Pankreasın Prekürsör Lezyonlarının Patolojisi
Özet
Bu belgede, Dünya Sağlık Örgütü (WHO) 2019 sınıflamasına göre pankreasın epitelyal prekürsör lezyonları; Pankreatik İntraepitelyal Neoplazi (PanİN), İntraduktal Papiller Müsinöz Neoplazm (İPMN), İntraduktal Onkositik Papiller Neoplazm (İOPN), İntraduktal Tübülopapiller Neoplazm (İTPN) ve Müsinöz Kistik Neoplazm (MKN) başlıkları altında detaylıca incelenmektedir. Pankreatik duktal adenokarsinomun ana prekürsörü olan PanİN, genellikle 5 mm'nin altında, gastrik diferansiasyon gösteren ve düşük veya yüksek dereceli olarak sınıflandırılan lezyonlardır. İPMN, genellikle 5 mm'den büyük, müsin üreten hücrelerin intraduktal proliferasyonu ile karakterize olup gastrik, intestinal ve pankreatobilier tiplere ayrılırken; MKN ise tipik olarak kadınlarda görülen, ovarian tip stroma içeren ve ana duktusla bağlantısı olmayan kistik yapılardır. İOPN ve İTPN, nadir görülen, genellikle yüksek dereceli displazi içeren intraduktal neoplazmlar olup, onkositik veya tübüler morfolojik özellikleri ile İPMN'den ayrılırlar. Makalede, bu lezyonların morfolojik özellikleri, immünohistokimyasal boyanma paternleri ve ayırıcı tanı kriterleri ele alınarak, invaziv karsinom riskine karşı patolojik değerlendirmenin kritik önemi vurgulanmaktadır.
This document provides a detailed examination of the epithelial precursor lesions of the pancreas according to the 2019 WHO classification, covering five main types: Pancreatic Intraepithelial Neoplasia (PanIN), Intraductal Papillary Mucinous Neoplasm (IPMN), Intraductal Oncocytic Papillary Neoplasm (IOPN), Intraductal Tubulopapillary Neoplasm (ITPN), and Mucinous Cystic Neoplasm (MCN). PanIN, the primary precursor to pancreatic ductal adenocarcinoma, typically consists of gastric-differentiated lesions under 5 mm classified as low or high-grade, while IPMN involves intraductal proliferation of mucin-producing cells over 5 mm, categorized into gastric, intestinal, and pancreatobiliary subtypes. MCN is characterized by an ovarian-type stroma and cystic structures usually found in women without main duct communication, whereas the rarer IOPN and ITPN are high-grade intraductal neoplasms distinguished from IPMN by their specific oncocytic or tubular morphologies. The article highlights the critical importance of pathological evaluation against invasive carcinoma risk by discussing morphological features, immunohistochemical staining patterns, and differential diagnosis criteria for each lesion type.
Referanslar
WHO Classification of Tumours 5th Edition. Digestive System Tumours. 2019
Haugk B. Pancreatic intraepithelial neoplasia-can we detect early pancreatic cancer? Histopathology 2010; 57: 503–14
Kozuka S,Sassa R,Taki T, et al. Realitoin of pancreatic duct hyperplasia to carcinoma. Cancer 1979 Apr;43(4):1418-28
Hunter J,Harmston C,Hughes P, et al. What is the nature of polyps detected by the NHS bowel cancer screening pilots? Colorectal Dis. 2011 May;13(5):538-41
Hruban RH, Takaori K, Klimstra DS, et al. An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms. Am J Surg Pathol 2004; 28: 977–87
Basturk O, Hong S-M, Wood LD, et al. A revised classification system and recommendations from the Baltimore consensus meeting for neoplastic precursor lesions in the pancreas. Am J Surg Pathol. 2015;39(12):1730–1741
Maitra A, Adsay NV, Argani P, et al. Multicomponent analysis of the pancreatic adenocarcinoma progression model using a pancreatic intraepithelial neoplasia tissue microarray. Mod Pathol. 2003 Sep:16(9);902-12
Adsay V, Mino-Kenudson M, Furukawa T, et al. Pathologic evaluation and reporting of intraductal papillary musinous neoplasm of the pancreas and other tumoral intraepithelial neoplasm of pancreatobiliary tract: recommendations of Verona consensus meeting. Ann Surg. 2016 Jan;263(1):162-77
