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The pancreatic intraepithelial neoplasia (PanIN) nomenclature and classification system, used to describe the microscopic epithelial precursor lesions of pancreatic ductal adenocarcinoma, replaced at least 70 different diagnostic terms for the same entities. The average time taken for the genetic progression from an initiating mutation in a normal ductal epithelial cell, through PanIN, to invasive ductal adenocarcinoma has been estimated to be 11.7 years. This chapter discusses the recently introduced two-tier classification, and the microscopic features, of PanIN, together with the differential diagnosis, including intraductal papillary mucinous neoplasia and cancerization of ducts.

Utilization of circulating tumor DNA as a novel and noninvasive test for diagnosis confirmation, therapy selection, and cancer surveillance is a rapidly growing area of interest. In the wake of FDA approval of a liquid biopsy test, it is important for clinicians to acknowledge the obvious clinical utility of liquid biopsy for cancer management throughout the course of the disease. This case report describes a female with invasive ductal adenocarcinoma of the breast, where liquid biopsy was instrumental for her cancer characterization and personalized therapy selection.

Most solid pancreatic tumors are invasive ductal adenocarcinoma (PDAC). Because PDAC is the most common tumor, it has become synonymous with the term "Pancreas Cancer." However, other malignant neoplasms occur in the pancreas (acinar, neuroendocrine and colloid carcinomas, and metastases) all with different outcomes. Because these tumors are often combined with PDAC in research databases, it causes misleading variability in the analysis of pancreatic cancers. We examine the histopathology of a variety of pancreatic cancers.

Pancreatic intraepithelial neoplasias (PanINs) are microscopic lesions of the pancreas. Traditionally viewed as a benign metaplasia of small ducts, evidence suggests that PanINs are neoplastic and that some PanINs progress to invasive ductal adenocarcinoma. The primary diagnostic challenge is distinguishing PanINs from other lesions, including invasive ductal adenocarcinoma, intraductal papillary mucinous neoplasm, and cancerization of benign ducts. PanINs are the most common of the pancreatic cancer precursor lesions, yet they remain poorly understood and are so small that they are almost clinically undetectable. Further study is required to define the role of PanINs in the carcinogenesis and early detection of pancreatic cancer.

We evaluated the effectiveness of dynamic computed tomography (CT) imaging in differentiating malignant intraductal papillary mucinous tumor (IPMT) with a large mural nodule from invasive ductal adenocarcinoma (IDAC).Dynamic CT was done in six IPMT and nine IDAC cases. In the IPMT cases, we made a histological map of the tumor. A region of interest (ROI) was established in the mural nodule of the IPMT, in the IDAC, and in the noncancerous portion of the pancreas. The change of density was analyzed statistically during preenhancement and the early and late phases. These results were compared between the IPMT and IDAC cases.Histologically, most of the mural nodule was papillary adenocarcinoma. In the IPMT cases, the postenhancement density of the mural nodule was significantly higher during the early phase than during the late phase. In IDAC cases, the postenhancement density was significantly higher in the late phase than in the early phase. In the early phase, tumor-pancreas density was significantly higher in the IPMT than in the IDAC. In the late phase, tumor-pancreas density was significantly higher in the IDAC than in the IPMT.Dynamic CT is useful for differentiating malignant IPMT with a large mural nodule from IDAC.

Background: Invasive ductal adenocarcinoma of the pancreas (IDAP) also spreads through the pancreatic ductal tree. The aim of this study was to clarify the clinicopathologic feature

