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Simple Summary This study investigated pancreatic morphological abnormalities leading to the early diagnosis of pancreatic ductal adenocarcinoma with computed tomography (CT) imaging. The “K-sign” detected in this study is an important CT finding as a pancreatic morphological abnormality that may be used as a reliable predictor of pancreatic cancer development. Abstract Pancreatic invasive ductal adenocarcinoma (PDAC) has a poor prognosis, and the detection of PDAC during the early stage is thought to improve prognosis. In this study, we retrospectively investigated pancreatic morphological abnormalities that lead to the early diagnosis of PDAC with computed tomography (CT) imaging. In total, 41 out of 308 patients diagnosed with pancreatic cancer between 2011 and 2017 in our institution were enrolled. As a control group for the group with pancreatic cancer, 4277 patients without pancreato-biliary diseases were enrolled. We retrospectively reviewed and analyzed the clinical data including patient characteristics, the clinical course and preoperative CT imaging with pancreatic morphological features. Out of 41 patients, 24 patients (58.5%) showed local K-shaped constriction of the pancreatic parenchyma “K-sign” on preoperative CT images. Eight patients (19.5%) showed localized fatty change. Out of 4277 control patients, seven patients (0.16%) showed K-sign. “K-sign” may be used for the early diagnosis of PDAC by CT imaging.

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.

Synchronous tumours of the pancreas are rare encounters, with few reported cases. Thus, new information can be brought about the diagnosis, proper management, and prognosis of cases. We believe that the presentation of this case can help to establish relevant conclusions. We report the case of a 54-year-old man, with the preoperative diagnosis of a cephalic intraductal papillary mucinous neoplasm (IPMN), who underwent a planned cephalic pancreatoduodenectomy with completion to total pancreatectomy based on the intraoperative extemporaneous histopathological examination of the resection margin. The final histopathological diagnosis was cephalic IPMN associated with invasive ductal adenocarcinoma (PDAC) and a small well-differentiated neuroendocrine tumour (NET) in the tail of the pancreas. No recurrence was detected in the 3 years of follow-up. We conducted a review of the literature to illustrate the particularities of the presented case; it identified 4 articles about the association of PDAC and NET and 8 articles regarding the association of IPMN with NET. Only 2 patients had a histopathological diagnosis of three synchronous tumours (IPMN, PDAC, and NET). We present a rare case of three synchronous pancreatic tumours, with a favourable evolution after a total pancreatectomy, only two other similar cases being reported in medical literature.

Although the presence of pancreatic tissue outside of the usual anatomical location of the pancreas is not an uncommon incidental finding, the risk of malignancy is extremely low. We report a case of ductal adenocarcinoma arising within a focus of heterotopic pancreas, occurring in the jejunum of an 81 year old woman. The patient presented with a history of progressive gastrointestinal occlusive symptoms. Computerized tomography showed a mass in the jejunum, which was surgically removed. Histopathology revealed an invasive pancreatic ductal adenocarcinoma from pancreatic tissue with no connection with the original gland (Heinrich type II). At the 12-month follow-up, there were no signs of recurrence. Despite the low risk of malignancy in heterotopic pancreas, adenocarcinoma is the most frequent histological type, and the prognosis is still not clear. Lesions incidentally detected during surgery and in symptomatic patients need to be removed by conservative procedures in order to exclude malignant disease.

Objective The aim of this study was to review our series of pancreatic resection specimen handling results and focus on the positivity of the tumor in various retroperitoneal surgical margins. Material and method Our archival cases from 2008 to 2018 were retrospectively examined, especially for the surgical margins. The demographics, tumor locations, and the diagnoses were recorded. The state of all of the retropancreatic surgical margins (anterior, posterior, superior, inferior, superior mesenteric vein and artery) were recorded. Results There were 285 cases, of which 157 were male and 128 female. The mean and median ages were 63.3 and 64, respectively. Invasive ductal adenocarcinoma was the most common diagnosis [202 cases (70.8%)]. Positivity was observed in 90 (31.5%) margins. The majority was in the superior mesenteric vein margin [n:24 (8.4%)]. This was followed by the anterior, resection and SMA margins. Conclusion Pancreatic resections should macroscopically be sampled by recommended methods in order to detect positivity in individual margins by proper grossing techniques. When this is applied, the superior mesenteric vein margin is the margin most prone to be positive for the tumor.

