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Presented by Ralph Hruban, M.D. and prepared by Hillary Elwood, M.D.
Case 1: This patient was found to have a markedly dilated duct in the tail of his pancreas.
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1. Question
Week 478: Case 1
This patient was found to have a markedly dilated duct in the tail of his pancreas. A distal pancreatectomy was performed.images/1alex/05162011case5image1.jpg
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images/1alex/05162011case5image5.jpgCorrect
Answer: High-grade dysplasia, suspect an adjacent invasive carcinoma
Histology: Non-invasive epithelial cells with dramatic atypia are present in the pancreatic ducts. Within single ducts there is an abrupt transition (a “step”) from cells with high-grade dysplasia to normal ductal cells.
Discussion: The combination of dysplasia beyond that typically seen in PanIN-3 together with abrupt transitions between histologically normal epithelium and an epithelium with extremely high-grade dysplasia is very worrisome for invasive cancer growing within pre-existing ducts. This process, known as “cancerization of the ducts,” can mimic a PanIN lesion, and it is important to recognize because it signals the likelihood of an adjacent invasive carcinoma.
Incorrect
Answer: High-grade dysplasia, suspect an adjacent invasive carcinoma
Histology: Non-invasive epithelial cells with dramatic atypia are present in the pancreatic ducts. Within single ducts there is an abrupt transition (a “step”) from cells with high-grade dysplasia to normal ductal cells.
Discussion: The combination of dysplasia beyond that typically seen in PanIN-3 together with abrupt transitions between histologically normal epithelium and an epithelium with extremely high-grade dysplasia is very worrisome for invasive cancer growing within pre-existing ducts. This process, known as “cancerization of the ducts,” can mimic a PanIN lesion, and it is important to recognize because it signals the likelihood of an adjacent invasive carcinoma.
