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Presented by Ralph Hruban, M.D. and prepared by Jeremy Vincent M.D.
Case 1: This elderly patient underwent a Whipple resection for an infiltrating ductal adenocarcinoma.
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1. Question
Week 508: Case 1
This elderly patient underwent a Whipple resection for an infiltrating ductal adenocarcinoma. The section shown is from the pancreatic neck margin.
Your diagnosis:Images/1Alex/123450case501.jpg
Images/1Alex/123450case502.jpg
Images/1Alex/123450case503.jpgCorrect
Answer: Invasive ductal adenocarcinoma
Histology: The lesion in question is formed by a layer of relatively well-differentiated epithelial cells. The cells are surrounded by the smooth muscle bundles of a vein, making this infiltrating adenocarcinoma in a venule.
Discussion: Venous invasion is common in infiltrating ductal adenocarcinoma of the pancreas, and when the cancers invade veins, for some strange reason, they tend to replace the endothelial layer with a single layer of neoplastic cells, and the neoplastic cells appear well-differentiated, even when the invasive cancer in the stroma is not. This lesion can be a real mimicker of PanIN lesions.
Reference(s):
– Vascular invasion in infiltrating ductal adenocarcinoma of the pancreas can mimic pancreatic intraepithelial neoplasia: a histopathologic study of 209 cases. Hong SM, Goggins M, Wolfgang CL, Schulick RD, Edil BH, Cameron JL, Handra-Luca A, Herman JM, Hruban RH. Am J Surg Pathol. 2012 Feb;36(2):235-41. PMID: 22082604Incorrect
Answer: Invasive ductal adenocarcinoma
Histology: The lesion in question is formed by a layer of relatively well-differentiated epithelial cells. The cells are surrounded by the smooth muscle bundles of a vein, making this infiltrating adenocarcinoma in a venule.
Discussion: Venous invasion is common in infiltrating ductal adenocarcinoma of the pancreas, and when the cancers invade veins, for some strange reason, they tend to replace the endothelial layer with a single layer of neoplastic cells, and the neoplastic cells appear well-differentiated, even when the invasive cancer in the stroma is not. This lesion can be a real mimicker of PanIN lesions.
Reference(s):
– Vascular invasion in infiltrating ductal adenocarcinoma of the pancreas can mimic pancreatic intraepithelial neoplasia: a histopathologic study of 209 cases. Hong SM, Goggins M, Wolfgang CL, Schulick RD, Edil BH, Cameron JL, Handra-Luca A, Herman JM, Hruban RH. Am J Surg Pathol. 2012 Feb;36(2):235-41. PMID: 22082604
