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home - Pancreas - Pancreatic Cancers - Pancreatic Cancer Written by Dr Sebastian Zeki

Knows the presentation investigation and staging of pancreatic

Recognises the importance of considering and being able to identify
uncommon pancreatic tumours (such as neuroendocrine or
intrapapillary mucinous tuours)

Knows the range of potential therapies and recognises the factors
that make such tumours potentially operable or inoperable

Knows the prevalence and natural history of benign cysts/serous
cystadenoma and potentially malignant cystic lesions

Knows the options for palliative treatment
Shows ability to sequence investigations appropriately
Understands value of multi-disciplinary team
Recognises the importance of considering possibility that the tumour
is unusual

Communicates effectively within the multi-disciplinary team and with
the patient and their family

Pancreatic Cancer

Rare neoplasms:Mixed exocrine and endocrine neoplasms.Ductal adenocarcinomas and acinar cell carcinomas- also commonly contain a minor population of cells with neuroendocrine differentiation that is detected by immunostains. Other Neoplasms1.Cystic Neoplasms2.Sarcomas Acinar, ductal or endocrine marker positive Lipase hypersecretion Ductal adenocarcinoma (90%) Comprised of mucous and signet cells, and may display a pattern consisting of glands, duct-like structures with papillary changes, or a cribriform pattern. Pathology:Dense stromal fibrosis due to TGF-b signalling alterationTherefore also called"scirrhous" or "desmoplastic" carcinomas. Epidemiology:Incidence and number of PanIN rise with age,Low grade PanIN (PanIN-1) 50% prevalence >50 yrs oldPanIN progress to invasive cancer. Normal ductal epithelium Papillary lesion no atypia ( PanIN-1) Papillary lesion with atypia PanIN-2 Invasive ductal adenocar - cinoma PanIN-3 KRas/ SMAD4/p16 65% in head 10 to 15 % in tail 5 to 10 % in body Duodenum Pancreatic Intraepithelial Neoplasia= Small (generally <5 mm) intraductal noninvasive lesion that is formed by metaplasia and proliferation of ductal epithelium.The epithelium is columnar and contains increased cytoplasmic mucin.The majority appear to arise in smaller intralobular ducts but can appear anywhere. Colloid carcinomas (2 % of ductal carcinomas)- Composed of pools of mucous with clusters of malignant duct cells.Adenosquamous cancers display areas of squamous differentiation; on occasion, the squamous component predominates.Less common variants include pleomor-phic carcinomas, sarcomatoid carcino-mas, and giant cell carcinomasVery rare: Medullary and signet ring carcinomas, hepatoid carcinoma, and benign neoplasms including teratoma and lymphoepithelial cyst. a) Ductal- 90% are all pancreatic cancers Types Acinar cell carcinoma-Rare malignant neoplasms that are usually solid, but are sometimes cystic.-Usually male adults- can occur anywhere in pancreas-Can cause lipase hypersecretion causing subcut fat necrosis ("pancreatic panniculitis"), and polyarthralgia- poor prognosis-Histologically, look like acinar cells, and contain zymogen granules-Overall prognosis better than for ductal adenocarcinoma. PancreatoblastomaSolid malignant neoplasms of presumed stem cell origin.They appear to arise from primitive cells that have the potential to differentiate along several lines.Mainly occur in infants and childrenM=F and arise anywhere in pancreas30% secrete aFPHistology: Composed of primitive small polygonal or spindle-shaped cells that is mixed with acinar, ductal or islet cells.Immunostaining can reveals acinar, ductal or endocrine markers among polygonal cells.Characteristic "squamoid" bodies are found among the primitive cells and provide a useful diagnostic feature.Less aggressive than ductal adenocarcinoma and have a higher cure rate after surgical resection.The prognosis is better in children than in adults. Local extension targets:The duodenum.The portal vein.The Superior mesenteric vessels.Perineural invasion.Occasionally there is local extension to the spleen, adrenal glands, vertebral column, transverse colon, and/or stomach. 3.Lymphomas 4.Endocrine neoplasms 5. eg, mixed ductal-endocrine carcinoma, mixed acinar-endocrine carcinoma, and mixed acinar-endocrine-ductal carcinoma Probably from pluripotent cells but different from pancreaticoblastomas as no primitve component Wide resection margin difficult due to proximity of aorta, superior mesenteric artery, and portal vein so retroperitoneal tissue behind head of the pancreas is most common site of recurrence. Pancreatic Cancer Pathology Written by Dr Sebastian Zeki

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