胰腺肿瘤病理诊断及教学新方法课件

1、An Algorithmic Approach to Diagnosing Tumors of the Pancreas: There is an APP for that!Based on AFIP Fascicle, 4th EditionThe Algorithm Consists of a series of branching decision points that lead to the diagnosisBased on AFIP Fascicle, 4th EditionFirst Question: Is the tumor solid or is it cystic?1.

2、 Is it Solid or Cystic?CT Appearance1. Is it Solid or Cystic?Gross AppearanceLet us Say the Tumor is SolidBased on AFIP Fascicle, 4th EditionSecond question:If the tumor is solid, is it cellular or hypocellular?Nature of Epithelium and StromaHypocellular: individual glands and abundant desmoplastic

3、stromaCellular: abundant neoplastic epithelium with minimal or hyalinized stromaIf the Tumor is HypocellularBased on AFIP Fascicle, 4th EditionThird question: If the tumor is hypocellular, does it have any of six featuresWe Use Six Features Because It Can Be Hard to Distinguish Between Pancreatic Ca

4、ncer and Reactive GlandsThis Case Was Pancreatic Cancer Metastatic to BoneFeatures Supporting AdenocarcinomaHaphazard growth patternIncomplete lumina and luminal necrosisNuclear variation 4:1Glands next to muscular vesselsPerineural invasionVascular invasionThe normal pancreas has a lobular growth1.

5、 Haphazard growth1. Haphazard growthThe normal pancreas has empty and complete lumina2. Luminal necrosis and incomplete luminaThe nuclei in normal pancreatic ducts vary only slightly in size3. Four-fold variation in nuclear size in a single glandIn the normal pancreas the muscular vessels are at per

6、iphery of lobules4. Glands next tomuscular artery4. Glands next tomuscular arteryNormally glands are not in nerves5. Perineural Invasion5. Perineural InvasionReactive islets can involve nervesNormally glands are not in vessels6. Lymphatic InvasionVenous Invasion Mimicking PanINVenous Invasion Mimick

7、ing PanINDPC4Features Supporting AdenocarcinomaHaphazard growth patternIncomplete lumina and luminal necrosisNuclear variation 4:1Glands next to muscular vesselsPerineural invasionVascular invasionBased on AFIP Fascicle, 4th EditionIf the tumor is CELLULAR: We next examine the Pattern of growth, nuc

8、lear features, & immunolabelingSolid, cellular epithelium with minimal or hyalinized stroma Pattern of GrowthNuclear FeaturesImmunolabelingPattern of Growth: AcinarNuclear Feature: Single Prominent NucleoliImmunolabeling: Trypsin, Chymotrypsin, BCL10Based on AFIP Fascicle, 4th EditionIf Acinar:Squam

9、oid Nests?Squamoid Nests= PancreatoblastomaNo Squamoid Nests = Acinar CarcinomaPattern of Growth: NestsPattern of Growth: RibbonsNuclear Feature: Salt and Pepper ChromatinImmunolabeling: Synaptophysin, chromograninBased on AFIP Fascicle, 4th EditionGrossly CYSTIC: Degenerative Vs. True CystsEpitheli

10、al Lined vs. DegenerativeEpithelial Lined vs. DegenerativeBased on AFIP Fascicle, 4th EditionDegenerativeInsidious Pattern of InvasionNuclear: GroovesImmunohistochemistry: CD10Immunohistochemistry: CD99Immunohistochemistry: Beta-cateninOther Features Helpful in Diagnosing a Solid-pseudopapillary Neo

11、plasmDelicate Vessels with Loosely Cohesive CellsSmears Help!Cholesterol CleftsHyaline GlobulesBased on AFIP Fascicle, 4th EditionTrue Lining:Serous vs. MucinousSerous vs. MucinousSerous Cystadenoma Based on AFIP Fascicle, 4th EditionMucinous:Ovarian Stroma?Nature of the Stroma: Ovarian vs. Collagen

12、ousOvarian Stroma PresentMucinous Cystic NeoplasmBased on AFIP Fascicle, 4th EditionCollagenous and connects with the duct systemCollagenous StromaIntraductal Papillary Mucinous NeoplasmUnique Molecular ProfilesJ. Wu et al, PNAS 2011Based on AFIP Fascicle, 4th EditionA Picture of the Chinese version of the APP will go HereThe App is Also Available in ChineseAn Algorithmic Approach to Diagnosing Tumors of the Pancreas: There is an APP for t