Pancreatic Cancer: Pathogenesis, Diagnosis, and Laboratory Tests

Pancreatic cancer is the eleventh cause of cancer death in Indonesia in 2020. However, pancreatic cancer is the second leading cause of cancer death in the United States after lung cancer. Although it is substantially less common than the other malignancies, pancreatic carcinoma is near the top of the list of killers because it is a highly aggressive cancer. Pancreatic cancer has multistep carcinogenesis, starting from the Pancreatic Intraductal Neoplasia (PanINs IA, IB, II, and III) and is ended with an invasive neoplastic lesion. The different incidence of pancreatic cancer between countries also shows the important role of environmental factors for the disease. A better understanding of the risk factors, genetics, molecular pathogenesis, symptoms associated with this disease, and the laboratory aspect is essential to inform both health professionals and the general population as the potential preventive and/or early detection measures.

Precursor Lesions of Cholangiocarcinoma: A Clinicopathologic Review

Cholangiocarcinoma (CCA) develops through multistep carcinogenesis. During the past decades, 2 precursors have been proved to evolve to CCA. The 2 main precursor lesions of CCA are biliary intraepithelial neoplasia and intraductal papillary neoplasm of the bile duct. It is an interesting and relatively novel entity for the hepatobiliary surgeons, radiologists, oncologists, and pathologists. It worth being familiar with these 2 entities for better communication between pathologists, oncologists, and surgeons to improve the treatment and follow-up of these lesions, which can definitely decrease their evolvement to CCA as an aggressive, poor prognostic, and life-threatening cancer. In this narrative review, I collected and discussed all published studies about these 2 precursor lesions of CCA including radiologic, clinical, and pathological manifestation.

Biliary Intraepithelial Neoplasia in Non-biliary Cirrhosis—Report From 100 Explanted Livers: A Single Center Experience

Background: Intrahepatic cholangiocarcinoma is a highly malignant tumor with a very short 5-year survival. Multistep carcinogenesis has been suggested as the main pathway for the development of this tumor. Main suggested precursors have been (1) biliary intraepithelial neoplasia (BilIN) and (2) intraductal papillary neoplasm of bile duct (IPNB). The former is flat and does not produce grossly and radiologically detectable mass lesion, but the latter produces grossly identifiable lesion. Objectives: The development of bile duct dysplasia (BilIN) in chronic biliary diseases has been investigated and proved, but the incidence of BilIN in non-biliary causes of cirrhosis such as hepatitis B and non-alcoholic steatohepatitis has very rarely been investigated. In this study, we have tried to find out the prevalence of BilIN in non-biliary cirrhosis. Patients and Methods: During the study period (2017-2018) in 100 explanted livers with the diagnosis of non-biliary cirrhosis, thorough sampling (at least 20 sections) was performed, and pathologic sections were studied for the presence of BilIN. Results: In the 100 studied livers with different diagnoses of non-biliary causes of cirrhosis, 31% of cases showed BilIN-1 and 2% of cases showed BiliIN-2. No case of BilIN-3 has been identified. Discussion and Conclusions: Non-biliary causes of cirrhosis should be considered as precursors of cholangiocarcinoma (BilIN); however, the incidence of this occurrence is low.