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.

症例は51歳女性．検診の腹部USで膵腫瘤を指摘され紹介となった．EUSでは膵頭体部移行部に内部に嚢胞成分を有する10mmの低エコー腫瘤を認め，ダイナミックCTでは腫瘤は指摘できず5mmの嚢胞のみを認めた．ERPでは膵管像に異常はなく膵液細胞診はclass IIIであった．IDUSでは10mmの腫瘤内に5mmの嚢胞を認めた．以上より術前診断は確定できず，膵内分泌腫瘍，Solid-pseudopapillary neoplasm，浸潤性膵管癌（膵癌）などの疑診にて膵中央切除を行った．術中迅速病理検査は膵癌であったため，亜全胃温存膵頭十二指腸切除術に術式を変更した．病理診断は中分化型管状腺癌でpTS1（15mm）pT1 pN0 cM0 fStage Iであり，嚢胞部分は拡張した腫瘍腺管であった．嚢胞を伴う小膵癌の診断は困難であるが，常に念頭に置き診療にあたることが重要と考えられた．

Cyclooxygenase-2 (COX-2) and p53 represent molecules linked to oncogenesis of pancreatic cancer, and there is also a known regulatory loop between mouse double minute 2 (MDM2) and p53. The complex cross talks between p53 and COX-2 and scenarios explaining patterns of p53 and COX-2 expressions in precursor and cancer lesions have been recently reported.The expressions of COX-2, p53, and MDM2 were examined using immunohistochemistry in 85 resection specimens of pancreatic ductal adenocarcinoma.The positive tumor expression rates of COX-2, p53, and MDM2 were 69.4%, 60.0%, and 41.2%, respectively. Significant correlations between COX-2 and p53 expressions and between p53 and MDM2 expressions were revealed. In the Kaplan-Meier analysis, no statistically significant correlations were found among the levels of COX-2, p53, and MDM2 expressions and survival rates. In the multivariate Cox proportional hazards regression model, grade and nodal status showed to be a valuable predictor of a worse overall survival.The reported findings confirmed the relationship of p53, MDM2, and COX-2 with the biological process of pancreatic cancer. The expression of none of the examined proteins showed to be a valuable independent prognostic factor. On the contrary, grade and nodal status showed to be a valuable predictor of a worse survival.

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

1996年までに切除した浸潤性膵管癌438例のうち, 5年以上長期生存した長期生存群17例と, 根治度A, B がえられたものの1年未満で癌再発死亡した早期 (再発) 死亡群29例を対象とし, 膵後方浸潤 (rp) の有無別に組織学的所見, 術式, 再発様式, quality of life (QOL) について比較検討した. rp (-) 例では, PL郭清を伴うD1+αが多かったが, ともに, 膵外神経叢浸潤 (p1) は陰性で, 長期生存群でりんぱ節転移n (+) が33%と少なかった. 早期 (再発) 死亡群では肝転移が75%であった. rp (+) 例では, PL郭清を伴うD1+αまたはD2が行われ, 長期生存群でn (+) が38%と少なく, 乳頭腺癌や高分化型管状腺癌が75%と多かった. 早期 (再発) 死亡群では肝転移, 後腹膜再発が68%, 40%で, 再発に伴うQOLの低下がみられた. 以上より, rp (-) 例ではD1+α以下の術式と効果的な肝転移対策, rp (+) 例ではPL郭清を伴うD2と局所制御のための補助療法, 効果的な肝転移対策が膵癌長期生存には必要と考えられた.