Furukawa T, Klöppel G, Volkan Adsay N, et al. Classification of types of intraductal papillary-mucinous neoplasm of the pancreas: a consensus study. Virchows Arch. 2005 Nov;447(5):794-9
Tschang TP, Garza-Garza R, Kissane JM. Pleomorphic carcinoma of the pancreas: an analysis of 15 cases. Cancer .1977 May;39(5):2114-26
Yokode M, Akita M, Fujikura K,et al. High-grade PanIN presenting with localised stricture of the main pancreatic duct: a clinicopathologic and molecular study of 10 cases suggests a clue fort the early detection of pancreatic cancer. Histopathology. 2018 Aug;73(2):247-58
Andea A, Sarkar F, Adsay VN. Clinicopathologic correlates of pancreatiz intraephitelial neoplasia:a comparative analysis of 82 cases with and 52 cases without pancreatic ducral adenocarcinoma. Mod Pathol.2003 Oct;16(10);996-1006
Adsay NV, Conlon KC, Zee SY, et al. Intraductal papillary-mucinous neoplasms of the pancreas: an analysis of in situ and invasive carcino¬mas in 28 patients. Cancer. 2002;94:62-77
Cellier C, Cuillerier E, Palazzo L, et al. Intraductal papillary and mucinous tumors of the pancreas: accuracy of preoperative computed tomography, endoscopic retrograde pancreatography and endoscopic ultrasonography, and long-term outcome in a large surgical series. Gastrointest Endosc. 1998;47:42-49
Azar C, Van de Stadt J, Rickaert F, et al. İntraductal papillary musinous tumors of the pancreas. Clinical and therapeutic issues in 32 patients. Gut. 1996 Sep;39(3):457-64
Bernard P, Scoazec JY, Joubert M, et al. Intraductal papillary-mucinous tumors of the pancreas: predictive criteria of malignancy according to pathological examination of 53 cases. Arch Surg. 2002;137:1274-1278
Tanaka M, Fernandez-Del Castillo C, Adsay V,et al. İnternational consensus guidelines 2012 for fort he management of IPMN and MCN of the pancreas. Pancreatology. 2012 May-June;12(3):183-97
Klöppel G, Bastürk O, Schlitter AM, et al. Intraductal neoplasms of the pancreas. Semin Diagn Pathol. 2014 Nov;31(6):452-66
Sahani DV, Kadavigere R, Blake M, et al. Intraductal papillary mucinous neoplasm of the pancreas: multi-detector row CT with 2D curved reformations-correlation with MRCP. Radiology. 2006 Feb;238(2):560-9
Pelaez-Luna M, Chari ST, Smyrk TC, et al. Do consensus indications for resection in branch duct intraductal papillary mucinous neoplasm predict malignancy? A study of 147 patients. Am J Gastroenterol. 2007 Aug;102(8):1759-64
Adsay NV, Merati K, Basturk O, et al. Pathologically and biologically distinc types of epithelium in intraductal papillary mucinous neoplasms: delineation of an ‘’intestinal ‘’ pathway of carcinogenesis in the pancreas. Am J Surg Pathol. 2004 Jul;28(7):839-48
Ban S, Naitoh Y, Mino-Kenudson M,et al. Intraductal papillary mucinous neoplasm(IPMN) of the pancreas: its histopathologic difference between 2 major types. Am J Surg Pathol. 2006 Dec;30(12):1561-9
Adsay NV, Merati K, Andea A, et al. The dichotomy in the preinvasive neoplasia to invasive carcinoma sequence in the pancreas: differential expression of MUC1 and MUC2 supports the existence of two separate pathways of carcinogenesis. Mod Pathol. 2002 Oct;15(10):1087-95
Jang KT, Park SM, Basturk O, et al. Clinicopathologic characteristics of 29 invasive carcinomas arising in 178 pancreatic mucinous cystic neoplasms with ovarian-type stroma: implications for management and prognosis. Am J Surg Pathol. 2015 Feb;39(2):179-87
Krasinskas AM, Oakley GJ, Bagci P, et al. ‘’Simple mucinous cyst’’ of the pancreas: a clinicopathologic analysis of 39 examples of diagnostically challenging entity distinct from intraductal papillary mucinous neoplasms and mucinous cystic neoplasms. Am J Surg Pathol. 2017 Jan;41(1):121-7
