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.



  • Pancreatic ductal adenocarcinoma (PDAC)


  • Pancreatic adenocarcinoma

  • Duct cell adenocarcinoma


  • Malignant epithelial neoplasm arising in pancreatic ductal system

    • 85-90% of all pancreatic neoplasms

  • Predominantly glandular differentiation


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



  • 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


  • 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)


  • Resection

    • Only 10-20% of cases resectable at diagnosis

  • Chemotherapy before resection, after resection, or both

    • Gemcitabine seems most promising


  • Dismal

    • Overall 5-year survival less than 5%


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


General Features

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

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