Pancreatic cancer classification: Difference between revisions

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*'''Cellular Classification of Pancreatic Cancer'''<ref name="cancergov">National Cancer Institute. Physician Data Query Database 2015. http://www.cancer.gov/publiciation/pdq</ref>
*'''Cellular Classification of Pancreatic Cancer'''<ref name="cancergov">National Cancer Institute. Physician Data Query Database 2015. http://www.cancer.gov/publiciation/pdq</ref>
:* Pancreatic cancer includes the following carcinomas:
:* Pancreatic cancer includes the following carcinomas:
::* ''Malignant''
::* '''''Malignant'''''
:::* Duct cell carcinoma (90% of all cases)
:::* Duct cell carcinoma (90% of all cases)
:::* [[Acinar cell carcinoma]]
:::* [[Acinar cell carcinoma]]
Line 25: Line 25:
:::* Unclassified
:::* Unclassified
:::* Undifferentiated carcinoma
:::* Undifferentiated carcinoma
::* ''Borderline Malignancies''
::* '''''Borderline Malignancies'''''
:::* Intraductal papillary mucinous tumor with dysplasia
:::* Intraductal papillary mucinous tumor with dysplasia
:::* Mucinous cystic tumor with dysplasia
:::* Mucinous cystic tumor with dysplasia
:::* Pseudopapillary solid tumor
:::* Pseudopapillary solid tumor


<br/>
<br />
*'''Types of Pancreatic Cancers:'''<ref name="pmid22592847">{{cite journal| author=Bond-Smith G, Banga N, Hammond TM, Imber CJ| title=Pancreatic adenocarcinoma. | journal=BMJ | year= 2012 | volume= 344 | issue=  | pages= e2476 | pmid=22592847 | doi=10.1136/bmj.e2476 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22592847  }} </ref>
*'''Types of Pancreatic Cancers:'''<ref name="pmid22592847">{{cite journal| author=Bond-Smith G, Banga N, Hammond TM, Imber CJ| title=Pancreatic adenocarcinoma. | journal=BMJ | year= 2012 | volume= 344 | issue=  | pages= e2476 | pmid=22592847 | doi=10.1136/bmj.e2476 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22592847  }} </ref>


{|
{|
! rowspan="1" colspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Types of Pancreatic Cancers'''
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Types of Pancreatic Cancers'''
|+  
|+  
| rowspan="1" colspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Pancreatic Exocrine Cancers'''
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Pancreatic Exocrine Cancers'''
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Adenocarcinoma
*Adenocarcinoma
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Acinar cell carcinoma
*Acinar cell carcinoma
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Adenosquamous carcinoma
*Adenosquamous carcinoma
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Giant cell tumour
*Giant cell tumour
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Intraductal papillary mucinous neoplasm (IPMN)
*Intraductal papillary mucinous neoplasm (IPMN)
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Mucinous cystadenocarcinoma
*Mucinous cystadenocarcinoma
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Pancreatoblastoma
*Pancreatoblastoma
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Serous cystadenocarcinoma
*Serous cystadenocarcinoma
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Solid and pseudopapillary tumours
*Solid and pseudopapillary tumours
|-
|-
|+
|+
| rowspan="1" colspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Pancreatic Endocrine Cancers (Pancreatic Neuroendocrine Tumours)'''
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Pancreatic Endocrine Cancers (Pancreatic Neuroendocrine Tumours)'''
|+
|+
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Gastrinoma
*Gastrinoma
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Glucagonoma
*Glucagonoma
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Insulinoma
*Insulinoma
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Nonfunctional islet cell tumour
*Nonfunctional islet cell tumour
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Somatostatinoma
*Somatostatinoma
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Vasoactive intestinal peptide releasing tumour (VIPoma)
*Vasoactive intestinal peptide releasing tumour (VIPoma)
|-
|-
|}
|}


