[26

Increasing evidence suggests that pancreatic ductal adenocarcinoma has identifiable precursor lesions. In pancreata resected for pancreatic cancer, the epithelial

Figure 5-1 A moderately differentiated ductal adenocarcinoma, which contains infiltrative glands of varous shapes and sizes surrounded by dense fibrous tissue. The duct forming cells are markedly atypical. (Original magnification, xlOO; from W├╝entz, R.E., andHruban, R.H.: Pathology of cancer of the pancreas. Surg. Oncol. Clin. North Am., 7:43, 1998, with permission.)

Figure 5-2 Ductal adenocarcinoma with perineural invasion. (Original magnification, x200; from Wilentz, RE, and Hruban, R.H.: Pathology of cancer of the pancreas. Surg. Oncol. Clin. North Am., 7:43, 1998, with permission.)

Figure 5-3 Progression (left to right) from normal ductal epithelium to low-grade pancreatic intraepithelial neoplasia, to high-grade intraepithelial neoplasia, and to infiltrating cancer. (From Wilentz, R.E., and Hruban, R.H.: Pathology of cancer of the pancreas. Surg. Oncol. Clin. North Am., 7:43, 1998, with permission.)

Figure 5-4 A histologic section including the duodenum (D), the ampulla of Vater (AV), the distal bile duct (BD), the proximal pancreatic duct (PD), and the pancreatic parenchyma (PP). A distal bile duct cancer (CA) is shown. (From Yeo, C.J., Sohn, T.A., Cameron, J.L., eta!.: Periampullary adenocarcinoma: Analysis of 5-year survivors. Ann. Surg., 227:821, 1998.

Figure 5-6 Mucinous cystadenoma. Tall, mucin-producing columnar cells line the cystic structure (top). Below the columnar cells is a dense "ovarian" stroma, often seen in mucinous cystadenomas in women. (Original magnification, xlOO; from Wilentz, R.E., and Hruban, R.H.: Pathology of cancer of the pancreas. Surg. Oncol. Clin. North Am., 7:43, 1998, with permission.)

TABLE 5-2 -- Tumor Suppressor Genes in Pancreatic Cancer

Gene

Chromosome Location

Frequency (%)

p53

17p

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