Ductal adenocarcinomas are firm, sclerotic and poorly defined masses that replace the normal lobular architecture of the gland. The cut surfaces are yellow to white. Haemorrhage and necrosis are uncommon, but microcystic areas may occur, particularly in larger tumours. In surgical series, most carcinomas of the pancreatic head measure 1.5–5.0 cm, with a mean diameter of 2.5–3.5 cm, while carcinomas of the body/tail are usually larger. Cancers measuring < 2 cm are infrequent
Hermanek P (1991)
and may be difficult to recognize on gross inspection.
Staging of exocrine pancreatic carcinoma.
Eur J Surg Oncol 17: 167-72
Carcinomas of the pancreatic head usually invade the common bile duct and/or the pancreatic duct and produce stenosis that results in proximal dilatation of both duct systems. More advanced pancreatic carcinomas in the head of the gland can involve the ampulla of Vater and/or the duodenal wall. Carcinomas in the body or tail obstruct the main pancreatic duct, but typically do not involve the common bile duct.
Stenosis of the main pancreatic duct can produce secondary changes in the upstream pancreatic parenchyma, including duct dilatation, retention-cyst formation and fibrous atrophy of the parenchyma (i.e. obstructive chronic pancreatitis). Gross distinction of chronic pancreatitis from invasive ductal adenocarcinoma is often difficult, making the limits of the neoplasm hard to define
Bosman FT, Carneiro F, Hruban RH, Theise ND (Eds.)
WHO Classification of Tumours of the Digestive System.
International Agency for Research on Cancer: Lyon 2010
|Infiltrating ductal adenocarcinoma|
|Ductal adenocarcinoma in the tail of the pancreas|