<br/>
<br />
*'''Types of Pancreatic Intraepithelial Neoplasia (PanIN):'''<ref name="pmid22592847">{{cite journal| author=Bond-Smith G, Banga N, Hammond TM, Imber CJ| title=Pancreatic adenocarcinoma. | journal=BMJ | year= 2012 | volume= 344 | issue=  | pages= e2476 | pmid=22592847 | doi=10.1136/bmj.e2476 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22592847  }} </ref>
*'''Types of Pancreatic Intraepithelial Neoplasia (PanIN):'''<ref name="pmid22592847">{{cite journal| author=Bond-Smith G, Banga N, Hammond TM, Imber CJ| title=Pancreatic adenocarcinoma. | journal=BMJ | year= 2012 | volume= 344 | issue=  | pages= e2476 | pmid=22592847 | doi=10.1136/bmj.e2476 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22592847  }} </ref>


{|
{|
! rowspan="1" colspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Types of Pancreatic Intraepithelial Neoplasia (PanIN)'''
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Types of Pancreatic Intraepithelial Neoplasia (PanIN)'''
|+  
|+  
| rowspan="1" colspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''PanIN 1 (low grade)'''
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''PanIN 1 (low grade)'''
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Minimal degree of atypia
*Minimal degree of atypia
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Subclassified into PanIN 1A: absence of micropapillary infoldings of the epithelium; and 1B, presence of micropapillary infoldings of the epithelium
*Subclassified into PanIN 1A: absence of micropapillary infoldings of the epithelium; and 1B, presence of micropapillary infoldings of the epithelium
|-
|-
|+
|+
| rowspan="1" colspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''PanIN 2 (intermediate grade)'''
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''PanIN 2 (intermediate grade)'''
|+
|+
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Moderate degree of atypia, including loss of polarity, nuclear crowding, enlarged nuclei, pseudostratification, and hyperchromatism
*Moderate degree of atypia, including loss of polarity, nuclear crowding, enlarged nuclei, pseudostratification, and hyperchromatism
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Mitoses are rarely seen
*Mitoses are rarely seen
|-
|-
|+
|+
| rowspan="1" colspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''PanIN 3 (high grade/carcinoma in situ)'''
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''PanIN 3 (high grade/carcinoma in situ)'''
|+
|+
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Severe atypia, with varying degrees of cribriforming, luminal necrosis, and atypical mitoses
*Severe atypia, with varying degrees of cribriforming, luminal necrosis, and atypical mitoses
|-
|-
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Contained within the basement membrane
*Contained within the basement membrane
|-
|-
|}
|}


<br/>
<br />
*'''Functional Pancreatic Neuroendocrine Tumors and their Characteristics are mentioned in the following table:'''<ref name="pmid25207767">{{cite journal| author=Ryan DP, Hong TS, Bardeesy N| title=Pancreatic adenocarcinoma. | journal=N Engl J Med | year= 2014 | volume= 371 | issue= 11 | pages= 1039-49 | pmid=25207767 | doi=10.1056/NEJMra1404198 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25207767  }} </ref>
*'''Functional Pancreatic Neuroendocrine Tumors and their Characteristics are mentioned in the following table:'''<ref name="pmid25207767">{{cite journal| author=Ryan DP, Hong TS, Bardeesy N| title=Pancreatic adenocarcinoma. | journal=N Engl J Med | year= 2014 | volume= 371 | issue= 11 | pages= 1039-49 | pmid=25207767 | doi=10.1056/NEJMra1404198 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25207767  }} </ref>


