Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Pancreatic Neoplasms: HELP
Articles by Nobuyuki Ohike
Based on 25 articles published since 2010
(Why 25 articles?)
||||

Between 2010 and 2020, Nobuyuki Ohike wrote the following 25 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Guideline Pathologic Evaluation and Reporting of Intraductal Papillary Mucinous Neoplasms of the Pancreas and Other Tumoral Intraepithelial Neoplasms of Pancreatobiliary Tract: Recommendations of Verona Consensus Meeting. 2016

Adsay, Volkan / Mino-Kenudson, Mari / Furukawa, Toru / Basturk, Olca / Zamboni, Giuseppe / Marchegiani, Giovanni / Bassi, Claudio / Salvia, Roberto / Malleo, Giuseppe / Paiella, Salvatore / Wolfgang, Christopher L / Matthaei, Hanno / Offerhaus, G Johan / Adham, Mustapha / Bruno, Marco J / Reid, Michelle D / Krasinskas, Alyssa / Klöppel, Günter / Ohike, Nobuyuki / Tajiri, Takuma / Jang, Kee-Taek / Roa, Juan Carlos / Allen, Peter / Fernández-del Castillo, Carlos / Jang, Jin-Young / Klimstra, David S / Hruban, Ralph H / Anonymous6721124. ·*Department of Pathology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA †Department of Pathology, Massachusetts General Hospital, Boston, MA ‡Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan §Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY ¶Department of Pathology, University of Verona, Verona, Italy ||Department of Surgery, Massachusetts General Hospital, Boston, MA **Department of Surgery, University of Verona, Verona, Italy ††Department of Surgery, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD ‡‡Departments of Surgery, University of Bonn, Bonn, Germany §§Departments of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands ¶¶Department of Surgery, Edouard Herriot Hospital, HCL, Lyon, France ||||Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands ***Departments of Pathology, Technical University, Munich, Germany †††Department of Pathology, Showa University Fujigaoka Hospital, Yokohama, Japan ‡‡‡Department of Pathology, Tokai University Hachioji Hospital, Tokyo, Japan §§§Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea ¶¶¶Department of Pathology, Pontificia Universidad Católica de Chile, Santiago, Chile ||||||Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY ****Department of Surgery, Massachusetts General Hospital, Boston, MA ††††Department of Surgery, Seoul National University Hospital, Seoul, Korea ‡‡‡‡Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD. ·Ann Surg · Pubmed #25775066.

ABSTRACT: BACKGROUND: There are no established guidelines for pathologic diagnosis/reporting of intraductal papillary mucinous neoplasms (IPMNs). DESIGN: An international multidisciplinary group, brought together by the Verona Pancreas Group in Italy-2013, was tasked to devise recommendations. RESULTS: (1) Crucial to rule out invasive carcinoma with extensive (if not complete) sampling. (2) Invasive component is to be documented in a full synoptic report including its size, type, grade, and stage. (3) The term "minimally invasive" should be avoided; instead, invasion size with stage and substaging of T1 (1a, b, c; ≤ 0.5, > 0.5-≤ 1, > 1 cm) is to be documented. (4) Largest diameter of the invasion, not the distance from the nearest duct, is to be used. (5) A category of "indeterminate/(suspicious) for invasion" is acceptable for rare cases. (6) The term "malignant" IPMN should be avoided. (7) The highest grade of dysplasia in the non-invasive component is to be documented separately. (8) Lesion size is to be correlated with imaging findings in cysts with rupture. (9) The main duct diameter and, if possible, its involvement are to be documented; however, it is not required to provide main versus branch duct classification in the resected tumor. (10) Subtyping as gastric/intestinal/pancreatobiliary/oncocytic/mixed is of value. (11) Frozen section is to be performed highly selectively, with appreciation of its shortcomings. (12) These principles also apply to other similar tumoral intraepithelial neoplasms (mucinous cystic neoplasms, intra-ampullary, and intra-biliary/cholecystic). CONCLUSIONS: These recommendations will ensure proper communication of salient tumor characteristics to the management teams, accurate comparison of data between analyses, and development of more effective management algorithms.

