Abstract
Ductal adenocarcinoma is by far the most frequent neoplasm of the pancreas. This chapter describes and illustrates the prototypical macroscopic and histological features of this cancer as well as the various histological patterns and numerous variants, together with their main differential diagnoses. Practical advice regarding grading, staging, and specific issues related to the macroscopic examination of surgical resection specimens for ductal adenocarcinoma is provided in detail and illustrated with numerous macroscopic and histological pictures. The use and limitations of immunohistochemistry for the differential diagnosis of ductal adenocarcinoma are discussed. A section of this chapter is specifically dedicated to the diagnostic issues related to the reporting of ductal adenocarcinoma following neoadjuvant treatment.
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References
Bosetti C, Bertuccio P, Negri E, La Vecchia C, Zeegers MP, Boffetta P. Pancreatic cancer: overview of descriptive epidemiology. Mol Carcinog. 2012;51:3–13.
Iacobuzio-Donahue CA. Genetic evolution of pancreatic cancer: lessons learnt from the pancreatic cancer genome sequencing project. Gut. 2012;61:1085–94.
Sobin LH, Gospodarowicz MK, Wittekind C, editors. UICC: TNM classification of malignant tumours. 7th ed. Oxford: Wiley-Blackwell; 2009.
Hruban RH, Boffetta P, Hiraoka N, Iacobuzio-Donahue C, Kato Y, Kern SE, et al. Ductal adenocarcinoma of the pancreas. In: Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. WHO classification of tumours of the digestive system, World Health Organization Classification of tumours. Lyon: International Agency for Research on Cancer (IARC); 2010. p. 281–91, chapter 12.
Kelly PJ, Shinagare S, Sainani N, Hong X, Ferrone C, Yilmaz O, et al. Cystic papillary pattern in pancreatic ductal adenocarcinoma: a heretofore undescribed morphologic pattern that mimics intraductal papillary mucinous carcinoma. Am J Surg Pathol. 2012;36:696–701.
Harsha HC, Kandasamy K, Ranganathan P, Rani S, Ramabadran S, Gollapudi S, et al. A compendium of potential biomarkers of pancreatic cancer. PLoS Med. 2009;6:e1000046.
Dennis JL, Hvidsten TR, Wit EC, Komorowski J, Bell AK, Downie I, et al. Markers of adenocarcinoma characteristic of the site of origin: development of a diagnostic algorithm. Clin Cancer Res. 2005;11:3766–72.
Liu H, Shi J, Anadan V, Wan HL, Diehl D, Blansfield J, et al. Reevaluation and identification of the best immunohistochemical panel (pVHL, maspin, S100P, IMP-3) for ductal adenocarcinoma of the pancreas. Arch Pathol Lab Med. 2012;136:601–9.
Winter JM, Tang LH, Klimstra DS, Brennan MF, Brody JR, Rocha FG, et al. A novel survival-based tissue microarray of pancreatic cancer validates MUC1 and mesothelin as markers. PLoS One. 2012;7:e40157.
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC cancer staging handbook. 7th ed. New York: Springer; 2010.
Björnstedt M, Franzén L, Glaumann H, Nordlinder H, Palmqvist R, Rissler P, Öst Å, Verbeke C. Gastrointestinal pathology – pancreas and peri-ampullary region. Recommendations from the KVAST Study Group of the Swedish Society for Pathology. Available at: http://svfp.se/node/240. Accessed 19 Oct 2012.
The Royal College of Pathologists. Standards and datasets for reporting cancers. Dataset for the histopathological reporting of carcinomas of the pancreas, ampulla of Vater and common bile duct. 2nd ed. London: The Royal College of Pathologists; 2010.
Verbeke CS, Knapp J, Gladhaug IP. Tumour growth is more dispersed in pancreatic head cancers than in rectal cancer – implications for resection margin assessment. Histopathology. 2011;59:1111–21.
Jamieson NB, Foulis AK, Oien KA, Going JJ, Glen P, Dickson EJ, et al. Positive immobilization margins alone do not influence survival following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. Ann Surg. 2010;251:1003–10.
Sharma S, Green KB. The pancreatic duct and its arteriovenous relationship. An underutilized aid in the diagnosis and distinction of pancreatic adenocarcinoma from pancreatic intraepithelial neoplasia. A study of 126 pancreatectomy specimens. Am J Surg Pathol. 2004;28:613–20.
Wachtel MS, Miller EJ. Focal changes of chronic pancreatitis and duct-arteriovenous relationships. Avoiding a diagnostic pitfall. Am J Surg Pathol. 2005;29:1521–3.
Westgaard A, Schjølberg AR, Cvancarova M, Eide TJ, Clausen OPF, Gladhaug IP. Differentiation markers in pancreatic head adenocarcinomas: MUC1 and MUC4 expression indicates poor prognosis in pancreatobiliary differentiated tumours. Histopathology. 2009;54:337–47.
Matsuoka L, Selby R, Genyk Y. The surgical management of pancreatic cancer. Gastroenterol Clin North Am. 2012;41:211–21.
Verbeke CS, Gladhaug IP. Resection margin involvement and tumour origin in pancreatic head cancer. Br J Surg. 2012;99:1036–49.
Páez D, Labonte MJ, Lenz H-J. Pancreatic cancer: medical management (novel chemotherapeutics). Gastroenterol Clin North Am. 2012;41:189–209.
Wilentz RE, Goggings M, Redston M, Marcus VA, Adsay NV, Sohn TA, et al. Genetic, immunohistochemical, and clinical features of medullary carcinoma of the pancreas. A newly described and characterized entity. Am J Pathol. 2000;156:1641–51.
Chatterjee D, Katz MH, Rashid A, Varadhachary GR, Wolff RA, Wang H, et al. Histologic grading the extent of residual carcinoma following neoadjuvant chemoradiation in pancreatic ductal adenocarcinoma. A predictor for patient outcome. Cancer. 2012;118:3182–90.
Evans DB, Rich TA, Byrd DR, Cleary KR, Connelly JH, Levin B, et al. Preoperative chemoradiation and pancreaticoduodenectomy for adenocarcinoma of the pancreas. Arch Surg. 1992;127:1335–9.
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Campbell, F., Verbeke, C.S. (2013). Ductal Adenocarcinoma. In: Pathology of the Pancreas. Springer, London. https://doi.org/10.1007/978-1-4471-2449-8_9
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DOI: https://doi.org/10.1007/978-1-4471-2449-8_9
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