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Giuseppe Zamboni
Università di VeronaOspedale S.Cuore-Don Calabria, Negrar
TUMORI DELLA PAPILLA
E DELLA
TESTA DEL PANCREAS
PANCREAS PAPILLA
PERIAMPOLLARE
TUMORI DELLA PAPILLA / TESTA DEL PANCREAS
Comune derivazione embriogenetica
Diagnosi Istologica/Citologica per tuttiDiagnosi Istologica/Citologica per tutti
1 CARCINOMA DEL PANCREAS1
ADENOCARCINOMA
Hruban, Pitman, KlimstraAFIP, 2007
Klöppel, KlimstraFletcher, 2007
NON RESECTABLE80-90%
RESECTABLE10-20%
Tissue diagnosisTissue diagnosis
1Percutaneous-US
Higher resolution (0.5 cm)
Lower neoplastic seeding
Sensitivity: 74% with pancreatitis
91% no pancreatitis
** Epithelial contamination
FNA-CytologyEndoscopic-US
CT Laparotomy
ADENOCARCINOMA
DIAGNOSI DIFFERENZIALE1
PANCREATITE
1. Endocrine Neoplasms
2. Solid Pseudopapillary Tumor
3. Acinar-cell Carcinoma
4. Pancreatoblastoma
NON-ADENOCARCINOMA SOLID NEOPLASMS
Metastases
ADENOCARCINOMA
Vs
MASS-FORMING AIP
1. There are no specific cytologic criteria
2. Dx may be suggested in correlation with clinical and radiological features
AIP-EUS-FNA Cytology
AIP: FNA-Core Biopsy
IGg4
AIP-Biopsy
71% of AIP cases are recognized (4/6 criteria) (sensitivity of 76%, with GEL 86%)
Non-AIP-CP: specificity of 100% (<3 criteria)
2 Carcinoma della Papilla
Adenocarcinoma variants
Papillary carcinoma
Mucinous carcinoma
Signet ring cell carcinoma
Clear cell carcinoma
Adenosquamous/Squamous cell carcinoma
Undifferentiated carcinoma
Undifferentiated carcinoma with Osteoclast-Like-GC
Neuroendocrine carcinoma
Intestinal Adenocarcinoma
Pancreatobiliary Adenocarcinoma
Westgaard et al, BMC Cancer-2008
1. BIOPSY
Histologic grade3
Histologic type2
Diagnosis of neoplasia12
2. SURGICAL PAPILLECTOMY
Resection margins4
Histologic grade3
Histologic type2
Recognition of anatomical structures12
PANCREATICODUODENECTOMY
1. Tumor
a) locationb) size / appearancec) histologic typed) histologic gradee) tumor spread
Howe et al Ann Surg, 1998
