Adsay N Volkan, Andea Aleodor, Basturk Olca, Kilinc Nihal, Nassar Hind, Cheng Jeanette D
Department of Pathology, The Karmanos Cancer Institute and Wayne State University, Harper Hospital, 3990 John R. Street, Detroit, MI 48201, USA.
Virchows Arch. 2004 Jun;444(6):527-35. doi: 10.1007/s00428-004-0987-3. Epub 2004 Apr 1.
The vast majority of pancreatic carcinomas are primary, and, among these, more than 90% are of ductal origin. However, a variety of extrapancreatic tumors may involve the pancreas secondarily and may manifest different clinicopathological characteristics and outcomes. In this study, pathology material from 973 surgical specimens and 4955 adult autopsy cases was reviewed to identify the tumors metastatic to or secondarily involving the pancreas. Biliary and periampullary neoplasms and tumors confined to peripancreatic soft tissue were excluded. In the autopsy series, the pancreas was involved by tumor in 190 cases, and 81 of these were secondary tumors. These were predominantly of epithelial origin, most commonly from lung (34), followed by GI tract (20), kidney (4), breast (3), liver (2), ovary (1), and urinary bladder (1). In addition, there were six tumors of hematopoietic origin, two melanomas, two sarcomas, and two mesotheliomas. Among the 973 surgical specimens, 38 cases contained metastatic tumors to the pancreas. Of these, 11 were lymphomas, and the others were carcinomas of stomach (7), kidney (6), lung (2), liver, prostate, ovary, uterus (1 case of each), and a Merkel cell carcinoma. In addition, there were three malignant gastrointestinal stromal tumors and one retroperitoneal leiomyosarcoma. In conclusion, lung cancer is the most common source of metastasis to pancreas, followed by gastrointestinal carcinomas and lymphomas. These tumors are usually seen in patients with disseminated disease and are detected mainly in autopsies. Secondary tumors constitute about 4% of pancreatic specimens in the authors' surgical database. Approximately one-third of them are clinically mistaken as primary tumors of the pancreas. These are predominantly hematopoietic malignancies or carcinomas of renal or gastric origin. Secondary tumors should be entertained in both the clinical and pathological differential diagnosis of pancreatic neoplasia.
绝大多数胰腺癌是原发性的，其中90%以上起源于导管。然而，多种胰腺外肿瘤可能继发累及胰腺，并可能表现出不同的临床病理特征和预后。在本研究中，回顾了973例手术标本和4955例成人尸检病例的病理资料，以确定转移至胰腺或继发累及胰腺的肿瘤。排除胆管和壶腹周围肿瘤以及局限于胰腺周围软组织的肿瘤。在尸检系列中，190例病例的胰腺有肿瘤累及，其中81例为继发性肿瘤。这些肿瘤主要起源于上皮，最常见的是来自肺（34例），其次是胃肠道（20例）、肾（4例）、乳腺（3例）、肝（2例）、卵巢（1例）和膀胱（1例）。此外，有6例造血系统起源的肿瘤、2例黑色素瘤、2例肉瘤和2例间皮瘤。在973例手术标本中，38例含有胰腺转移瘤。其中，11例为淋巴瘤，其他为胃癌（7例）、肾癌（6例）、肺癌（2例）、肝癌、前列腺癌、卵巢癌、子宫癌（各1例）以及1例默克尔细胞癌。此外，有3例恶性胃肠道间质瘤和1例腹膜后平滑肌肉瘤。总之，肺癌是胰腺转移最常见的来源，其次是胃肠道癌和淋巴瘤。这些肿瘤通常见于播散性疾病患者，主要在尸检中发现。继发性肿瘤在作者的手术数据库中约占胰腺标本的4%。其中约三分之一在临床上被误诊为胰腺原发性肿瘤。这些主要是造血系统恶性肿瘤或肾或胃起源的癌。在胰腺肿瘤的临床和病理鉴别诊断中均应考虑继发性肿瘤。