2 Review A case of concurrent pancreatic intraepithelial neoplasia and type 1 autoimmune pancreatitis with marked pancreatic duct dilatation. 2016

Takano, Yuichi / Nagahama, Masatsugu / Yamamura, Eiichi / Maruoka, Naotaka / Yokomizo, Kazuaki / Mizukami, Hiroki / Tanaka, Jun-Ichi / Ohike, Nobuyuki. ·Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-Shi, Kanagawa, 227-8501, Japan. yuichitakano1028@yahoo.co.jp. · Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-Shi, Kanagawa, 227-8501, Japan. · Department of Surgery, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan. · Department of Diagnostic Pathology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan. ·Clin J Gastroenterol · Pubmed #27351197.

ABSTRACT: The case patient was a previously healthy 82-year-old male. Abdominal ultrasound during a medical check-up revealed a dilatation of the main pancreatic duct, and the patient was referred to our hospital for closer examination. Contrast-enhanced computed tomography (CT) revealed a low-density mass of 20 mm in the pancreatic head-body transitional area. Magnetic resonance cholangiopancreatography (MRCP) revealed marked dilatation of the main pancreatic duct and branches in the body-tail. On endoscopic ultrasonography (EUS), a hypoechoic mass with irregular shape was detected, which was consistent with the area of pancreatic duct stenosis. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and pancreatic juice cytology were performed; however, there were no malignant findings. Serum IgG4 levels had increased to 299 mg/dL. Cancer of the pancreatic head was suspected and a pancreaticoduodenectomy was thus performed. Macroscopic findings included a white mass with indistinct border in the constricted part of the pancreatic duct and mottled fatty replacement of the pancreatic head. Pathologically, a large amount of IgG4-positive plasma cells was found in the white mass, with storiform fibrosis and obstructive phlebitis, which led to the diagnosis of type 1 autoimmune pancreatitis (AIP). Furthermore, scattered low-high grade pancreatic intraepithelial neoplasia lesions were observed throughout the pancreatic head, separately from the AIP lesion. This is an interesting case that suggests an association between AIP and pancreatic cancer. We report the case with a review of relevant literature.

3 Review Pathologic staging of pancreatic, ampullary, biliary, and gallbladder cancers: pitfalls and practical limitations of the current AJCC/UICC TNM staging system and opportunities for improvement. 2012

Adsay, N Volkan / Bagci, Pelin / Tajiri, Takuma / Oliva, Irma / Ohike, Nobuyuki / Balci, Serdar / Gonzalez, Raul S / Basturk, Olca / Jang, Kee-Taek / Roa, Juan Carlos. ·Department of Pathology, Emory University, School of Medicine, Atlanta, Georgia, USA. volkan.adsay@emory.edu ·Semin Diagn Pathol · Pubmed #23062420.

