Naito Yoshiki, Kinoshita Hisafumi, Okabe Yoshinobu, Arikawa Shunji, Higaki Koichi, Morimitsu Yosuke, Yamasaki Fumio, Suda Koichi, Yasumoto Makiko, Kusano Hironori, Nakashima Osamu, Yano Hirohisa
Department of Pathology, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan.
J Hepatobiliary Pancreat Surg. 2009;16(4):478-84. doi: 10.1007/s00534-009-0078-6. Epub 2009 Apr 15.
BACKGROUND/PURPOSE: By the time undifferentiated carcinoma is detected, it has formed a large mass, and it is reportedly difficult to pathologically observe its relationship with the pancreatic duct. In this study, we examined the pancreatic ducts of seven patients of surgical samples, and pathomorphologically investigated the relationship between the adenocarcinomatous and sarcomatous components and the pattern of tumor extension. In addition, we evaluated the usefulness of pancreatic juice cytology by comparison with the findings of the main pancreatic duct (MPD).
Seven primary undifferentiated carcinomas of the pancreas (from three male and four female patients with a mean age of 59 years) were analyzed. Histopathological evaluation was based on the WHO diagnostic criteria. Pancreatic juice cytology was performed and evaluated in two patients.
All the undifferentiated carcinomas contained adenocarcinomatous and sarcomatous components, and two had a distinct glandular structure. However, we could not pathomorphologically confirm the continuity of the adenomatous with the sarcomatous components in any of the patients. Three undifferentiated carcinomas contained osteoclast-like giant cells. Pathological observation of the tumor and MPD was possible in three of the seven undifferentiated carcinomas. PanIN-3 was observed in the MPD of three patients, suggesting extension into the MPD. In one of these three, the tumor presented intraductal growth in the MPD, and preoperative pancreatic juice cytology revealed atypical cells with osteoclast-like giant cells. In the remaining two, the tumor extraductally compressed the MPD upward.
Undifferentiated carcinoma showed two patterns of cancer extension: (1) invasion and expansive growth during the sarcomatous transformation of adenocarcinoma, and (2) intraductal extension. In addition, some undifferentiated carcinomas showed extension in the MPD. Of note, postoperative pancreatic juice cytology may be useful for the diagnosis.
背景/目的：未分化癌被发现时已形成较大肿块，据报道很难从病理学角度观察其与胰管的关系。在本研究中，我们检查了7例手术样本患者的胰管，并从病理形态学角度研究了腺癌成分与肉瘤成分之间的关系以及肿瘤的扩展模式。此外，我们通过与主胰管（MPD）的检查结果相比较，评估了胰液细胞学检查的实用性。
分析了7例原发性胰腺未分化癌（3例男性和4例女性患者，平均年龄59岁）。组织病理学评估依据世界卫生组织的诊断标准。对2例患者进行了胰液细胞学检查并进行评估。
所有未分化癌均包含腺癌成分与肉瘤成分，其中2例具有明显的腺管结构。然而，我们无法从病理形态学上证实任何一例患者的腺瘤成分与肉瘤成分之间具有连续性。3例未分化癌含有破骨细胞样巨细胞。7例未分化癌中有3例能够对肿瘤和MPD进行病理观察。3例患者的MPD中观察到了胰腺上皮内瘤变-3（PanIN-3），提示肿瘤已扩展至MPD。在这3例中的1例中，肿瘤在MPD内呈导管内生长，术前胰液细胞学检查发现了含有破骨细胞样巨细胞的非典型细胞。在其余2例中，肿瘤从导管外向上压迫MPD。
未分化癌表现出两种癌症扩展模式：（1）腺癌肉瘤样转化过程中的浸润性生长和膨胀性生长，以及（2）导管内扩展。此外，一些未分化癌在MPD中也有扩展。值得注意的是，术后胰液细胞学检查可能有助于诊断。
