Pancreatic metastases from primary breast cancer are very rare. We report a case of pancreatic metastasis from invasive ductal carcinoma 13 years after the initial diagnosis of breast cancer. When the pancreatic mass was discovered, it was believed to be a primary pancreatic cancer due to the long interval from the initial diagnosis of breast cancer to metastasis. However, it was confirmed as metastatic breast cancer based on the pathology after surgical removal. Follow-up imaging has shown no recurrence.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Diagnosis ; Follow-Up Studies ; Neoplasm Metastasis* ; Pancreatic Neoplasms ; Pathology ; Recurrence

Mucinous (colloid) carcinoma is defined as pools of stromal extracellular mucin containing scanty, floating carcinoma cells. It is a well-defined entity in breast or large bowel. However, mucinous noncystic carcinoma of the pancreas (MNCC) is uncommon, comprising between 1% and 3% of all carcinomas of the pancreas. In the past, MNCC generally had been categorized together with ordinary ductal adenocarcinoma or misdiagnosed as mucinous cystadenocarcinoma or signet-ring cell carcinoma. The new WHO classification lists MNCC as a variant of ductal adenocarcinoma. Herein, we report a 32-year-old woman with incidentally found pancreatic body mass who underwent subtotal pancreatectomy. She was diagnosed as MNCC histologically.
Adenocarcinoma, Mucinous/*diagnosis/etiology/pathology ; Adult ; Breast Neoplasms/diagnosis ; Carcinoma, Pancreatic Ductal/*diagnosis/pathology ; Diagnosis, Differential ; Female ; Humans ; Pancreatic Neoplasms/*diagnosis/pathology ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the value of intraoperative fine needle aspiration cytology (IFNAC) examination in the diagnosis of pancreatic lesions.

METHODSThe clinicopathological data of 491 patients with pancreatic lesions treated in our hospital from May 1998 to June 2013 were retrospectively analyzed. Their clinical features, IFNAC findings, pathological results after IFNAC examination and related complications were summarized. The factors affecting the aspiration biopsy accuracy were analyzed using logistic regression and multi factor analysis.

RESULTS491 patients with pancreatic lesions were examined by IFNAC. Among them, cancer cells were found in 434 cases (positive), and were not found in 57 cases (negative). Among the 310 cases who underwent surgical operation, postoperative pathology confirmed 209 cases of pancreatic ductal adenocarcinoma, 8 cases of pancreatic cystadenocarcinoma, 23 cases of solid pseudopapillary tumor of the pancreas, 15 cases of pancreatic neuroendocrine tumor, 14 cases of intraductal papillary mucinous tumor, 2 cases of primary pancreatic gastrointestinal stromal tumor, 17 cases of pancreatic serous cystadenoma, and 22 cases of chronic mass-forming type pancreatitis. The IFNAC test showed a sensitivity of 97.9% (425/434), and specificity of 89.5% (51/57). The IFNAC examination-related complications were pancreatic leakage in a total of 12 patients which were cured after treatment. No bleeding complication was observed. Logistic multivariate analysis showed that tumor size, cystic degeneration, lymph node metastasis and associated chronic pancreatitis are independent factors affecting the IFNAC examination of pancreatic carcinoma.

CONCLUSIONSIFNAC examination has a high sensitivity and specificity, and with a good safety in clinical use. IFNAC can be used as a powerful tool for the diagnosis of pancreatic cancer, with a high clinical value in use. In the cytology-negative cases, cytology alone can not rule out the diagnosis of pancreatic cancer. Through repeated sampling and combined with intraoperative frozen section pathology can improve the diagnostic accuracy.

Biopsy, Fine-Needle ; Biopsy, Needle ; Carcinoma, Pancreatic Ductal ; diagnosis ; pathology ; Cystadenoma, Serous ; diagnosis ; pathology ; Frozen Sections ; Humans ; Pancreas ; pathology ; Pancreatic Neoplasms ; diagnosis ; pathology ; Retrospective Studies ; Sensitivity and Specificity

OBJECTIVETo study the clinicopathologic and immunohistochemical features, and the prognosis of intraductal papillary mucinous neoplasms (IPMN) of the pancreas.

METHODSThe clinical findings, morphologic features, immunophenotype and prognosis were investigated in 61 cases of IPMN.

