Sato H, Liss AS, Mizukami Y. Large-duct pattern invasive adenocarcinoma of the pancreas–a variant mimicking pancreatic cystic neoplasms: A minireview. World J Gastroenterol 2021; 27(23): 3262-3278 [PMID: 34163110 DOI: 10.3748/wjg.v27.i23.3262]
Corresponding Author of This Article
Hiroki Sato, MD, Academic Fellow, Doctor, Research Fellow, Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1, Midorigaoka Higashi 2-1, Asahikawa 0788510, Hokkaido, Japan. hirokisato@asahikawa-med.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jun 21, 2021; 27(23): 3262-3278 Published online Jun 21, 2021. doi: 10.3748/wjg.v27.i23.3262
Large-duct pattern invasive adenocarcinoma of the pancreas–a variant mimicking pancreatic cystic neoplasms: A minireview
Hiroki Sato, Andrew Scott Liss, Yusuke Mizukami
Hiroki Sato, Yusuke Mizukami, Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
Hiroki Sato, Andrew Scott Liss, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, United States
Yusuke Mizukami, Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo 0650033, Hokkaido, Japan
Author contributions: Sato H wrote and edited the manuscript and collected clinical and pathological data; Mizukami Y reviewed the discussion on pathological findings and genetic alterations in the manuscript; Liss AS revised the manuscript and provided recommendations for the manuscript; all authors have read and approved the final manuscript.
Supported byJapan Society for the Promotion of Science (JSPS) KAKENHI, No. 19K17480 (to Sato H), and No. 20H03655 (Mizukami Y).
Conflict-of-interest statement: There is no conflict of interest associated with any of the authors who contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hiroki Sato, MD, Academic Fellow, Doctor, Research Fellow, Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1, Midorigaoka Higashi 2-1, Asahikawa 0788510, Hokkaido, Japan. hirokisato@asahikawa-med.ac.jp
Received: January 28, 2021 Peer-review started: January 28, 2021 First decision: February 24, 2021 Revised: March 9, 2021 Accepted: May 17, 2021 Article in press: May 17, 2021 Published online: June 21, 2021
Abstract
Pancreatic cancer currently has no subtypes that inform clinical decisions; hence, there exists an opportunity to rearrange the morphological and molecular taxonomy that guides a better understanding of tumor characteristics. Nonetheless, accumulating studies to date have revealed the large-duct type variant, a unique subtype of pancreatic ductal adenocarcinoma (PDA) with cystic features. This subtype often radiographically mimics intraductal papillary mucinous neoplasms (IPMNs) and involves multiple small cysts occasionally associated with solid masses. The “bunch-of-grapes” sign, an imaging characteristic of IPMNs, is absent in large-duct PDA. Large-duct PDA defines the mucin profile, and genetic alterations are useful in distinguishing large-duct PDA from IPMNs. Histologically, neoplastic ducts measure over 0.5 mm, forming large ductal elements. Similar to classic PDAs, this subtype is frequently accompanied by perineural invasion and abundant desmoplastic reactions, and KRAS mutations in codon 12 are nearly ubiquitous. Despite such morphological similarities with IPMNs, the prognosis of large-duct PDA is equivalent to that of classic PDA. Differential diagnosis is therefore essential.
Core Tip: This review integrates the current knowledge about large-duct pattern invasive adenocarcinoma of the pancreas [large-duct pancreatic ductal adenocarcinoma (PDA)]. This subtype is a rare exocrine pancreatic neoplasm and often mimics intraductal papillary mucinous neoplasms (IPMNs). However, its prognosis is notably different from that of IPMNs, and distinguishing this subtype from IPMNs preoperatively is crucial. We summarized the morphological features and genetic landscape of large-duct PDA, with a primary focus on its differences from other types of pancreatic cystic neoplasms. The information aid in making appropriate decisions when tackling atypical pancreatic cystic neoplasms.
