Difference between revisions of "Pancreas"

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Pancreas (view source)

Revision as of 10:44, 5 March 2014

3,276 bytes removed ,  10:44, 5 March 2014
→‎Invasive ductal carcinoma of the pancreas: split out
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*[[AKA]] ''pancreatic ductal adenocarcinoma''.
*[[AKA]] ''pancreatic ductal adenocarcinoma''.
*[[AKA]] ''pancreatic adenocarcinoma''.
*[[AKA]] ''pancreatic adenocarcinoma''.
===General===
{{Main|Invasive ductal carcinoma of the pancreas}}
*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>
*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.
 
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.
 
===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]].
 
====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.


==Pancreatic neuroendocrine tumour==
==Pancreatic neuroendocrine tumour==
Michael
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