RESULTSOf these 61 cases, 33 were in the pancreatic head and 14 were in the body and tail, and 14 in the entire pancreas. The average patients' age was 61.8 years. The initial symptom was abdominal pain in 37 cases, and the tumors were detected at routine checkup in 14 cases. The imaging examination showed dilated ducts and/or cystic and solid masses. Grossly, 32 cases were multi-loculated cystic masses containing mucin and papillary areas; 13 cases were solid. Microscopically, the IPMN showed four patterns, including gastric-type (16 cases), intestinal-type (21 cases), pancreatobiliary-type (21 cases) and eosinophilic-type (3 cases). The IPMN cohort included 13, 13 and 6 IPMN with low, intermediate and high-grade dysplasia respectively, and 29 IPMN associated with invasive carcinoma. The IPMN associated carcinomas were mainly ductal adenocarcinoma (23/29, 79.3%), followed by colloid carcinoma (4/29, 13.8%) and undifferentiated carcinoma (2/29, 6.9%). Immunohistochemically, IPMN expressed MUC5AC (51/57, 89.4%), MUC2 (21/57, 36.8%), and MUC1 (13/46, 28.3%). The mean postoperative follow-up period was 32 months (range 12-112 months). Six of 61 patients were lost to follow-up. Overall 5-year survival rate was 76%. The 5-year survival rate of IPMN with low, intermediate or high-grade dysplasia was 100%, and recurrence was local in 3 patients. The 3-year survival rate of IPMN associated with invasive carcinoma was 55%. 12 of 13 patients died within 2 years after operation.

CONCLUSIONSIPMN is a common cystic neoplasm of the pancreas located in the ducts. The pathologic types and classifications are clearly defined. MUC stains are helpful for the diagnosis and papillary typing. IPMN with invasive carcinoma was associated with significantly worse survival than IPMN with dysplasia.

Adenocarcinoma, Mucinous ; diagnosis ; pathology ; Carcinoma, Pancreatic Ductal ; diagnosis ; pathology ; Humans ; Middle Aged ; Mucins ; metabolism ; Neoplasm Recurrence, Local ; Pancreas ; pathology ; Pancreatic Neoplasms ; diagnosis ; pathology ; Prognosis ; Survival Rate

Carcinoma, Intraductal, Noninfiltrating ; diagnosis ; pathology ; surgery ; Carcinoma, Pancreatic Ductal ; pathology ; Diagnosis, Differential ; Humans ; Male ; Prostate ; pathology ; Prostatic Intraepithelial Neoplasia ; pathology ; Prostatic Neoplasms ; diagnosis ; pathology ; surgery

Intraductal papillary mucinous neoplasm (IPMN) is frequently found recently and is a precancerous lesion. Main duct-type should be resected since it can easily progress to invasive IPMN, whereas branch duct-type (BD) usually remains silent without malignant transformation. BD-IPMN should be resected if it has mural nodule, thick wall or septum, or solid component which are the obvious risk factors for malignancy. If the cyst size of BD-IPMN is more than 3 cm in diameter without obvious risk factors, it can be followed-up regularly or can be treated either with surgical resection or endoscopic ultrasonography (EUS)-guided ethanol lavage. Small BD-IPMN less than 3 cm in size without risk factors can be followed up with sonography, CT scan or EUS annually.
Adenocarcinoma, Mucinous/diagnosis/pathology/*therapy ; Carcinoma, Pancreatic Ductal/diagnosis/pathology/*therapy ; Carcinoma, Papillary/diagnosis/pathology/*therapy ; Diagnosis, Differential ; Ethanol/therapeutic use ; Humans ; Pancreatic Neoplasms/diagnosis/pathology/*therapy ; Risk Factors ; Tomography, X-Ray Computed

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a unique disease entity that is characterized by predominant intraductal growth of mucinous cells, copious mucin production, and subsequent cystic dilatation of pancreatic ducts. IPMN shows a spectrum of histologic and imaging findings and possesses as the potential for malignant transformation arising from adenoma to invasive carcinoma. It is important to determine the type, extent of duct involvement, and presence of malignant transformation, and to assess tumor grading prior to surgical resection. Thus, it would be helpful for physicians managing patients with IPMN of the pancreas to have a guideline for the diagnosis and treatment of IPMN. In this review, a role of radiological evaluation for diagnosis and preoperative assessment is described as well as presentation of the guideline for patient management.
Adenocarcinoma, Mucinous/*diagnosis/pathology/surgery ; Carcinoma, Pancreatic Ductal/*diagnosis/pathology/surgery ; Carcinoma, Papillary/*diagnosis/pathology/surgery ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Pancreatic Neoplasms/*diagnosis/pathology/surgery ; Preoperative Care ; Prognosis ; Tomography, X-Ray Computed

