Ductal Adenocarcinoma, including Variants



Ductal Adenocarcinoma, including Variants


Mari Mino-Kenudson, MD









This gross photograph shows the cut surface of a large pancreatic adenocarcinoma. The surface is firm, white, and gritty. Note the dilated pancreatic duct image.






Perineural invasion is a common feature of pancreatic ductal adenocarcinoma.


TERMINOLOGY


Abbreviations



  • Pancreatic ductal adenocarcinoma (PDAC)


Synonyms



  • Pancreatic adenocarcinoma


  • Duct cell adenocarcinoma


Definitions



  • Malignant epithelial neoplasm arising in pancreatic ductal system



    • 85-90% of all pancreatic neoplasms


  • Predominantly glandular differentiation


ETIOLOGY/PATHOGENESIS


Hereditary Risk Factors



  • Family history of pancreatic cancer


  • Hereditary pancreatitis


  • Peutz-Jeghers syndrome


  • Familial atypical multiple mole melanoma syndrome


  • BRCA2 and BRCA1 mutations


Medical Risk Factors



  • Chronic pancreatitis


  • Diabetes mellitus


  • Previous cholecystectomy or partial gastrectomy


Environmental and Occupational Risk Factors



  • Cigarette smoking approximately doubles risk


  • Diet high in meat, fat, nitrates, and pork products increases risk


  • Obesity


  • Chemicals (solvents, DDT, gasoline)


  • Occupational (coal gas workers, metal working, hide tanning, dry cleaning)


Precursor Lesions



  • Pancreatic intraepithelial neoplasia


CLINICAL ISSUES


Epidemiology



  • Age



    • Peak incidence in 7th and 8th decades of life



      • Rare before age 40


      • Majority of cases occur between age 60-80


  • Gender



    • More common in men than in women (1.3:1)


  • Ethnicity



    • More common in Maoris, native Hawaiians, and African-Americans in USA


Presentation



  • Very nonspecific symptoms may result in delay in diagnosis



    • Epigastric pain radiating to the back


    • Weight loss


    • Painless jaundice


    • Signs of biliary obstruction


  • Disease associations



    • Trousseau syndrome (migratory thrombophlebitis)


    • Diabetes mellitus


    • Sister Mary Joseph sign (palpable periumbilical nodules)


    • Courvoisier sign (distended, palpable gallbladder)


Treatment



  • Resection



    • Only 10-20% of cases resectable at diagnosis


  • Chemotherapy before resection, after resection, or both



    • Gemcitabine seems most promising


Prognosis



  • Dismal



    • Overall 5-year survival less than 5%



IMAGE FINDINGS


General Features



  • CT scan is most commonly used radiological method for diagnosis and staging


  • Magnetic resonance angiography can be used to examine vascular anatomy and determine resectability


  • Endoscopic ultrasound also very reliable for diagnosis and staging


  • ERCP/MRCP help visualize ductal system


MACROSCOPIC FEATURES


General Features

Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Ductal Adenocarcinoma, including Variants
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