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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.

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Letný bioptický seminár SD-IAP Senec 21-22.6.2013

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  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

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