With increasing indence and peculiar clinico-pathological features, intraductal papillary mucinous neoplasm (IPMN) of the pancreas has been a major interest in the field of pancreatology. Although pathologic and clinical diversities make difficulty in decision of treatment of IPMN in some circumstances, surgical treatment is generally indicated for main duct IPMN and branch duct IPMN with suspected malignancy (tumor size >or=30 mm, mural nodules, dilated main pancreatic duct, or positive cytology) or prominent symptoms. IPMN has a favorable prognosis after the resection. However, invasive IPMN shows poor prognosis comparable to stage-matched pancreatic ductal adenocarcinoma. Conventional pancreatic resection is recommended in case of highly suspected malignant cases, and organ preserving pancreatectomy or minimal invasive surgery could be used, especially in benign looking branch duct IPMN. Before the surgical resection, clinician should consider patient's general and social condition as well as risk of malignancy to select proper type and extent of surgery.
Adenocarcinoma, Mucinous/diagnosis/pathology/*surgery ; Carcinoma, Pancreatic Ductal/diagnosis/pathology/*surgery ; Carcinoma, Papillary/diagnosis/pathology/*surgery ; Humans ; *Pancreatectomy ; Pancreatic Neoplasms/diagnosis/pathology/*surgery ; Preoperative Care ; Survival Analysis ; Treatment Outcome

No abstract available.
Adenocarcinoma, Mucinous/diagnosis/pathology ; Adenocarcinoma, Papillary/diagnosis/pathology ; Carcinoma, Pancreatic Ductal/*diagnosis/pathology/surgery ; Diagnosis, Differential ; Humans ; Male ; Middle Aged ; Mucin-1/analysis ; Pancreatic Neoplasms/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms are included in mucin-producing pancreatic tumors. The reports about IPMN are not uncommon but those about the mucinous cystic neoplasms are relatively few. The aims of this study were to define the natural history of resected mucinous cystic neoplasms of the pancreas and to identify the findings which suggest malignancy. METHODS: The authors retrospectively evaluated the clinical outcomes of 41 patients with mucinous cystic neoplasms who were surgically resected at Asan Medical Center between 1995 and 2004. RESULTS: Women (n=33) were more frequently affected than men (n=8). Thirty three patients (80.6%) had adenoma, 1 (2.4%) borderline malignancy, 1 (2.4%) carcinoma in situ, and 6 (14.6%) invasive mucinous cystadenocarcinoma. The most frequent symptom was abdominal pain (39%). About half of the enrolled patients were asymptomatic. Unilocular type (79%) was more frequent than the multilocular type (21%) on gross morphology. The tumor size of invasive mucinous cystic neopolasms was larger than that of non-invasive mucinous cystic neoplalsms (p=0.01). Abdominal pain was more frequent in invasive mucinous cystic neoplasms (p=0.026). On gross morphology, mural nodules were detected in 4 of 6 patients with invasive mucinous cystic neoplasms. However, they were not detected in any patients with non-invasive mucinous cystic neoplasms. Recurrence developed in none of the 35 patients with non-invasive mucinous cystic neoplasms, however 2 of the 6 patients with invasive mucinous cystic neoplasms died within 5 years. CONCLUSIONS: Clinical predictors of invasive mucinous cystic neoplasms are suggested to be tumor size and abdominal pain. The prognosis of the non-invasive mucinous cystic neoplasms is excellent when curative resection is performed.
Adenocarcinoma, Mucinous/*diagnosis/pathology/surgery ; Adult ; Aged ; Carcinoma, Pancreatic Ductal/diagnosis/pathology/surgery ; Cystadenocarcinoma, Mucinous/diagnosis/pathology ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Invasiveness ; Pancreatic Neoplasms/*diagnosis/pathology/surgery ; Retrospective Studies ; Survival Analysis