1 / 17

Letný bioptický seminár SD-IAP Senec 21-22.6.2013

Letný bioptický seminár SD-IAP Senec 21-22.6.2013. MUDr. Juraj Marcinek, PhD. Prípad SD-IAP 480. Ústav patologickej anatómie a Konzultačné centrum hematopatológie UNM a JLF UK.

lalasa
Download Presentation

Letný bioptický seminár SD-IAP Senec 21-22.6.2013

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Letný bioptický seminár SD-IAP Senec 21-22.6.2013 MUDr. Juraj Marcinek, PhD. Prípad SD-IAP 480 Ústav patologickej anatómie a Konzultačné centrum hematopatológie UNM a JLF UK

  2. Letný bioptický seminár SD-IAP 9 - 10.11.2012. Prípad SD-IAP 480 • 68 yer old man – Ca capitis pancreatis (cT3 N1 MX) • makroskopic finding: vhite tumorous mas of 18mm rising aroud pancreatic duct in the • head of pancreas • under duodenal serosa visible tumorous mass corresponding to LN

  3. Letný bioptický seminár SD-IAP 21 – 22.6.2013. Prípad SD-IAP 480

  4. Letný bioptický seminár SD-IAP 21 – 22.6.2013. Prípad SD-IAP 480

  5. Letný bioptický seminár SD-IAP 21 – 22.6.2013. Prípad SD-IAP 480

  6. Letný bioptický seminár SD-IAP 21 – 22.6.2013. Prípad SD-IAP 480 ?

  7. Letný bioptický seminár SD-IAP 21 – 22.6.2013. Prípad SD-IAP 480 PAS PAS PAS PAS-K

  8. Letný bioptický seminár SD-IAP 21 – 22.6.2013. Prípad SD-IAP 480 CK7 CK20 CK17 CK19

  9. Letný bioptický seminár SD-IAP 21 – 22.6.2013. Prípad SD-IAP 480 CEAm CEAp trypsine chymotrypsine

  10. Letný bioptický seminár SD-IAP 21 – 22.6.2013. Prípad SD-IAP 480 villin AFP HepPar1 CD10

  11. Letný bioptický seminár SD-IAP 21 – 22.6.2013. Prípad SD-IAP 480 Β-catenin glypican 3 ? hepatoid carcinoma of pancreas with focal ductal differentiation Schmorl TTF1

  12. Letný bioptický seminár SD-IAP 21 – 22.6.2013. Prípad SD-IAP 480 • hepatoid carcinomas – heterogenous neoplasms with morphologic and phenotypic • resemblance to hepatocellular carcinoma (HCC) • - most common arise in stomach (since Ishikura et al. 1985) • - less common in ovary, testis, esophagus, duodenum, pancreas, • colon, rectum, lung, gallblader, urinary tract, uterus, vagina • - morphology: trabecular / pseudoacinar / solid growth pattern • polygonal cells with abundant cytoplasm • central vesicular nuclei with prominent nucleoli • pleomorphic cells, sinusoidal vascularisation • intracytoplasmic PAS+ hyalinne globules • occasional bile production • - usually at least partial tubular/tubulopapilar • growth pattern • - immunohistochemistry: markers of hepatocellular differetiation: • AFP, HepPar1, polyklonal CEA, CD10, glypican 3, albumin mRNA • - usually not all markers are present • - coexpression of cytokeratins atypical for HCC

  13. Letný bioptický seminár SD-IAP 21 – 22.6.2013. Prípad SD-IAP 480 • hepatoid carcinoma of pancreas – rare neoplasm • - larges study contains 15 cases (Kai et al., Pathology • International 2012) • - clinically unspecific symptoms • - can have elevated serum AFP (7/15) • - can differentiate form acinar/ductal/islet cells of • pancreas • - common associated with other cellular carcinoma • component (endocrine features 5/15, ductal • carcinoma 3/15, acinar carcinoma 1/15) • prognosis – hepatoid carcinomas have generally poor prognosis • - most tumors are aggressive with metastasis at time of diagnosis • - mainly hematogenous metastases into liver, vascular permeation (veins) • - pancreatic hepatoid carcinomas – variable prognosis depending on stage at • the time of diagnosis

  14. Letný bioptický seminár SD-IAP 21 – 22.6.2013. Prípad SD-IAP 480 • differential diagnosis of hepatoid carcinomas from: • 1. hepatocellular carcinoma with extrahepatic spreading – problematic to impossible • hepatoid carcinomas - morphologically similar, but often contain variabile amounth • glandular or tubulopapilary adenocarcinomatous component • - immunohistochemical pattern of HCC usually incomplete with • strong coexpression of cytokeratins atypical fo HCC (CK19, • CK17, CK20) • - CEAm+ in adenocarcinomatous component • - CEAp+ in both components (luminal/canalicular in hepatoid c.) • - most important are clinical informations of liver finding • - HCC spread into pancreas is a rare (2,7-5,6%) and late finding • - multiple liver nodules without chronic liver disease associated • with other large large gastrointestinal tumor are prone to be • metastases

  15. Letný bioptický seminár SD-IAP 21 – 22.6.2013. Prípad SD-IAP 480 • differential diagnosis of hepatoid carcinoma of pancreas • 2. acinar cell carcinoma (solid variant) • – morphologically similar cells, granular PAS+ cytoplasm, uniform, basal oriented nuclei • and „palisading“ of nuclei around vessels, distinct nucleoli • - absence of dezmoplastic stroma • - immunohistochemically: lipase+, trypsin+, chymotripsin+ • CK19-, CK7-, CK20-, AFP (10% positive)

  16. Letný bioptický seminár SD-IAP 21 – 22.6.2013. Prípad SD-IAP 480 • differential diagnosis of hepatoid carcinoma of pancreas • 3. pancreatoblastoma • - mainly in children (1st. decade of live) • - trabecular and solid growth pattern with/without other pancreatic structures • (acinar, ductal, endocrine, stromal) • - presence of atypical squamoid corpusles • - a mesenchymal component with stromal hyalinisation may be present • - immunohistochemically: lipase+, trypsin+, chymotripsin+, AFP+, HMW-CK+

  17. Tlstá, Veľká Fatra, 2.7.2008 pohľad na Ostredok a Ostrú Ďakujem za pozornosť

More Related