Chronic pancreatitis or pancreatic ductal adenocarcinoma?
The histopathologic distinction of ductal adenocarcinoma (DA) of the pancreas from chronic pancreatitis (CP) is a well-known challenge. Several parameters have been determined by the authors and other investigators to be useful in this distinction. The findings that are entirely diagnostic for DA ar...
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Veröffentlicht in: | Seminars in diagnostic pathology 2004-11, Vol.21 (4), p.268-276 |
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creator | Adsay, N. Volkan Bandyopadhyay, Sudeshna Basturk, Olca Othman, Mohammad Cheng, Jeanette D. Klöppel, Günter Klimstra, David S. |
description | The histopathologic distinction of ductal adenocarcinoma (DA) of the pancreas from chronic pancreatitis (CP) is a well-known challenge. Several parameters have been determined by the authors and other investigators to be useful in this distinction. The findings that are entirely diagnostic for DA are perineural and vascular invasion; however, they are rarely detectable in biopsy specimens. The most common findings that are highly suggestive of DC and can also be expected in biopsy specimens include random distribution of ductal structures, irregular ductal contours, nuclear enlargement (>3 times the size of a lymphocyte), and pleomorphism, distinct nucleoli, and mitosis. Other, somewhat rarer findings are uninterrupted proliferation of numerous (>50) ducts, intraluminal necrotic cellular debris, hyperchromatic raisinoid nucleoli, the presence of naked ducts in fat without surrounding pancreatic elements or fibrous tissue, and ducts lying adjacent to arterioles. Findings that favor a benign process over an invasive carcinoma are: lobular architecture with clusters of evenly spaced ductal units, uniformly sized ductal elements, smooth ductal contours, ducts surrounded by acini or islets, and intraluminal mucoprotein plugs. Combinations of these criteria should aid in the differential diagnosis of invasive ductal adenocarcinoma from benign/reactive ducts in the pancreas. |
doi_str_mv | 10.1053/j.semdp.2005.08.002 |
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Volkan ; Bandyopadhyay, Sudeshna ; Basturk, Olca ; Othman, Mohammad ; Cheng, Jeanette D. ; Klöppel, Günter ; Klimstra, David S.</creator><creatorcontrib>Adsay, N. Volkan ; Bandyopadhyay, Sudeshna ; Basturk, Olca ; Othman, Mohammad ; Cheng, Jeanette D. ; Klöppel, Günter ; Klimstra, David S.</creatorcontrib><description>The histopathologic distinction of ductal adenocarcinoma (DA) of the pancreas from chronic pancreatitis (CP) is a well-known challenge. Several parameters have been determined by the authors and other investigators to be useful in this distinction. The findings that are entirely diagnostic for DA are perineural and vascular invasion; however, they are rarely detectable in biopsy specimens. The most common findings that are highly suggestive of DC and can also be expected in biopsy specimens include random distribution of ductal structures, irregular ductal contours, nuclear enlargement (>3 times the size of a lymphocyte), and pleomorphism, distinct nucleoli, and mitosis. Other, somewhat rarer findings are uninterrupted proliferation of numerous (>50) ducts, intraluminal necrotic cellular debris, hyperchromatic raisinoid nucleoli, the presence of naked ducts in fat without surrounding pancreatic elements or fibrous tissue, and ducts lying adjacent to arterioles. Findings that favor a benign process over an invasive carcinoma are: lobular architecture with clusters of evenly spaced ductal units, uniformly sized ductal elements, smooth ductal contours, ducts surrounded by acini or islets, and intraluminal mucoprotein plugs. Combinations of these criteria should aid in the differential diagnosis of invasive ductal adenocarcinoma from benign/reactive ducts in the pancreas.</description><identifier>ISSN: 0740-2570</identifier><identifier>EISSN: 1930-1111</identifier><identifier>DOI: 10.1053/j.semdp.2005.08.002</identifier><identifier>PMID: 16273946</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Carcinoma, Pancreatic Ductal - pathology ; Diagnosis, Differential ; Differential diagnosis ; Ductal adenocarcinoma ; Humans ; Pancreatic Neoplasms - pathology ; Pancreatitis ; Pancreatitis, Chronic - pathology</subject><ispartof>Seminars in diagnostic pathology, 2004-11, Vol.21 (4), p.268-276</ispartof><rights>2005 Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c357t-b661a30a956bac5a83927b1ee53031ca3afa18a4468161ec4c99dcdc95b355893</citedby><cites>FETCH-LOGICAL-c357t-b661a30a956bac5a83927b1ee53031ca3afa18a4468161ec4c99dcdc95b355893</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1053/j.semdp.2005.08.002$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,782,786,3552,27931,27932,46002</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16273946$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Adsay, N. Volkan</creatorcontrib><creatorcontrib>Bandyopadhyay, Sudeshna</creatorcontrib><creatorcontrib>Basturk, Olca</creatorcontrib><creatorcontrib>Othman, Mohammad</creatorcontrib><creatorcontrib>Cheng, Jeanette D.</creatorcontrib><creatorcontrib>Klöppel, Günter</creatorcontrib><creatorcontrib>Klimstra, David S.</creatorcontrib><title>Chronic pancreatitis or pancreatic ductal adenocarcinoma?