Protein Plug in the Pancreatic Duct Mimicking Pancreatic Adenocarcinoma

Introduction/Objective. Pancreatic cancer may be accompanied by infections caused by various microorganisms. It is uncertain wheatear pancreatic infection precedes development of cancer or vice versa. The aim of this study is to analyze routes of infections from duodenum through pancreatic duct to determine what types of microorganisms can get through this duct into pancreas and nearby tissue. Methods. In patients subjected to cephalic duodenopancreatectomy sec. Whipple due to adenocarcinoma of papilla Vateri, duodenum or head of the pancreas, swabs from duodenal mucosa, pancreatic duct and pancreatic tissue at the line of the resection, were taken. Microscopic slides were prepared directly from patients? specimens and also from colonies on culture plates and both were Gram stained. Results. Candida was present in all three types of swabs (duodenum, pancreatic duct and tissue), while bacteria, depending of the species (Pseudomonas aeruginosa. ? hemolytic Streptococcus, Coagulase Negative Staphylococcus, Enterococcus spp, Serratia spp), were present in pancreatic duct or tissue, but not in duodenum. Conclusion. There is connection between presence of microorganisms and pathology of the pancreatic adenocarcinoma. Results show that Candida infection originates from duodenum, while bacterial infections originate directly from blood or tissue injuries.

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Invasive Large Duct Type Pancreatic Adenocarcinoma: A Diagnostically Challenging Entity

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqab191.131 ◽

2021 ◽

Vol 156 (Supplement_1) ◽

pp. S63-S64

Author(s):

M M Al-Attar ◽

S M Khedr

Keyword(s):

Pancreatic Duct ◽

Pancreatic Adenocarcinoma ◽

Main Pancreatic Duct ◽

Correct Diagnosis ◽

Pancreatic Head ◽

Side Branch ◽

Ductal Adenocarcinoma ◽

Diagnostic Challenge ◽

Invasive Adenocarcinoma ◽

Non Invasive

Abstract Introduction/Objective Large duct type invasive pancreatic adenocarcinoma is a morphological variant of pancreatic ductal adenocarcinoma that poses a radiologic and pathologic diagnostic challenge as it closely mimics other non- invasive neoplasms, including mucinous cystic neoplasms and intraductal papillary mucinous neoplasms (IPMN). We report a case of large duct type invasive adenocarcinoma that on radiology closely mimics an IPMN. Methods/Case Report The case id that of a 73-year-old male presenting with weight loss and chronic diarrhea. Abdominal imaging revealed features suggestive of main duct IPMN with possible side branch extension into the pancreatic head. Endoscopic retrograde cholangiopancreatography showed a bile duct stricture that was stented and biopsied, revealing mucinous material with neoplastic cells. A Whipple procedure was performed, revealing a 3.3 cm, tank-pink, papillary lesion in the pancreatic head, that is partially cystic with mucinous contents, and displaying exophytic extension into the main pancreatic duct. Microscopically, the lesion consists of a high-grade IPMN involving the main pancreatic duct with side branch extension, and associated with invasive adenocarcinoma, the majority of which is of the large duct type, showing irregularly distributed large ducts with jagged edges and surrounding desmoplasia, with intra-luminal mucinous material and neutrophils. The lining cells show focal pseudo-stratification and bland cytology. Foci of conventional type invasive adenocarcinoma, clusters of invasive tumor cells, and peri-neural invasion are also identified. Post- procedure, the patient underwent chemotherapy with marked symptomatic improvement. Results (if a Case Study enter NA) NA Conclusion Large duct type invasive adenocarcinoma of the pancreas can closely mimic non-invasive pancreatic neoplasms, posing diagnostic challenges that require identification of subtle features to achieve the correct diagnosis and guide treatment.

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