref name=Ref_PCPBoD8_471>{{Ref PCPBoD8|471}}</ref> | |||
*Smoking (RR ~ 2). | |||
*Pancreatitis. | |||
*Family history, esp. [[BRCA2]]. | |||
*[[Diabetes mellitus]] - modest risk increase (RR ~ 1.5-2). | |||
*Previous gastrectomy. | |||
*Heavy drinking of alcohol may weakly increase risk. | |||
Molecular characteristics:<ref name=Ref_PCPBoD8_470-1>{{Ref PCPBoD8|470-1}}</ref><ref name=pmid19896096>{{Cite journal | last1 = Furukawa | first1 = T. | title = Molecular pathology of pancreatic cancer: implications for molecular targeting therapy. | journal = Clin Gastroenterol Hepatol | volume = 7 | issue = 11 Suppl | pages = S35-9 | month = Nov | year = 2009 | doi = 10.1016/j.cgh.2009.07.035 | PMID = 19896096 }}</ref> | |||
#KRAS (oncogene) mutation in ~ 90% of cases. | |||
#CDKN2A<ref name=omim600160>{{OMIM|600160}}</ref> ([[AKA]] p16) inactivation ~ 95% of cases. | |||
#TP53 (AKA p53). | |||
#SMAD4. | |||
Clinical: | |||
*Serum CA19-9 - >2504 U/ml predicts outcome.<ref name=pmid28924968>{{Cite journal | last1 = Usón Junior | first1 = PLS. | last2 = Callegaro-Filho | first2 = D. | last3 = Bugano | first3 = DDG. | last4 = Moura | first4 = F. | last5 = Maluf | first5 = FC. | title = Predictive Value of Serum Carbohydrate Antigen 19-9 (CA19-9) for Early Mortality in Advanced Pancreatic Cancer. | journal = J Gastrointest Cancer | volume = 49 | issue = 4 | pages = 481-486 | month = Dec | year = 2018 | doi = 10.1007/s12029-017-0007-x | PMID = 28924968 }}</ref> | |||
==Gross== | |||
Features:<ref name="pmid2015921">{{Cite journal | last1 = Hermanek | first1 = P. | title = Staging of exocrine pancreatic carcinoma. | journal = Eur J Surg Oncol | volume = 17 | issue = 2 | pages = 167-72 | month = Apr | year = 1991 | doi = | PMID = 2015921 }}</ref> | |||
*Firm, sclerotic and poorly defined masses that replace the normal lobular architecture of the gland. | |||
*Cut surface are yellow to white. | |||
*The mean diameter of pancreatic head tumor is between 2.5-3.5cm. | |||
==Microscopic== | |||
Features:<ref name=Ref_PBoD951>{{Ref PBoD|951}}</ref> | |||
*Often glandular, may be solid. | |||
*Nuclei. | |||
**May be bland - little pleomorphism. | |||
**Often small nuclei. | |||
**Sometimes [[coffee-bean nuclei|coffee-bean]] appearance. | |||
*Cytoplasm - granular, abundant. | |||
*Quasi endocrine look. | |||
**May stain positive for endocrine markers. | |||
Other features: | |||
*+/-Necrosis. | |||
*+/-Myxoid degeneration. | |||
*+/-Cells around vessels. | |||
DDx: | |||
*[[Chronic pancreatitis]].<ref name=pmid16273946>{{Cite journal | last1 = Adsay | first1 = NV. | last2 = Bandyopadhyay | first2 = S. | last3 = Basturk | first3 = O. | last4 = Othman | first4 = M. | last5 = Cheng | first5 = JD. | last6 = Klöppel | first6 = G. | last7 = Klimstra | first7 = DS. | title = Chronic pancreatitis or pancreatic ductal adenocarcinoma? | journal = Semin Diagn Pathol | volume = 21 | issue = 4 | pages = 268-76 | month = Nov | year = 2004 | doi = | PMID = 16273946 }}</ref> | |||
*[[Cholangiocarcinoma]]. | |||
*[[Pancreatic intraepithelial neoplasia]] (PanIN). | |||
===Images=== | |||
<gallery> | |||
Image:Pancreas_adenocarcinoma_(3)_Case_01.jpg | Pancreatic adenocarcinoma (WC) | |||
Image:Pancreas_adenocarcinoma_(2)_Case_01.jpg | Pancreatic adenocarcinoma (WC) | |||
Image:Pancreas_neoplasia_carcinoma_sequence.png | Normal pancreas, pancreatic intraepithelial neoplasia and pancreatic carcinoma (WC) | |||
Image:Pancreas_FNA;_adenocarcinoma_vs._normal_ductal_epithelium_(200x).jpg| Pancreatic adenocarcinoma - cytopathology (WC) | |||
</gallery> | |||
www: | |||
*[http://path.upmc.edu/cases/case384.html Pancreatic adenocarcinoma - several images (upmc.edu)]. | |||
==IHC== | |||
Features:<ref name=Ref_Lester3>{{Ref Lester3|94}}</ref> | |||
*CD7 +ve. | |||
*CD20 +ve. | |||
*SMAD4 -ve ~55% of cases -- stomach usually +ve. | |||
*CDX2 -ve/+ve. | |||
*CEA +ve.<ref name=pmid16183479>{{Cite journal | last1 = Adsay | first1 = NV. | last2 = Basturk | first2 = O. | last3 = Cheng | first3 = JD. | last4 = Andea | first4 = AA. | title = Ductal neoplasia of the pancreas: nosologic, clinicopathologic, and biologic aspects. | journal = Semin Radiat Oncol | volume = 15 | issue = 4 | pages = 254-64 | month = Oct | year = 2005 | doi = 10.1016/j.semradonc.2005.04.001 | PMID = 16183479 }}</ref> | |||
==Sign out== | |||
<pre> | |||
MASS, PANCREAS, CORE BIOPSY: | |||
- ADENOCARCINOMA, MODERATELY DIFFERENTIATED. | |||
</pre> | |||
Note: | |||
*On biopsy, it isn't easy to separate from [[cholangiocarcinoma]]. Thus, it is better to stay vague. | |||
==See also== | |||
*[[Pancreas]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Pancreas]] | |||