Pancreatic Ductal Adenocarcinoma. 2020

Jasreman Dhillon, and Michel Betancourt
Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida, USA, Jasreman.Dhillon@moffitt.org.

The most frequent indication for pancreatic fine-needle aspiration sampling is to confirm or exclude a pancreatic ductal adenocarcinoma (PDAC). PDAC is the most common malignant neoplasm of the pancreas, and the term pancreatic cancer typically connotes this entity. The conventional type of PDAC is a tubular adenocarcinoma, with a number of morphological variations described. Morphologically distinct but related entities include adenosquamous carcinoma, undifferentiated carcinoma, and undifferentiated carcinoma with osteoclast-type giant cells. Unrelated carcinomas with ductal lineage include colloid carcinoma and medullary carcinoma. Less commonly reported carcinomas include signet ring cell carcinoma, hepatoid carcinoma, and oncocytic carcinoma. Here we will focus on the cytological findings of PDAC and other carcinomas of ductal lineage, briefly touching upon their clinical features, histologic appearance, and clinically useful serum markers. The differential diagnosis, pitfalls, and useful ancillary studies will also be reviewed. A diagnosis of PDAC should not be taken lightly given that it can potentially result in a pancreatic resection. Familiarity with the entities described in this review will help practicing cytopathologists confront these cases with appropriate information needed in order to render a clinically valuable diagnosis.

UI MeSH Term Description Entries
D010179 Pancreas A nodular organ in the ABDOMEN that contains a mixture of ENDOCRINE GLANDS and EXOCRINE GLANDS. The small endocrine portion consists of the ISLETS OF LANGERHANS secreting a number of hormones into the blood stream. The large exocrine portion (EXOCRINE PANCREAS) is a compound acinar gland that secretes several digestive enzymes into the pancreatic ductal system that empties into the DUODENUM.
D002288 Adenocarcinoma, Mucinous An adenocarcinoma producing mucin in significant amounts. (From Dorland, 27th ed) Carcinoma, Colloid,Carcinoma, Mucinous,Adenocarcinomas, Mucinous,Carcinomas, Colloid,Carcinomas, Mucinous,Colloid Carcinoma,Colloid Carcinomas,Mucinous Adenocarcinoma,Mucinous Adenocarcinomas,Mucinous Carcinoma,Mucinous Carcinomas
D003937 Diagnosis, Differential Determination of which one of two or more diseases or conditions a patient is suffering from by systematically comparing and contrasting results of diagnostic measures. Diagnoses, Differential,Differential Diagnoses,Differential Diagnosis
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000230 Adenocarcinoma A malignant epithelial tumor with a glandular organization. Adenocarcinoma, Basal Cell,Adenocarcinoma, Granular Cell,Adenocarcinoma, Oxyphilic,Adenocarcinoma, Tubular,Adenoma, Malignant,Carcinoma, Cribriform,Carcinoma, Granular Cell,Carcinoma, Tubular,Adenocarcinomas,Adenocarcinomas, Basal Cell,Adenocarcinomas, Granular Cell,Adenocarcinomas, Oxyphilic,Adenocarcinomas, Tubular,Adenomas, Malignant,Basal Cell Adenocarcinoma,Basal Cell Adenocarcinomas,Carcinomas, Cribriform,Carcinomas, Granular Cell,Carcinomas, Tubular,Cribriform Carcinoma,Cribriform Carcinomas,Granular Cell Adenocarcinoma,Granular Cell Adenocarcinomas,Granular Cell Carcinoma,Granular Cell Carcinomas,Malignant Adenoma,Malignant Adenomas,Oxyphilic Adenocarcinoma,Oxyphilic Adenocarcinomas,Tubular Adenocarcinoma,Tubular Adenocarcinomas,Tubular Carcinoma,Tubular Carcinomas
D044963 Biopsy, Fine-Needle Using fine needles (finer than 22-gauge) to remove tissue or fluid specimens from the living body for examination in the pathology laboratory and for disease diagnosis. Aspiration Biopsy, Fine-Needle,Fine Needle Biopsy,Fine-Needle Aspiration,Aspiration Biopsies, Fine-Needle,Aspiration Biopsy, Fine Needle,Aspiration, Fine-Needle,Aspirations, Fine-Needle,Biopsies, Fine Needle,Biopsies, Fine-Needle,Biopsies, Fine-Needle Aspiration,Biopsy, Fine Needle,Biopsy, Fine-Needle Aspiration,Fine Needle Aspiration,Fine Needle Biopsies,Fine-Needle Aspiration Biopsies,Fine-Needle Aspiration Biopsy,Fine-Needle Aspirations,Fine-Needle Biopsies,Fine-Needle Biopsy,Needle Biopsies, Fine,Needle Biopsy, Fine
D018276 Carcinoma, Medullary A carcinoma composed mainly of epithelial elements with little or no stroma. Medullary carcinomas of the breast constitute 5%-7% of all mammary carcinomas; medullary carcinomas of the thyroid comprise 3%-10% of all thyroid malignancies. (From Dorland, 27th ed; DeVita Jr et al., Cancer: Principles & Practice of Oncology, 3d ed, p1141; Segen, Dictionary of Modern Medicine, 1992) Carcinomas, Medullary,Medullary Carcinoma,Medullary Carcinomas
D021441 Carcinoma, Pancreatic Ductal Carcinoma that arises from the PANCREATIC DUCTS. It accounts for the majority of cancers derived from the PANCREAS. Pancreatic Ductal Carcinoma,Carcinoma, Ductal, Pancreatic,Duct-Cell Carcinoma of the Pancreas,Duct-Cell Carcinoma, Pancreas,Ductal Carcinoma of the Pancreas,Pancreatic Duct Cell Carcinoma,Carcinoma, Pancreas Duct-Cell,Carcinomas, Pancreas Duct-Cell,Carcinomas, Pancreatic Ductal,Duct Cell Carcinoma of the Pancreas,Duct Cell Carcinoma, Pancreas,Duct-Cell Carcinomas, Pancreas,Ductal Carcinoma, Pancreatic,Ductal Carcinomas, Pancreatic,Pancreas Duct-Cell Carcinoma,Pancreas Duct-Cell Carcinomas,Pancreatic Ductal Carcinomas

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