Relation of pancreatic duct hyperplasia to carcinoma

Abstract

In order to find a relationship between ductal hyperplasia and carcinoma of the pancreas, histological and histochemical examinations were made on pancreatic specimens of 1,174 autopsy patients with special attention to the age incidence of the former. Ductal hyperplasia was divided into 3 types; nonpapillary, papillary, and atypical hyperplasia. All three types of hyperplasia and ductal carcinoma showed a similar tinctorial property in mucous histochemistry. In general, atypical hyperplasia was seen in the pancreas having papillary hyperplasia which was found in the pancreas associated with nonpapillary hyperplasia. All three types of hyperplasia were apparently more frequent in cancerous pancreases than in non-cancerous ones. They were also more common in the head of the pancreas than in the body and tail. Age incidence also suggests a sequential change from nonpapillary hyperplasia through papillary and atypical ones to carcinoma.Cancer 43:1418-1428, 1979.HE GREAT MAJORITY of carcinomas of the T exocrine elements of the pancreas is of duct cell rigi in.^,^ The relationship of pancreatic duct hyperplasia to pancreatic carcinoma has been emphasized by Sommers et al.," because of the high incidence of ductal hyperplasia in carcinomatous pancreases. Cubilla and Fitzgerald3 also found a similar relation. However, following Birnstingl's report, they noted that there was obstruction to the pancreatic duct in most of their cases, a complicating factor in the assessment of ductal papillary hyperplasia. Birnstingl,2 in cases with a variety of acute and chronic nonpancreatic diseases and. no cancer of the pancreas, reported an incidence of 29% having hyperplastic columnar epithelium. It seems to be necessary for clarification of the relationship between ductal hyperplasia and carcinoma of the pancreas to reevaluate the age incidence of ductal hyperplasia in noncancerous pancreases. If ductal hyperplasia is a change preceding pancreatic carcinoma, it should appear in younger patients than those with pancreatic carcinoma. The aim of the present study is to find possible From the 2nd Department of Pathology, Nagoya University School of Medicine, Nagoya, Japan.Address for reprints: S. Komka, MD, T h e 2nd Department of Pathology, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466, Japan.Accepted for publication May 22, 1978. transition from ductal hyperplasia to carcinoma by histology and mucous histochemistry and to study age difference in incidence between ductal hyperplasia and pancreatic carcinoma. MATERIALS AND METHODSUsing autopsy cases at our laboratory, available routine microscopic sections of 1,174 pancreases of which 24 had infiltrating carcinoma were examined. Mostly one section, sometimes two or more sections, was prepared from one pancreas. Selected cases were stained with periodic acid Schiff/alcian blue pH 2.5 and high iron diamine/alcian blue pH 2.5.'*"Ductal hyperplasia was defined as ducts with large epithelial cells which are more than twice as tall as normal cells, because en...

The K-ras mutation pattern in pancreatic ductal adenocarcinoma usually is identical to that in associated normal, hyperplastic, and metaplastic ductal epithelium

“…The 5% sensitivity of our assay combining denaturing gradient gel electrophoresis and direct sequencing on PCR-amplified material is sufficient for (29) our samples containing either a single cell or two to three cells. The lower percentage of mutations in our study most likely is due to the selection of the samples because we excluded atypical papillary hyperplasia (i.e., severe ductal dysplasia), 16 which is associated with a high percentage of mutations as shown by Lemoine et al 18 and Moskaluk et al 21 The most commonly observed type of lesion in our study was mucinous cell hypertrophy (42%), also known as simple hyperplasia, 23 followed by ductal papillary hyperplasia (30%), adenomatoid hyperplasia (10%), and squamous metaplasia (4%). This proportional distribution generally confirms the results of other investigations.…”

“…This proportional distribution generally confirms the results of other investigations. 10,17,23,24 To study the spatial association between pancreatic ductal lesions and invasive ductal adenocarcinoma, we compared the frequency of ductal lesions adjacent to the tumors with their frequency at the tumor free resection margin that was at a distance of at least 1 cm from the tumor. This examination revealed that, irrespective of type, the lesions were distributed evenly in adjacent and remote tissues.…”

Neoplasms of the Ampulla of Vater with Concurrent Pancreatic Intraductal Neoplasia: A Histological and Molecular Study

“…Since then, many studies have shown an association between pancreatic adenocarcinoma and intraductal neoplasia (6,7,9). PanIN has been estimated to occur commonly in patients without a history of pancreatic cancer in autopsy samples and in pancreatic tissue removed for nonneoplastic disease, with different studies having a prevalence of around 20 to 30%, though it is considerably more frequent in patients with carcinoma (6,7,8,21). High-grade PanIN occurs only rarely in patients without a history of pancreatic neoplasia (6,7).…”

An Introduction to Pancreatic Adenocarcinoma Genetics, Pathology and Therapy

“…Like all epithelial malignancies, pancreatic cancer arises from non-invasive precursor lesions after a prolonged series of stepwise progressions. [11][12][13][14] Almost 100 years ago, Hulst noted many transitional forms between normal pancreatic ductal epithelium and invasive cancer. 11 He suggested that the first change was a simple cellular hypertrophy, the second involved acquisition of a papillary architecture, and the last was an irregular growth of epithelium very similar to cancer.…”