Pathology and Genetics

Part of the Medical Radiology book series (MEDRAD)


PDAC is an aggressive disease and early infiltrates peripancreatic tissues and adjacent organs, and gives distant metastasis and peritoneal involvement, making often surgical resection impossible. About 80% of PDACs are inoperable at the time of diagnosis. However, even if radiologically resectable, some PDAC microscopically involves the resection margins (pancreatic, retroperitoneal, or biliary, the retroperitoneal being the most important because it cannot be evaluated intraoperatorially) resulting in a nonradical excision. Local aggressiveness consists in the invasion of contiguous structures and organs (spleen, stomach, left adrenal gland, colon, and peritoneum), whereas distant metastases can occur in liver, lungs, adrenals, kidneys, bones, brain, and skin.

Most PDACs arise in the head of the pancreas often involving and occluding the intrapancreatic biliary duct and the main pancreatic duct, typically resulting in their upstream dilation associated with jaundice and cholangitis when the former is involved, and cystic formation with a variable degree of scleroatrophy of the surrounding parenchyma when the latter is involved. PDAC can spread through the papilla of Vater and duodenal wall with or without ulceration, raising the problem of differential diagnosis with primary duodenal and ampulla of Vater carcinomas infiltrating the pancreatic parenchyma. Less frequently, PDACs occur in the tail, where they are usually larger at diagnosis, determining weaker symptoms mainly due to loco-regional invasiveness.