Line 131: Line 131:
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Functional Pancreatic Neuroendocrine Tumors and their Characteristics'''
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Functional Pancreatic Neuroendocrine Tumors and their Characteristics'''
|+  
|+  
| rowspan="1" colspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Tumor type and syndrome'''
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Tumor type and syndrome'''
| rowspan="1" colspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Location in pancreas'''
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Location in pancreas'''
| rowspan="1" colspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Signs and symptoms'''
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Signs and symptoms'''
| rowspan="1" colspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Circulating biomarkers'''
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Circulating biomarkers'''
|-
|-
| style="background:#DCDCDC; + | '''Insulinoma (Whipple’s triad)'''
| style="background:#DCDCDC; + " | '''Insulinoma (Whipple’s triad)'''
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Head, body, tail (evenly distributed)
*Head, body, tail (evenly distributed)
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Hypoglycemia, dizziness, sweating, tachycardia, tremulousness, confusion, seizure
*Hypoglycemia, dizziness, sweating, tachycardia, tremulousness, confusion, seizure
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*CgA and CgB, insulin inappropriate for blood glucose level, proinsulin, C-peptide
*CgA and CgB, insulin inappropriate for blood glucose level, proinsulin, C-peptide
|-
|-
| style="background:#DCDCDC; + | '''Gastrinoma (Zollinger–Ellison)'''
| style="background:#DCDCDC; + " | '''Gastrinoma (Zollinger–Ellison)'''
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Gastrinoma triangle Often extrapancreatic (duodenal); can be found anywhere in gland
*Gastrinoma triangle Often extrapancreatic (duodenal); can be found anywhere in gland
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Gastric acid hypersecretion, peptic ulcer, diarrhea, esophagitis, epigastric pain
*Gastric acid hypersecretion, peptic ulcer, diarrhea, esophagitis, epigastric pain
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*CgA, gastrin, PP (35%)
*CgA, gastrin, PP (35%)
|-
|-
| style="background:#DCDCDC; + | '''VIPoma (Verner– Morrison syndrome, WDHA)'''
| style="background:#DCDCDC; + " | '''VIPoma (Verner– Morrison syndrome, WDHA)'''
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Distal pancreas (body and tail) Often spread outside pancreas
*Distal pancreas (body and tail) Often spread outside pancreas
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Watery diarrhea, hypokalemia, achlorhydria (or acidosis)
*Watery diarrhea, hypokalemia, achlorhydria (or acidosis)
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*CgA, VIP
*CgA, VIP
|-
|-
| style="background:#DCDCDC; + | '''Glucagonoma'''
| style="background:#DCDCDC; + " | '''Glucagonoma'''
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Body and tail of pancreas Often large and spread outside pancreas
*Body and tail of pancreas Often large and spread outside pancreas
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Diabetes (hyperglycemia), necrolytic migratory erythema, stomatitis, glossitis, angular cheilitis
*Diabetes (hyperglycemia), necrolytic migratory erythema, stomatitis, glossitis, angular cheilitis
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*CgA, glucagon, glycentin
*CgA, glucagon, glycentin
|-
|-
| style="background:#DCDCDC; + | '''Somatostatinoma'''
| style="background:#DCDCDC; + " | '''Somatostatinoma'''
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Pancreatoduodenal groove, ampullary, periampullary
*Pancreatoduodenal groove, ampullary, periampullary
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Gallstones, diabetes (hyperglycemia), steatorrhea
*Gallstones, diabetes (hyperglycemia), steatorrhea
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*CgA, somatostatin
*CgA, somatostatin
|-
|-
| style="background:#DCDCDC; + | '''Ppoma'''
| style="background:#DCDCDC; + " | '''Ppoma'''
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*Head of pancreas
*Head of pancreas
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*None
*None
| style="background:#F5F5F5; + |  
| style="background:#F5F5F5; + " |  
*CgA, PP
*CgA, PP
|-
|-

Revision as of 14:36, 14 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]

Overview

Pancreatic cancer can be classified into malignant and borderline malignant. Duct cell carcinoma is the most common type of pancreatic cancer.

Classification

  • Cellular Classification of Pancreatic Cancer[1]
  • Pancreatic cancer includes the following carcinomas:
  • Malignant
  • Duct cell carcinoma (90% of all cases)
  • Acinar cell carcinoma
  • Adenosquamous carcinoma
  • Cystadenocarcinoma (serous and mucinous types)
  • Giant cell carcinoma
  • Invasive adenocarcinoma associated with cystic mucinous neoplasm or intraductal papillary mucinous neoplasm
  • Mixed type (ductal-endocrine or acinar-endocrine)
  • Mucinous carcinoma
  • Pancreatoblastoma
  • Papillary-cystic neoplasm (Frantz tumor). This tumor has lower malignant potential and may be cured with surgery alone
  • Papillary mucinous carcinoma
  • Signet ring carcinoma
  • Small cell carcinoma
  • Unclassified
  • Undifferentiated carcinoma
  • Borderline Malignancies
  • Intraductal papillary mucinous tumor with dysplasia
  • Mucinous cystic tumor with dysplasia
  • Pseudopapillary solid tumor


