Mostafa Mohamed E, Erbarut-Seven Ipek, Pehlivanoglu Burcin, Adsay Volkan
Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Pathology, School of Medicine, Marmara University, Istanbul, Turkey.
Chin Clin Oncol. 2017 Dec;6(6):59. doi: 10.21037/cco.2017.12.01.
As the most common and most important cancer of the pancreas, with rapid mortality and now also as the third leading cause of cancer-related deaths in the United States, pancreatic ductal adenocarcinoma (PDAC) has become synonymous with "pancreas cancer". PDAC is also the prototype of the "pancreatobiliary-type" adenocarcinomas, along the biliary tract, ampullary and gallbladder cancers with the similar morphology and behavior. Recent molecular profiling studies have identified distinct subsets of PDAC, potentially with different behaviors and targetability. Moreover, while PDAC is by far the most common cancer of the pancreas, there are various other types that occur in this organ and are erroneously classified together with PDAC. Many of these have different molecular and biologic characteristics that warrant their management separately although they are also technically "pancreatic cancers". While some are closely related to PDAC and have as aggressive behavior (such as adenosquamous carcinomas which are recently recognized under "basal" like category in profiling studies, which are actually even worse prognostically than PDACs), in the meantime, others such as colloid carcinoma has a much better behavior than PDAC, and as a carcinoma with intestinal lineage (MUC2/CDX2) colloid carcinoma may require an entirely different treatment approach as well. Similarly, medullary carcinomas also appear to have different biology. Additionally, non-ductal cancers such as acinar, neuroendocrine, solid-pseudopapillary neoplasms and pancreatoblastoma have their respective clinicopathologic and molecular associations and warrant careful elimination in the management and study protocols. Another very problematic aspect in the classification of "pancreas cancer" is its delineation from the cancers of neighboring organs, in particular, ampullary/duodenal and common bile duct (CBD) cancers, for which recently more refined criteria have been provided. Additionally, the possibility of metastasis from another site and lymphomas also need to be considered. In summary, there is a whole host of cancers that occur in the pancreas that ought to be considered carefully before a case is classified as an ordinary "pancreas cancer" (PDAC).
作为胰腺癌中最常见且最重要的类型,其死亡率高,目前也是美国癌症相关死亡的第三大主要原因,胰腺导管腺癌(PDAC)已成为“胰腺癌”的代名词。PDAC也是“胰胆型”腺癌的原型,与胆道癌、壶腹癌和胆囊癌具有相似的形态和行为。最近的分子谱分析研究已确定了PDAC的不同亚组,其行为和靶向性可能不同。此外,虽然PDAC是迄今为止胰腺最常见的癌症,但该器官还存在其他各种类型的癌症,它们被错误地与PDAC归为一类。其中许多癌症具有不同的分子和生物学特征,尽管在技术上它们也属于“胰腺癌”,但仍需要分别进行管理。虽然有些与PDAC密切相关且具有侵袭性行为(如在谱分析研究中最近被归为“基底样”类别的腺鳞癌,其预后实际上比PDAC更差),但与此同时,其他一些癌症如黏液腺癌的行为比PDAC好得多,作为具有肠型谱系(MUC2/CDX2)的癌症,黏液腺癌可能也需要完全不同的治疗方法。同样,髓样癌似乎也有不同的生物学特性。此外,非导管癌如腺泡癌、神经内分泌癌、实性假乳头状肿瘤和胰腺母细胞瘤有各自的临床病理和分子关联,在管理和研究方案中需要仔细鉴别。“胰腺癌”分类中另一个非常棘手的方面是将其与邻近器官的癌症区分开来,特别是壶腹/十二指肠癌和胆总管(CBD)癌,最近已为此提供了更精细的标准。此外,还需要考虑来自其他部位的转移瘤和淋巴瘤的可能性。总之,在将一个病例归类为普通的“胰腺癌”(PDAC)之前,需要仔细考虑发生在胰腺的众多癌症。
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