Background Although invasive ductal adenocarcinoma of the pancreas (PDAC) manifests as a relatively uniform histomorphological feature of the pancreatobiliary type, it may be complicated by metaplastic changes and heterogeneous gastric and intestinal elements. This study aimed to investigate the complication rate and clinicopathological significance of such heterogeneous elements. Methods Fifty-nine patients who underwent resection of PDAC were examined in this study. Immunohistochemically, tumors showing high expression (>25%) of the intestinal-type (INT) marker CDX2 were classified as PDAC with INT. Those with high expression (>25%) of the gastric-type (GAS) marker MUC5AC were classified as PDAC with GAS, while those with high expression of both markers were classified as PDAC with INT/GAS. These patients were compared with those with PDAC of the negative group in which neither markers was highly expressed to examine their clinicopathological significance. Results In the 59 patients, 31 (52.5%) showed high CDX2 or MUC5AC expression. Twenty-eight patients (47.5%) belonged to a negative group, 11 (18.6%) to a PDAC with INT group, 15 (25.4%) to a PDAC with GAS group, and 5 (8.5%) to a PDAC with INT/GAS group. No significant differences were observed for age, gender, size, localization, T classification, or prognosis among the four groups. Although the PDAC with GAS group had well differentiated types significantly more than the other groups, the rate of lymph node metastasis in this group was significantly higher (PDAC with GAS: 73%; other groups: 36%). Conclusion Complications with heterogeneous elements are not uncommon in PDAC, and this should be considered during the diagnosis and treatment of PDAC along with histogenesis of the disease.

To determine the frequency of intraductal papillary mucinous neoplasm (IPMN) in patients with and without invasive ductal adenocarcinoma (IDAC).82 patients underwent pancreatectomy for pancreas adenocarcinoma. 68/82 subjects underwent at least one preoperative imaging study including CT (n = 43), MRI (n = 25), or both (n = 12). Imaging studies were retrospectively evaluated to determine if IPMN was present in the gland at a location distant from IDAC. In 183 different adult patients undergoing MRI for renal mass, images were evaluated to determine the frequency of IPMN. Fisher's exact test was used to test whether the prevalence of IPMN was greater among patients with pancreas cancer than those without.Five of 68 (7.3%) patients who underwent pancreatic resection for IDAC had IPMN at a site distant from the cancer. Two of 182 (1.1%) patients undergoing MRI for renal cancer had imaging evidence of IPMN. There was a significant difference (p = 0.017) in the prevalence of IPMN between patients with and without IDAC. The odds ratio for IPMN as a predictor of pancreas cancer was estimated as 7.18.IPMN occurs with increased frequency in patients with pancreas cancer as opposed to those without pancreas cancer. and IAP.

Invasive ductal adenocarcinoma (IDA) of the pancreas (IDAP) originating from the ductal gland has a poor prognosis worldwide. To improve the prognosis, treatment for noninvasive carcinoma stages is

The clinicopathologic features of the cases of three patients with intraductal carcinoma of major salivary gland are described. As in the breast, these lesions of salivary ducts appear to represent an in situ or preinvasive phase of the disease. On follow-up, one patient had a local recurrence, and in another patient, the tumor subsequently became invasive. This experience suggests that wide surgical excision (preferably total parotidectomy) may be curative but that resections limited to grossly visible disease will result in local recurrence and/or the development of invasive ductal adenocarcinoma.

Publisher Summary This chapter presents a study analyzing carcinoembryonic antigen (CEA) in mammary and extramammary Paget's disease. Paraffin-embedded biopsy specimens from cases of seven mammary and 12 extramammary Paget's disease were collected from the Department of Dermatology and from the Department of Gynaecology and Obstetrics of the University Central Hospital, Helsinki, Finland. An intraductal or invasive ductal adenocarcinoma of the breast was found in every patient with mammary Paget's disease. In six cases, the biopsies from the primary tumor were also studied for the presence of CEA. The lesions of extramammary Paget's disease were located in the vulva in six instances, in the inguinal skin in three, in the pubic area in two, and in the axilla in one patient. No deeper malignancies were clinically detectable in any of these patients. CEA was found in the Paget's cells in five out of seven cases of mammary Paget's disease. The CEA-positive material was located in the cytoplasm of the cells. The intensity of the reaction was not evenly distributed in every cell, and it also varied from case to case.