Pancreatic Cancer Main Pancreatic Duct Lymph Node Ratio Duodenal Wall Hereditary Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Basturk O, Coban I, Adsay NV (2009) Pancreatic cysts: pathologic classification, differential diagnosis, and clinical implications. Arch Pathol Lab Med 133:423–438PubMedGoogle Scholar
  2. Bellizzi AM, Stelow EB (2009) Pancreatic cytopathology: a practical approach and review. Arch Pathos Lab Med 133:388–404Google Scholar
  3. Couch FJ, Johnson MR, Rabe K et al (2005) Germ line Fanconi anemia complementation group C mutations and pancreatic cancer. Cancer Res 65:383–386PubMedGoogle Scholar
  4. Cubilla A, Fitzgerald P (1984) Tumours of the exocrine pancreas – Atlas of tumor pathology. Armed Forces Institute of Pathology, Washington, D.C.Google Scholar
  5. Furukawa T, Kloppel G, Volkan Adsay N et al (2005) Classification of types of intraductal papillarymucinous neoplasm of the pancreas: a consensus study. Virchows Arch 447:794–799PubMedCrossRefGoogle Scholar
  6. Goggins M, Schutte M, Lu J et al (1996) Germline BRCA2 gene mutations in patients with apparently sporadic pancreatic carcinomas. Cancer Res 56:5360–5364PubMedGoogle Scholar
  7. Hamilton S, Aaltonen L (2000) Pathology and genetics of tumors of the digestive system. IARC Press, LyonGoogle Scholar
  8. Hanahan D, Weinberg RA (2000) The hallmarks of cancer. Cell 100:57–70PubMedCrossRefGoogle Scholar
  9. Harada T, Chelala C, Bhakta V et al (2008) Genome-wide DNA copy number analysis in pancreatic cancer using high-density single nucleotide polymorphism arrays. Oncogene 27:1951–1960PubMedCentralPubMedCrossRefGoogle Scholar
  10. Harsha HC, Kandasamy K, Ranganathan P et al (2009) A compendium of potential biomarkers of pancreatic cancer. PLoS Med 6:e1000046PubMedCentralPubMedCrossRefGoogle Scholar
  11. Hruban RH, Takaori K, Klimstra DS et al (2004) An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms. Am J Surg Pathol 28:977–987PubMedCrossRefGoogle Scholar
  12. Hruban RH, Klein AP, Eshleman JR, Axilbund JE, Goggins M (2007) Familial pancreatic cancer: from genes to improved patient care. Expert Rev Gastroenterol Hepatol 1:81–88PubMedCrossRefGoogle Scholar
  13. Ischenko I, Seeliger H, Schaffer M, Jauch KW, Bruns CJ (2008) Cancer stem cells: how can we target them? Curr Med Chem 15:3171–3184PubMedCrossRefGoogle Scholar
  14. Jones S, Zhang X, Parsons DW et al (2008) Core signaling pathways in human pancreatic cancers revealed by global genomic analyses. Science 321:1801–1806PubMedCentralPubMedCrossRefGoogle Scholar
  15. Katoh Y, Katoh M (2006) Hedgehog signaling pathway and gastrointestinal stem cell signaling network (review). Int J Mol Med 18:1019–1023PubMedGoogle Scholar
  16. Kim MP, Evans DB, Vu TM, Fleming JB (2009) The recognition and surgical management of heritable lesions of the pancreas. Surg Oncol Clin N Am 18:99–119; ixGoogle Scholar
  17. Klein AP, Brune KA, Petersen GM et al (2004) Prospective risk of pancreatic cancer in familial pancreatic cancer kindreds. Cancer Res 64:2634–2638PubMedCrossRefGoogle Scholar
  18. Klimstra DS, Pitman MB, Hruban RH (2009) An algorithmic approach to the diagnosis of pancreatic neoplasms. Arch Pathol Lab Med 133:454–464PubMedGoogle Scholar
  19. Kloppel G (1994) Pancreatic, nonendocrine tumours. In: Pancreatic pathology. Churchill Livingstone, EdinburghGoogle Scholar
  20. Kloppel G, Adsay NV (2009) Chronic pancreatitis and the differential diagnosis versus pancreatic cancer. Arch Pathol Lab Med 133:382–387PubMedGoogle Scholar
  21. Kluijt I, Cats A, Fockens P, Nio Y, Gouma DJ, Bruno MJ (2009) Atypical familial presentation of FAMMM syndrome with a high incidence of pancreatic cancer: case finding of asymptomatic individuals by EUS surveillance. J Clin Gastroenterol 43:853–857Google Scholar
  22. Larghi A, Verna EC, Lecca PG, Costamagna G (2009) Screening for pancreatic cancer in high-risk individuals: a call for endoscopic ultrasound. Clin Cancer Res 15:1907–1914PubMedCrossRefGoogle Scholar
  23. Lewis BC (2006) Development of the pancreas and pancreatic cancer. Endocrinol Metab Clin North Am 35:397–404; xiGoogle Scholar
  24. Lynch HT, Fusaro RM, Lynch JF (2007) Hereditary cancer syndrome diagnosis: molecular genetic clues and cancer control. Future Oncol 3:169–181PubMedCrossRefGoogle Scholar
  25. Maitra A, Hruban RH (2008) Pancreatic cancer. Annu Rev Pathol 3:157–188PubMedCentralPubMedCrossRefGoogle Scholar
  26. Ottenhof NA, Milne AN, Morsink FH et al (2009) Pancreatic intraepithelial neoplasia and pancreatic tumorigenesis: of mice and men. Arch Pathol Lab Med 133:375–381PubMedGoogle Scholar
  27. Pawlik TM, Gleisner AL, Cameron JL et al (2007) Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer. Surgery 141:610–618PubMedCrossRefGoogle Scholar
  28. Riediger H, Keck T, Wellner U et al (2009) The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer. J Gastrointest Surg 13:1337–1344PubMedCrossRefGoogle Scholar
  29. Sohn TA, Yeo CJ, Cameron JL et al (2004) Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg 239:788–797; discussion 97–99Google Scholar
  30. van der Heijden MS, Yeo CJ, Hruban RH, Kern SE (2003) Fanconi anemia gene mutations in young-onset pancreatic cancer. Cancer Res 63:2585–2588PubMedGoogle Scholar
  31. van der Heijden MS, Brody JR, Dezentje DA et al (2005) In vivo therapeutic responses contingent on Fanconi anemia/BRCA2 status of the tumor. Clin Cancer Res 11:7508–7515PubMedCrossRefGoogle Scholar
  32. Wang Z, Zhang Y, Banerjee S, Li Y, Sarkar FH (2006) Notch-1 down-regulation by curcumin is associated with the inhibition of cell growth and the induction of apoptosis in pancreatic cancer cells. Cancer 106:2503–2513PubMedCrossRefGoogle Scholar
  33. Westgaard A, Schjolberg AR, Cvancarova M, Eide TJ, Clausen OP, Gladhaug IP (2009) Differentiation markers in pancreatic head adenocarcinomas: MUC1 and MUC4 expression indicates poor prognosis in pancreatobiliary differentiated tumours. Histopathology 54:337–347PubMedCentralPubMedCrossRefGoogle Scholar
  34. Wilentz RE, Albores-Saavedra J, Zahurak M et al (1999) Pathologic examination accurately predicts prognosis in mucinous cystic neoplasms of the pancreas. Am J Surg Pathol 23:1320–1327PubMedCrossRefGoogle Scholar
  35. Yamamoto H, Itoh F, Nakamura H et al (2001) Genetic and clinical features of human pancreatic ductal adenocarcinomas with widespread microsatellite instability. Cancer Res 61:3139–3144PubMedGoogle Scholar
  36. Zamboni G, Scarpa A, Bogina G et al (1999) Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors. Am J Surg Pathol 23:410–422PubMedCrossRefGoogle Scholar
  37. Zamboni G, Capelli P, Pesci A, Beghelli S, Luttges J, Kloppel G (2000) Pancreatic head mass: what can be done? Classification: the pathological point of view. JOP 1:77–84PubMedGoogle Scholar
  38. Zamboni G, Capelli P, Scarpa A et al (2009) Nonneoplastic mimickers of pancreatic neoplasms. Arch Pathol Lab Med 133:439–453PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Department of PathologyUniversity of VeronaVeronaItaly

Personalised recommendations