Pancreatic ductal adenocarcinomas with multiple large cystic structures: A clinicopathologic and immunohistochemical study of seven cases

Nitta, Tsuyoshi; Mitsuhashi, Tomoko; Hatanaka, Yutaka; Hirano, Satoshi; Matsuno, Yoshihiro

doi:10.1016/j.pan.2013.05.004

Cited by 10 publications

(6 citation statements)

References 19 publications

(25 reference statements)

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“…This finding is similar to that in a previous report of a large series of ACP cases, which demonstrated that cyst formation occurred in nine of 35 ACP cases (26%)[ 5 ]. On the other hand, PDAC with cystic features has been reported to account for 7%-11% of all PDAC cases[ 14 , 15 ]. Kosmahl et al[ 16 ] reported that 38 of 483 (8%) cases of PDAC and its variants, including adenosquamous carcinomas and ACPs, had cystic features.…”

Section: Discussionmentioning

confidence: 99%

Anaplastic carcinoma of the pancreas: Case report and literature review of reported cases in Japan

Hoshimoto¹,

Matsui²,

Miyata³

et al. 2016

WJG

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We report a case of a 64-year-old woman with anaplastic carcinoma of the pancreas (ACP) with cyst formation and review 60 ACP cases reported in Japan. In 20% of cases, laboratory tests revealed severe anemia (hemoglobin level < 10.0 g/dL) and elevated leucocyte counts (> 12000/mm3), which were likely attributable to rapid tumor growth, intratumoral hemorrhage, and necrosis. Elevated serum CA19-9 levels were observed in 55% of cases. Cyst-like structures were observed on imaging in 47% of cases, and this finding appears to reflect subsequent cystic degeneration in the lesion. Macroscopically, hemorrhagic necrosis was observed in 77% of cases, and cyst formation was observed in 33% of cases. ACP should be considered when diagnosing pancreatic tumors with a cyst-like appearance, especially in the presence of severe anemia, elevated leucocyte counts, or elevated serum CA19-9 levels.

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Section: Discussionmentioning

confidence: 99%

Anaplastic carcinoma of the pancreas: Case report and literature review of reported cases in Japan

Hoshimoto¹,

Matsui²,

Miyata³

et al. 2016

WJG

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“…According to the 5 th edition of the World health organization (WHO) Classification of Digestive System Tumors, large duct type PDAC qualifies as a growth pattern and not as a special type of PDAC (such as adenosquamous, micropapillary or anaplastic/sarcomatoid undifferentiated carcinoma, for instance). With over two decades of research concerning this pattern of PDAC, pathologic diagnostic criteria were specified and arguments in favor to categorize the large duct pattern of PDAC as a subtype of PDAC accumulated [3,9,[11][12][13][14][15]. Irregular shaped, expanded ducts with a diameter of more than 0.5mm in the majority of the histological tumor sections (>50%), corresponding to macroscopic impression of microcysts and exclusion of mimickers set pathologists for the right diagnosis [9,12].…”

Section: Discussionmentioning

confidence: 99%

Pancreatic Ductal Adenocarcinoma and “Pseudo-IPMN”

2022

Ann Case Report

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Cystic tumors of the pancreas bear the potential to be challenging entities for clinicians and pathologists. The most common cystic precursor lesion of pancreatic ductal adenocarcinoma (PDAC) is the intraductal papillary mucinous neoplasm (IPMN). As several cystic pancreatic lesions with distinct clinical consequences can be easily confused with IPMNs, awareness of morphological pitfalls to avoid misdiagnosis and mistreatment is important. Here we describe the clinicopathologic case of a 54-year-old male patient with a radiologically unexpected PDAC with large duct pattern/large duct type PDAC and address mimickers of IPMN ("pseudo-IPMN").

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“…In pancreatic ductal carcinoma, retention cysts may occur secondary to intraluminal obstruction of the pancreatic ducts. Nitta et al [ 1 ] described a series of cystic pancreatic ductal adenocarcinomas that had distinctive morphologic and immunohistochemical features. In that report, the maximal cyst diameter was 2.0 cm or more in all patients (range, 2.0–5.0 cm; mean, 3.7 cm).…”

Section: Discussionmentioning

confidence: 99%

“…In that report, the maximal cyst diameter was 2.0 cm or more in all patients (range, 2.0–5.0 cm; mean, 3.7 cm). The average tumor size including the multiple large cystic structures was 6.0 cm (range, 4.0–8.0 cm) [ 1 ]. Cystic tumors of the pancreas occur with less frequency than solid lesions, and are often detected incidentally, as many of these lesions are small and asymptomatic [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Pancreatic cancer accompanied by a moderate-sized pseudocyst with extrapancreatic growth

et al. 2015

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BackgroundPancreatic cancer accompanied by a moderate-sized pseudocyst with extrapancreatic growth is extremely rare. Diagnosis of pancreatic cancer on preoperative imaging is difficult when the pancreatic parenchyma is compressed by a pseudocyst and becomes unclear. Despite advances in imaging techniques, accurate preoperative diagnosis of cystic lesions of the pancreas remains difficult. In this case, it was challenging to diagnose pancreatic cancer preoperatively as we could not accurately assess the pancreatic parenchyma, which had been compressed by a moderate-sized cystic lesion with extrapancreatic growth.Case presentationA 63-year-old woman underwent investigations for epigastric abdominal pain. She had no history of pancreatitis. Although we suspected pancreatic ductal carcinoma with a pancreatic cyst, there was no mass lesion or low-density area suggestive of pancreatic cancer. We did not immediately suspect pancreatic cancer, as development of a moderate-sized cyst with extrapancreatic growth is extremely rare and known tumor markers were not elevated. Therefore, we initially suspected that a massive benign cyst (mucinous cyst neoplasm, serous cyst neoplasm, or intraductal papillary mucinous neoplasm) resulted in stenosis of the main pancreatic duct. We were unable to reach a definitive diagnosis prior to the operation. We had planned a pancreaticoduodenectomy to reach a definitive diagnosis. However, we could not remove the tumor because of significant invasion of the surrounding tissue (portal vein, superior mesenteric vein, etc.). The fluid content of the cyst was serous, and aspiration cytology from the pancreatic cyst was Class III (no malignancy), but the surrounding white connective tissue samples were positive for pancreatic adenocarcinoma on pathological examination during surgery. We repeated imaging (CT, MRI, endoscopic ultrasound, etc.) postoperatively, but there were neither mass lesions nor a low-density area suggestive of pancreatic cancer. In retrospect, we think that the slight pancreatic duct dilation was the only finding suggestive of pancreatic cancer.ConclusionsIt is difficult to diagnose pancreatic cancer with pseudocyst preoperatively. If a pancreatic cyst is found in patients who had normal tumor marker levels or no history of pancreatitis, we should always consider the possibility of pancreatic cancer. In such cases, slight pancreatic duct dilation may be a diagnostic clue.

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Pancreatic ductal adenocarcinomas with multiple large cystic structures: A clinicopathologic and immunohistochemical study of seven cases

Abstract: Background/Objectives: Pancreatic ductal adenocarcinoma (PDA) with cystic

Cited by 10 publications

References 19 publications

Anaplastic carcinoma of the pancreas: Case report and literature review of reported cases in Japan

Anaplastic carcinoma of the pancreas: Case report and literature review of reported cases in Japan

Pancreatic Ductal Adenocarcinoma and “Pseudo-IPMN”

Pancreatic cancer accompanied by a moderate-sized pseudocyst with extrapancreatic growth

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