Chari ST, Yadav D, Smyrk TC, et al. Study of reccurrence after surgical resection of intraductal papillary mucinous neoplasm of the pancreas. Gastroenterology. 2002 Nov;123(5):1500-7
D’Onofrio M, De Robertis R, Tinazzi Martini P, et al. Oncocytic intraductal papillary mucinous neoplasm of the pancreas: imaging and histopathological findings. Pancreas. 2016 Oct;45(9):1233-42
Adsay NV, Adair CF, Heffess CS, et al. Intraductal oncocytic papillary neoplasms of the pancreas. Am J Surg Pathol. 1996 Aug;20(8):980-94
Lüttges J, Zamboni G, Longnecker D, et al. The immunohistochemical mucin expression pattern distinguishes different types of intraductal papillary mucinous neoplasm of the pancreas and determines their relationship to mucinous noncystic carcinoma and ductal adenocarcinoma. Am J Surg Pathol. 2001 Jul;25(7):942-8
Marchegiani G, Mino-Kenudson M, Ferrone CR, et al. Oncocytic-type intraductal papillary mucinous neoplasms: a unique malignant pancreatic tumor with good long-term prognosis. J Am Coll Surg. 2015 May;220(5):839-44
Basturk O, Adsay V, Askan G, et al. Intraductal tubulopapillary neoplasm of the pancreas: a clinicopathologic and immunohistochemical analysis of 33 cases. Am J Surg Pathol. 2017 Mar;41(3):313-25
Yamaguchi H, Shimizu M, Ban S, et al. Intraductal tubulopapillary neoplasm of the pancreas distinct from pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms. Am J Surg Pathol. 2009 Aug;33(8):1164-72
Date K, Okabayashi T, Shima Y, et al. Clinicopathological features and surgical outcomes of intraductal tubulopapillary neoplasm of the pancreas: a systematic rewiev. Langenbecks Arch Surg. 2016 Jun;401(4):439-47
Raid MD, Lewis MM, Willingham FF, et al. The evolving role of pathology in new developments , classification, terminology and diagnosis of pancreatobiliary neoplasm. Arch Pathol Lab Med. 2017 Mar;14(3):366-80
La Rosa S, Adsay V, Albarello L, et al. Clinicopathologic study of 62 acinar cell carcinomas of the pancreas: insights into the morphology and immunophenotype and search for prognostic markers. Am J Surg Pathol. 2012 Dec;36(12):1782-95
Kosmahl M, Pauser U, Peters K, et al. Cystic neoplasms of the pancreas and tumor-like lesions with cystic features: a review of 418 cases and classification proposal. Virchows Arch. 2004 Aug;445(2):168-78
Thompson LD, Becker RC, Przygodzki RM, et al. Mucinous cystic neoplasm(mucinous csytadenocarcinoma of low grade malignant potential) of the pancreas: a clinicopathologic study of 130 cases. Am J Surg Pathol. 1999 Jan;23(1):1-16
Zhelnin K, Xue Y, Quigley B, et al. Nonmucinous biliary epithelium is a frequent finding and is often the predominant epithelial type in mucinous cystic neopalsms of the pancreas and liver. Am J Surg Pathol. 2017 Jan;4(1):116-20
Tanaka M, Chari S, Adsay V,et al. İnternational consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006;6(1-2):17-32
Zamboni G, Scarpa A, Bogina G, et al. Mucinous cystic tumors of the pancreas: a clinicopathological features, prognosis and relationship to other mucinous cystic tumors. Am J Surg Pathol. 1999 Apr;23(4):410-22
Aldaoud N, Joudeh A, Al-Momen S, et al. Anaplastic carcinoma arising in a mucinous cystic neoplasm masquerading as pancreatic pseudocyst. Diagn Cytopathol. 2016 Jun;44(6):538-42
Fukushima N, Fukayama M. Mucinous cystic neoplasms of the pancreas: pathology and molecular genetics. J Hepatobiliary Pancreat Surg. 2007;14(3):238-42
Mills SE, Greenson JK, Homick JL, et al., editors. Sternberg’s diagnostic surgical pathology. 6th ed. Philadelphia(PA): Lippincott Williams&Wilkins;2015