</title><title>Seminars in diagnostic pathology</title><addtitle>Semin Diagn Pathol</addtitle><description>The histopathologic distinction of ductal adenocarcinoma (DA) of the pancreas from chronic pancreatitis (CP) is a well-known challenge. Several parameters have been determined by the authors and other investigators to be useful in this distinction. The findings that are entirely diagnostic for DA are perineural and vascular invasion; however, they are rarely detectable in biopsy specimens. The most common findings that are highly suggestive of DC and can also be expected in biopsy specimens include random distribution of ductal structures, irregular ductal contours, nuclear enlargement (>3 times the size of a lymphocyte), and pleomorphism, distinct nucleoli, and mitosis. Other, somewhat rarer findings are uninterrupted proliferation of numerous (>50) ducts, intraluminal necrotic cellular debris, hyperchromatic raisinoid nucleoli, the presence of naked ducts in fat without surrounding pancreatic elements or fibrous tissue, and ducts lying adjacent to arterioles. Findings that favor a benign process over an invasive carcinoma are: lobular architecture with clusters of evenly spaced ductal units, uniformly sized ductal elements, smooth ductal contours, ducts surrounded by acini or islets, and intraluminal mucoprotein plugs. Combinations of these criteria should aid in the differential diagnosis of invasive ductal adenocarcinoma from benign/reactive ducts in the pancreas.</description><subject>Carcinoma, Pancreatic Ductal - pathology</subject><subject>Diagnosis, Differential</subject><subject>Differential diagnosis</subject><subject>Ductal adenocarcinoma</subject><subject>Humans</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatitis</subject><subject>Pancreatitis, Chronic - pathology</subject><issn>0740-2570</issn><issn>1930-1111</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1Lw0AQhhdRbK3-AkF68pY4m80m2YOIFL-g4EXPy2QyxS35cjcR_PemtuDNuQwDzzvDPEJcSoglaHWzjQM3VR8nADqGIgZIjsRcGgWRnOpYzCFPIUp0DjNxFsIWQOUgzamYySzJlUmzuTCrD9-1jpY9tuQZBze4sOz830zLaqQB6yVW3HaEnlzbNXh3Lk42WAe-OPSFeH98eFs9R-vXp5fV_ToipfMhKrNMogI0OiuRNBbKJHkpmbUCJQkVblAWmKZZITPJlJIxFVVkdKm0LoxaiOv93t53nyOHwTYuENc1ttyNwWZ5YmQiYQLVHiTfheB5Y3vvGvTfVoLdGbNb-2vM7oxZKOxkbEpdHdaPZcPVX-agaAJu9wBPT3459jaQ45a4cp5psFXn_j3wAzMcfUA</recordid><startdate>20041101</startdate><enddate>20041101</enddate><creator>Adsay, N. 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Volkan</creatorcontrib><creatorcontrib>Bandyopadhyay, Sudeshna</creatorcontrib><creatorcontrib>Basturk, Olca</creatorcontrib><creatorcontrib>Othman, Mohammad</creatorcontrib><creatorcontrib>Cheng, Jeanette D.</creatorcontrib><creatorcontrib>Klöppel, Günter</creatorcontrib><creatorcontrib>Klimstra, David S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Seminars in diagnostic pathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Adsay, N. Volkan</au><au>Bandyopadhyay, Sudeshna</au><au>Basturk, Olca</au><au>Othman, Mohammad</au><au>Cheng, Jeanette D.</au><au>Klöppel, Günter</au><au>Klimstra, David S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Chronic pancreatitis or pancreatic ductal adenocarcinoma?</atitle><jtitle>Seminars in diagnostic pathology</jtitle><addtitle>Semin Diagn Pathol</addtitle><date>2004-11-01</date><risdate>2004</risdate><volume>21</volume><issue>4</issue><spage>268</spage><epage>276</epage><pages>268-276</pages><issn>0740-2570</issn><eissn>1930-1111</eissn><abstract>The histopathologic distinction of ductal adenocarcinoma (DA) of the pancreas from chronic pancreatitis (CP) is a well-known challenge. Several parameters have been determined by the authors and other investigators to be useful in this distinction. The findings that are entirely diagnostic for DA are perineural and vascular invasion; however, they are rarely detectable in biopsy specimens. The most common findings that are highly suggestive of DC and can also be expected in biopsy specimens include random distribution of ductal structures, irregular ductal contours, nuclear enlargement (>3 times the size of a lymphocyte), and pleomorphism, distinct nucleoli, and mitosis. Other, somewhat rarer findings are uninterrupted proliferation of numerous (>50) ducts, intraluminal necrotic cellular debris, hyperchromatic raisinoid nucleoli, the presence of naked ducts in fat without surrounding pancreatic elements or fibrous tissue, and ducts lying adjacent to arterioles. Findings that favor a benign process over an invasive carcinoma are: lobular architecture with clusters of evenly spaced ductal units, uniformly sized ductal elements, smooth ductal contours, ducts surrounded by acini or islets, and intraluminal mucoprotein plugs. Combinations of these criteria should aid in the differential diagnosis of invasive ductal adenocarcinoma from benign/reactive ducts in the pancreas.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>16273946</pmid><doi>10.1053/j.semdp.2005.08.002</doi><tpages>9</tpages></addata></record> |
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subjects | Carcinoma, Pancreatic Ductal - pathology Diagnosis, Differential Differential diagnosis Ductal adenocarcinoma Humans Pancreatic Neoplasms - pathology Pancreatitis Pancreatitis, Chronic - pathology |
title | Chronic pancreatitis or pancreatic ductal adenocarcinoma? |
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