Department of Histopathology, Medical University of Silesia, Medyków 18, 40-754, Katowice, Poland.
Virchows Arch. 2011 Apr;458(4):439-51. doi: 10.1007/s00428-011-1056-3. Epub 2011 Mar 3.
Early onset pancreatic cancer (EOPC) constitutes less than 5% of all newly diagnosed cases of pancreatic cancer (PC). Although histopathological characteristics of EOPC have been described, no detailed reports on precursor lesions of EOPC are available. In the present study, we aimed to describe histopathological picture of extratumoral parenchyma in 23 cases of EOPCs (definition based on the threshold value of 45 years of age) with particular emphasis on two types of precursor lesions of PC: pancreatic intraepithelial neoplasia (PanIN) and intraductal papillary mucinous neoplasms (IPMNs). The types, grades, and densities of precursor lesions of PC were compared in patients with EOPCs, in young patients with neuroendocrine neoplasms (NENs), and in older (at the age of 46 or more) patients with PC. PanINs were found in 95.6% of cases of EOPCs. PanINs-3 were found in 39.1% of EOPC cases. Densities of all PanIN grades in EOPC cases were larger than in young patients with NENs. Density of PanINs-1A in EOPC cases was larger than in older patients with PC, but densities of PanINs of other grades were comparable. IPMN was found only in a single patient with EOPC but in 20% of older patients with PC. PanINs are the most prevalent precursor lesions of EOPC. IPMNs are rarely precursor lesions of EOPC. Relatively high density of low-grade PanINs-1 in extratumoral parenchyma of patients with EOPC may result from unknown multifocal genetic alterations in pancreatic tissue in patients with EOPCs.
早发性胰腺癌（EOPC）构成所有新诊断的胰腺癌（PC）病例的不到 5%。尽管已经描述了 EOPC 的组织病理学特征，但尚无关于 EOPC 前驱病变的详细报告。在本研究中，我们旨在描述 23 例 EOPC 病例的肿瘤外实质的组织病理学图像（基于 45 岁的阈值定义），特别强调 PC 的两种前驱病变：胰腺上皮内瘤变（PanIN）和导管内乳头状黏液性肿瘤（IPMN）。比较了 EOPC 患者、年轻神经内分泌肿瘤（NEN）患者和年龄较大（46 岁或以上）PC 患者中 PC 前驱病变的类型、等级和密度。在 95.6%的 EOPC 病例中发现了 PanINs。在 39.1%的 EOPC 病例中发现了 PanINs-3。EOPC 病例中所有 PanIN 级别的密度均大于年轻 NEN 患者。EOPC 病例中 PanINs-1A 的密度大于老年 PC 患者，但其他等级的 PanIN 密度相当。在 EOPC 患者中仅发现 1 例 IPMN，但在 20%的老年 PC 患者中发现。PanINs 是 EOPC 最常见的前驱病变。IPMNs 很少是 EOPC 的前驱病变。EOPC 患者肿瘤外实质中低级别 PanINs-1 的相对高密度可能是由于 EOPC 患者胰腺组织中未知的多灶性遗传改变所致。