  • Types of Pancreatic Cancers:[2]
Types of Pancreatic Cancers
Pancreatic Exocrine Cancers
  • Adenocarcinoma
  • Acinar cell carcinoma
  • Adenosquamous carcinoma
  • Giant cell tumour
  • Intraductal papillary mucinous neoplasm (IPMN)
  • Mucinous cystadenocarcinoma
  • Pancreatoblastoma
  • Serous cystadenocarcinoma
  • Solid and pseudopapillary tumours
Pancreatic Endocrine Cancers (Pancreatic Neuroendocrine Tumours)
  • Gastrinoma
  • Glucagonoma
  • Insulinoma
  • Nonfunctional islet cell tumour
  • Somatostatinoma
  • Vasoactive intestinal peptide releasing tumour (VIPoma)


  • Types of Pancreatic Intraepithelial Neoplasia (PanIN):[2]
Types of Pancreatic Intraepithelial Neoplasia (PanIN)
PanIN 1 (low grade)
  • Minimal degree of atypia
  • Subclassified into PanIN 1A: absence of micropapillary infoldings of the epithelium; and 1B, presence of micropapillary infoldings of the epithelium
PanIN 2 (intermediate grade)
  • Moderate degree of atypia, including loss of polarity, nuclear crowding, enlarged nuclei, pseudostratification, and hyperchromatism
  • Mitoses are rarely seen
PanIN 3 (high grade/carcinoma in situ)
  • Severe atypia, with varying degrees of cribriforming, luminal necrosis, and atypical mitoses
  • Contained within the basement membrane


  • Functional Pancreatic Neuroendocrine Tumors and their Characteristics are mentioned in the following table:[3]
Functional Pancreatic Neuroendocrine Tumors and their Characteristics
Tumor type and syndrome Location in pancreas Signs and symptoms Circulating biomarkers
Insulinoma (Whipple’s triad)
  • Head, body, tail (evenly distributed)
  • Hypoglycemia, dizziness, sweating, tachycardia, tremulousness, confusion, seizure
  • CgA and CgB, insulin inappropriate for blood glucose level, proinsulin, C-peptide
Gastrinoma (Zollinger–Ellison)
  • Gastrinoma triangle Often extrapancreatic (duodenal); can be found anywhere in gland
  • Gastric acid hypersecretion, peptic ulcer, diarrhea, esophagitis, epigastric pain
  • CgA, gastrin, PP (35%)
VIPoma (Verner– Morrison syndrome, WDHA)
  • Distal pancreas (body and tail) Often spread outside pancreas
  • Watery diarrhea, hypokalemia, achlorhydria (or acidosis)
  • CgA, VIP
Glucagonoma
  • Body and tail of pancreas Often large and spread outside pancreas
  • Diabetes (hyperglycemia), necrolytic migratory erythema, stomatitis, glossitis, angular cheilitis
  • CgA, glucagon, glycentin
Somatostatinoma
  • Pancreatoduodenal groove, ampullary, periampullary
  • Gallstones, diabetes (hyperglycemia), steatorrhea
  • CgA, somatostatin
Ppoma
  • Head of pancreas
  • None
  • CgA, PP

Refrences

  1. ↑ National Cancer Institute. Physician Data Query Database 2015. http://www.cancer.gov/publiciation/pdq
  2. ↑ 2.0 2.1 Bond-Smith G, Banga N, Hammond TM, Imber CJ (2012). "Pancreatic adenocarcinoma". BMJ. 344: e2476. doi:10.1136/bmj.e2476. PMID 22592847.
  3. ↑ Ryan DP, Hong TS, Bardeesy N (2014). "Pancreatic adenocarcinoma". N Engl J Med. 371 (11): 1039–49. doi:10.1056/NEJMra1404198. PMID 25207767.
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