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Exocrine pancreatic tumours and their histological
classification. A study based on 167 autopsy and 97 surgical
cases.
Histopathology.
1983 Sep;7 (5): 645-61.
Based on
histopathological examination of 264 exocrine pancreatic tumours
(167 autopsy and 97 surgical) from the files of the Institute of
Pathology, University of Hamburg, over a 15-yr period
(1966-1980), a histogenetic classification is proposed. In
addition to the more common neoplasms this also includes rarer
and more recently defined entities. Of the 264 tumours, 250 were
of duct origin, 10 acinar and four of uncertain histogenesis.
Ductal adenocarcinoma, subdivided into a well-differentiated and
a poorly-differentiated type, was most frequent (81.1%),
followed by its variants: pleomorphic giant cell carcinoma 5.3%,
adenosquamous carcinoma 3.8%, and mucinous carcinoma 1.1%. All
these had a poor prognosis. Serous cystadenoma (1.1%), mucinous
cystic tumour (1.5%) and intraductal papilloma (0.8%), which
were rare tumours and mostly apparent in surgical material,
proved to be benign or of only latent malignancy. The group of
tumours of acinar cell origin consisted of the solid and cystic
tumour (2.7%) with favourable prognosis and the acinar cell
carcinoma (1.1%). No pancreatoblastoma was observed. The
pleomorphic carcinomas of the small cell type (1.5%) were
classed as tumours of uncertain histogenesis.
Morphological patterns of primary nonendocrine human pancreas
carcinoma.Cancer
Res. 1975 Aug;35(8):2234-48.
The study
of histological sections of 406 cases of nonendocrine pancreas
carcinoma at Memorial Hospital indicated that morphological
patterns of pancreas carcinoma could be delineated as follows:
duct cell adenocarcinoma (76%), giant-cell carcinoma (5%),
microadenocarcinoma (4%), adenosquamous cancinoma (4%), mucinous
adenocarcinoma (2%), anaplastic carcinoma (2%),
cystadenocarcinoma (1%), acinar cell carcinoma (1%), carcinoma
in childhood (under 1%), unclassified (7%). In 195 cases of
patients with pancreas carcinoma, search was made for changes in
the pancreas duct epithelium and these were compared to duct
epithelium in a control group of 100 pancreases from autopsies
of patients with nonpancreatic cancer. The following incidences
were found for pancreas cancer and nonpancreatic cancer,
respectively: mucous cell hypertrophy, 39 versus 28%; pyloric
gland metaplasia, 28 and 17%; epidermoid metaplasia, 6 and 12%;
papillary hyperplasia, 42 and 12%; atypical duct hyperplasia,
14% and none; cancinoma in situ in 19% and none in the control
group. Mucin in the majority of pancreas cancers suggested that
the cell type of origin of the common pancreas cancer is the
mucin-producing duct epithelium. The association of atypias and
carcinomas in situ in the patients with pancreas carcinoma
implies, by analogy to other organs, that there may be a
significant latent period between the appearance of carcinoma in
situ and the grossly recognizable pancreas cancer.
Nonductal
neoplasms of the pancreas.Mod
Pathol.2007;20 Suppl 1:S94-112.
Although
the majority of pancreatic neoplasms are infiltrating ductal
adenocarcinomas or other neoplasms with ductal differentiation,
neoplasms with acinar, endocrine, mixed, or uncertain
differentiation constitute a diverse and distinctive group. The
most common and best-characterized nonductal neoplasms are
pancreatic endocrine neoplasm, acinar cell carcinoma,
pancreatoblastoma, and solid pseudopapillary neoplasm. This
review details the clinical and pathologic features of these
nonductal neoplasms, highlighting diagnostic criteria including
the use of specific immunohistochemical stains to define the
cellular differentiation of the neoplasms. Non
ductal-adenocarcinoma neoplasms of the pancreas.Chir
Ital. 1999 May-Jun;51(3):181-8.