膵頭部癌に対する全胃幽門輪温存膵頭十二指腸切除 (PpPD) の適応を, 十二指腸第1部または胃への癌の直接浸潤を認めず, 胃周囲リンパ節 ((3), (4), (5), (6), (7)) への転移を認めないこととした1989年以降の膵頭部浸潤性膵管癌切除例154例を対象に, PpPD66例と胃切除を伴う膵頭十二指腸切除 (胃切除PD) 88例の2群に分け, 比較検討した. 拡大手術は, ともに約80%に安全に行われ, 進行度, 根治度もPpPDと胃切除PDで差はなかった. 5生率, 平均生存期間もともに差はなく, PpPDでおのおの, 35%, 15.0か月であった. 再発様式はともに後腹膜再発, 肝転移が多くを占め, PpPDで胃周囲リンパ節再発例はなかった. Performance, Statusと体重変動からみた術後のQuality of Life (QOL) もPpPDと胃切除PDに差はなく良好であった. 以上より, 上記の適応基準を用いれば, 根治性, 安全性, 術後QOLを損なうことなく, 膵頭部癌に対する基本術式としてPpPDを導入できると考えられた.

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.

The aim of this study was to determine the prognostic factors and assess the impact of excessive operative blood loss (OBL) on survival after pancreatectomy for invasive ductal adenocarcinoma.From the retrospective analysis, 271 patients were eligible for evaluation. Overall survival was assessed to clarify the prognostic determinants, including patient characteristics, perioperative factors, and tumor characteristics.The overall survival was significantly affected by the amount of OBL. The median survival times were 26.0, 15.3, and 8.7 months for OBL less than 1000, 1000 to 2000, and greater than 2000 mL, respectively (1000 vs 1000-2000 mL, P=0.019; 1000-2000 vs2000 mL, P0.0001). Operative blood loss greater than 2000 mL remained an independent prognostic factor in multivariate analysis (P=0.003; hazards ratio, 2.55). Operative blood loss of 2010 mL was found to be an appropriate cutoff level to predict early mortality within 6 months after resection (sensitivity, 0.660; specificity, 0.739). Male sex, year of resection, and plexus invasion were independently associated with OBL greater than 2000 mL.Excessive OBL was found to be a prognostic determinant of survival after surgery for pancreatic cancer. Operative blood loss can be used to stratify the risk for pancreatic cancer mortality. Successful curative resection with limited blood loss can contribute to improved survival.

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

A case of a primary squamous cell carcinoma of the breast in a patient with synchronous contralateral invasive ductal adenocarcinoma is reported. To our knowledge, no dynamic MR mammography of this pathology is described in the literature. On MR, it presented as a mainly non-enhancing, partially cystic mass with an enhancing irregular peripheral rim. In the differential diagnosis of a mass with unsharp margins and an irregular border of the cystic or the non-enhancing area on MR mammography, a primary squamous cell carcinoma must be included.

Introduction Some clinicopathological indicators were reported as poor prognosis of invasive ductal adenocarcinoma of pancreas. The aim of this study is to find out the new indicator for prognosis. Download : Download full-size image Methods Two hundred forty-nine patients with invasive ductal adenocarcinoma of pancreas who underwent macroscopically radical resection between 2000 and 2009 were retrospectively analyzed. Eleven clinicopathological factors were obtained from a review of the medical charts. Analyses of survival were performed using Kaplan-Meier method, and differences between the curves were tested using log-rank test. Factors related to survival were analyzed with the Cox proportional hazards regression model. Results The overall 1, 3, 5 year survival rates were 78.7, 32.1, 25.3% with 22.0 months in median survival time. Median follow up time of all survivors was 33.0 months. There were 27 patients who survived more than 5 years. There were 45 patients with CEA>5.0, 59 patients with CA199>500 and 23 patients with both. In the analyses of survival, 9 factors: preoperative CEA>5.0 ug/dl (p=0.02), CA199>500IU/l (p=0.04), right side tumor location (p=0.07), tumor size>2cm (p=0.07), pathological poor differentiation of tumor (p Conclusion Elevated preoperative CEA level was the new indicator of the poor prognosis and the patients with that should be considered to be performed neoadjuvant therapy followed by surgery.

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.