Klöppel Günter, Adsay N Volkan
Department of Pathology, Universityof Kiel, House 14, Arnold-Heller-Str. 3, 24105 Kiel, Germany.
Arch Pathol Lab Med. 2009 Mar;133(3):382-7. doi: 10.5858/133.3.382.
Distinguishing chronic pancreatitis from pancreatic ductal adenocarcinoma (PDAC) is a well-known challenge, at both the clinical and the morphologic level.
To focus on the histopathologic findings that are diagnostic or suggestive of PDAC.
Findings that are specific to PDAC are the presence of duct structures in perineural and vascular spaces and ("naked") ducts in fatty tissue. However, these findings are only observed in specimens containing extrapancreatic tissue. The features that are suggestive of PDAC in specimens from the pancreas include haphazard distribution of ductlike structures (ie, loss of a lobular pattern), markedly irregular ductal contours, ruptured ducts, nuclear enlargement, pleomorphism and hyperchromatism, and mitotic figures. Immunohistologic markers that are helpful are carcinoembryonic antigen, MUC1, p53, and Ki-67/ MIB1.
There are a few features that are diagnostic and a number that are suggestive of PDAC. Therefore, a combination of several features may be required to clearly distinguish chronic pancreatitis from invasive PDAC.
在临床和形态学层面，鉴别慢性胰腺炎与胰腺导管腺癌（PDAC）都是一项众所周知的挑战。
关注对PDAC具有诊断意义或提示性的组织病理学表现。
PDAC的特异性表现包括神经周围和血管间隙中存在导管结构以及脂肪组织中的（“裸露”）导管。然而，这些表现仅在含有胰腺外组织的标本中观察到。胰腺标本中提示PDAC的特征包括导管样结构分布杂乱（即小叶结构丧失）、导管轮廓明显不规则、导管破裂、核增大、多形性和深染，以及有丝分裂象。有帮助的免疫组织化学标志物包括癌胚抗原、MUC1、p53和Ki-67/MIB1。
有一些特征对PDAC具有诊断意义，还有一些特征提示PDAC。因此，可能需要综合多种特征才能明确区分慢性胰腺炎与浸润性PDAC。