Pancreatic
Non Ductal-Adenocarcinoma Neoplasms (PNDAN) represent about 20% of
pancreatic and periampullary tumors and should be considered in
differential diagnosis with ductal adenocarcinoma in the presence of
isolated pancreatic mass. From January 1992 to December 1998, 238
patients were operated on for pancreatic and periampullary masses.
Fifty-five patients had PNDAN: 24 endocrine tumors, 7 serous
cystadenomas, 6 intraductal papillary-mucinous tumors, 5 acinar
carcinomas, 4 mucinous cystadenomas, 3 metastatic tumors, 2 cystic
papillary tumors, 2 solid cystadenocarcinomas, 1 neurilemmoma, and 1
pancreatoblastoma; 19 were benign and 36 were malignant or
borderline tumors. A correct preoperative diagnosis was obtained in
58% of the cases. In all other cases, diagnosis was achieved
intraoperatively. Major (18 pancreaticoduodenectomies, 17 left
splenopancreatectomies, 1 total pancreatectomy) and minor resections
(5 central pancreatectomy, 10 enucleations) were performed; curative
surgical operations were carried out on 39/55 patients (curative
resectability: 71%). Operative mortality and morbidity were 1.8% and
21.8%, respectively. Three and 5-year actuarial survival for
malignant or borderline PNDANs are 65% and 40% versus 31% (3-year)
for ductal adenocarcinoma of pancreatic head treated by
pancreaticoduodenectomy (p-value = 0.03). We believe that pancreatic
masses that are not ductal adenocarcinomas, can be aggressively
resected even if large in size, resulting in a better outcome than
ductal adenocarcinoma itself.
Clinicopathological features and diagnostic points of uncommon
pancreatic tumors.Rinsho
Byori. 1994 Feb;42(2):143-9.
Clinicopathological features of uncommon pancreatic tumors including
solid cystic tumor (SCT), acinar cell carcinoma and
pancreatoblastoma are described, based upon a literature survey and
own experiences. They are often discovered by US and CT as
asymptomatic pseudocystic tumor. SCTs almost always occur in young
female and Pancreatoblastoma, in children less than five years old.
The prognosis is very favorable in SCT, and relatively good in
acinar cell carcinoma and pancreatoblastoma. Pancreatoblastoma is
often associated with the elevation of serum AFP levels.
Characteristic histological features and immunocytochemical features
are also described, all of which are very different from those of
usual pancreatic ductal carcinoma. Molecular biological features
including the results of k-ras and p53 point mutation are also
discussed. In addition to the clinicopathological features, these
uncommon tumors are very different from usual ductal carcinoma in
the molecular biological features.
Morphological study of 391 cases of exocrine pancreatic tumours with
special reference to the classification of exocrine pancreatic
carcinoma.J
Pathol. 1985 May;146(1):17-29.
Three hundred
and ninety-one cases of primary pancreatic tumours, excluding
endocrine tumours, were studied histologically. Carcinoma of the
exocrine pancreas formed the largest group (98.5 per cent), benign
tumours (1.25 per cent) and other malignant tumours (0.25 per cent)
formed the remainder. Ductal adenocarcinoma was the commonest type
and was divided into four sub-types, papillary, well, moderately and
poorly differentiated duct adenocarcinoma. The moderately and poorly
differentiated tumours were the commonest types. Papillary carcinoma
was separated from the well differentiated tumours by its different
morphological appearances and was found to exhibit different
behaviour. Other special morphological types of pancreatic
carcinoma, pleomorphic,mucinous, adenosquamous, acinar,
microadeno carcinoma, cystadeno carcinoma and oncocytic carcinoma were
also represented. Benign microcyst adenomata (four cases) were
considered because of their interesting morphological features and
their significance in the differential diagnosis of carcinoma . Based
on the morphology and behaviour of these 391 tumours, the
classification of pancreatic carcinoma is discussed and some rare
types are compared with previously reported cases and discussed.
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