Chronic pancreatitis
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Chronic pancreatitis is a relatively common pathology of the pancreas that can be confused for a pancreatic cancer.
General
- May be confused with ductal adenocarcinoma radiologically... and pathologically.
- Often due to ethanol abuse.
Complications:[1]
- Malabsorption.
- Diabetes mellitus.
- Pseudocysts.
Autoimmune pancreatitis
Histologic subtypes of autoimmune pancreatitis:[2]
- Lymphoplasmacytic sclerosing pancreatitis (LPSP).
- Typically IgG4 positive -- one of the IgG4-related systemic diseases.
- Approximately 80% of cases.[3]
- Idiopathic duct-centric chronic pancreatitis (IDCP).
- Typically IgG4 negative.
- Approximately 20% of cases.
Lymphoplasmacytic sclerosing pancreatitis
General:
- Serum IgG4 +ve.[5]
Microscopic:
- Lymphoplasmacytic infiltrate.
IHC:
- Plasma cells IgG4 +ve.
Radiology
Plain film findings:
- Calcifications.
Microscopic
Features of chronic pancreatitis:[6]
- Preservation of lobular architecture - evenly spaced ductal units.
- Uniformly sized ductal elements.
- Smooth ductal contours.
- Ducts surrounded by acini or islets.
- Islets usu. preserved better than acini.[7]
- Intraluminal mucoprotein plugs.
Images:
Adenocarcinoma versus pancreatitis
This contrasts with the features of adenocarcinoma:[6]
- Ductal architecture:
- Random distribution of ductal structures.
- Irregular ductal contours.
- "Naked ducts in fat"; ducts without surrounding pancreatic elements or fibrous tissue.
- Ducts adjacent to arterioles.
- Nuclear atypia:
- Enlargement (>3 times the size of a lymphocyte).
- Pleomorphism.
- Distinct nucleoli.
- Hyperchromatic raisinoid nucleoli.
- Generally assoc. with malignancy:
- Perineural and vascular invasion (rare).
- Mitosis.
- Necrotic cellular debris (intraluminal).
Notes:
- Memory device: give 'em a fair chance at a benign diagnosis. Features suggestive of malignant:
- Fat, adjacent to.
- Arteriole, adjacent to.
- Irregular ducts.
- Random distribution of ducts/non-lobular arrangement.
IHC
- IgG4 +ve plasma cells - IgG4 sclerosing disease.
Positive in pancreatic carcinoma:[8]
- p53.
- Mesothelin.
See also
References
- ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 469. ISBN 978-1416054542.
- ↑ URL: http://path.upmc.edu/cases/case651/dx.html. Accessed on: 28 January 2012.
- ↑ 3.0 3.1 Kamisawa, T.; Takuma, K.; Tabata, T.; Inaba, Y.; Egawa, N.; Tsuruta, K.; Hishima, T.; Sasaki, T. et al. (Jan 2011). "Serum IgG4-negative autoimmune pancreatitis.". J Gastroenterol 46 (1): 108-16. doi:10.1007/s00535-010-0317-2. PMID 20824290.
- ↑ Ikeura, T.; Takaoka, M.; Uchida, K.; Shimatani, M.; Miyoshi, H.; Kusuda, T.; Kurishima, A.; Fukui, Y. et al. (2012). "Autoimmune pancreatitis with histologically proven lymphoplasmacytic sclerosing pancreatitis with granulocytic epithelial lesions.". Intern Med 51 (7): 733-7. PMID 22466829.
- ↑ Krasinskas, AM.; Raina, A.; Khalid, A.; Tublin, M.; Yadav, D. (Jun 2007). "Autoimmune pancreatitis.". Gastroenterol Clin North Am 36 (2): 239-57, vii. doi:10.1016/j.gtc.2007.03.015. PMID 17533077.
- ↑ 6.0 6.1 Adsay, NV.; Bandyopadhyay, S.; Basturk, O.; Othman, M.; Cheng, JD.; Klöppel, G.; Klimstra, DS. (Nov 2004). "Chronic pancreatitis or pancreatic ductal adenocarcinoma?". Semin Diagn Pathol 21 (4): 268-76. PMID 16273946.
- ↑ Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 225. ISBN 978-1416002741.
- ↑ Hornick, JL.; Lauwers, GY.; Odze, RD. (Mar 2005). "Immunohistochemistry can help distinguish metastatic pancreatic adenocarcinomas from bile duct adenomas and hamartomas of the liver.". Am J Surg Pathol 29 (3): 381-9. PMID 15725808.