ABSTRACT: Tumors of the ampulla-pancreatobiliary tract are encountered increasingly; however, their staging can be highly challenging due to lack of familiarity. In this review article, the various issues encountered in staging of these tumors at the pathologic level are evaluated and possible solutions for daily practice as well as potential improvements for future staging protocols are discussed. While N-stage parameters have now been well established (the number of lymph nodes required in pancreatoduodenectomies is 12), the T-staging has several issues: for the pancreas, the discovery of small cancers arising in intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) necessitates the creation of substages of T1 (as T1a, b, and c); lack of proper definition of "peripancreatic soft tissue" and "common bile duct involvement" (as to which part is meant) makes T3 highly subjective. Increasing resectability of main vessels (portal vein) brings the need to redefine a "T" for such cases. For the ampulla, due to factors like anatomic complexity of the region and the under-appreciation of three-dimensional spread of the tumors in this area (in particular, the frequent extension into periduodenal soft tissues and duodenal serosa, which are not addressed in the current system and which require specific grossing approaches to document), the current T-staging lacks reproducibility and clinical relevance, and therefore, major revisions are needed. Recently proposed refined definition and site-specific subclassification of ampullary tumors highlight the areas for improvement. For the extrahepatic bile ducts, the staging schemes that use the depth of invasion may be more practical to circumvent the inconsistencies in the histologic layering of the ducts; better definition of terms like "periductal spread" is needed. For the gallbladder, since many gallbladder cancers are "unapparent" (found in clinically and grossly unsuspected cholecystectomies), establishing proper grossing protocols and adequate sampling are crucial. Since the gallbladder does not have the distinct layering of the other gastrointestinal organs, the definitions of Tis/T1a/T1b lack practicality, and therefore, "early gallbladder carcinoma" category proposed in high-risk regions may have to be recognized instead. Involvement of the Rokitansky-Aschoff sinuses should be a part of the evaluation and management of these early gallbladder cancers; for advanced cancers, documentation of hepatic versus serosal involvement is necessary. In summary, T-staging of ampulla-pancreatobiliary tract tumors has many challenges. Proper grossing and appreciation of histo-anatomic subtleties of this region are crucial in addressing these issues and achieving more applicable and clinically relevant staging systems in the future.

4 Review [Pathology of pancreatic neuroendocrine tumor]. 2011

Ohike, Nobuyuki / Morohoshi, Toshio. ·First Department of Pathology, Showa University School of Medicine. ·Nihon Rinsho · Pubmed #21834162.

ABSTRACT: -- No abstract --

5 Article [Six cases of anaplastic pancreatic carcinoma diagnosed by endoscopic ultrasound-guided fine needle aspiration]. 2019

Niiya, Fumitaka / Takano, Yuichi / Kobayashi, Takahiro / Yamamura, Eiichi / Maruoka, Naotaka / Norose, Tomoko / Ohike, Nobuyuki / Nagahama, Masatsugu. ·Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital. · Department of Gastroenterology, Odawara Municipal Hospital. · Department of Diagnostic Pathology, Showa University Fujigaoka Hospital. ·Nihon Shokakibyo Gakkai Zasshi · Pubmed #31827044.

ABSTRACT: Anaplastic pancreatic carcinoma is a rare form of pancreatic cancer with an extremely poor prognosis. Its diagnosis is often based on surgical specimens and few reports have described the use of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis. In this study, we examined six patients (mean age, 70.5 years;sex ratio, 1:1) who were diagnosed with anaplastic pancreatic carcinoma using EUS-FNA. The carcinomas were located in the pancreatic head, body, and tail in one, three, and two patients, respectively. The mean tumor diameter was 49.2mm. Five patients opted for best supportive care due to poor performance status and one underwent chemotherapy (GEM+nab-PTX). The median survival was 40.5 (14-98) days. The characteristic imaging findings of anaplastic pancreatic carcinoma, including central necrosis, marginal contrast enhancement, cystic findings, and internal calcification, were frequently observed in the patients. Anaplastic pancreatic carcinoma can also be diagnosed using biopsy tissue;however, a pathologist's consultation is required to differentiate the disease based on imaging findings for an accurate diagnosis.

6 Article A Consensus Study of the Grading and Typing of Intraductal Papillary Mucinous Neoplasms of the Pancreas. 2019

Furukawa, Toru / Fukushima, Noriyoshi / Itoi, Takao / Ohike, Nobuyuki / Mitsuhashi, Tomoko / Nakagohri, Toshio / Notohara, Kenji / Shimizu, Michio / Tajiri, Takuma / Tanaka, Mariko / Yamaguchi, Hiroshi / Yanagisawa, Akio / Sugiyama, Masanori / Okazaki, Kazuichi. ·Department of Pathology, Jichi Medical University, Shimotsuke. · Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo. · Department of Pathology, Showa University Fujigaoka Hospital, Yokohama. · Department of Surgical Pathology, Hokkaido University Hospital, Sapporo. · Department of Surgery, Tokai University School of Medicine, Isehara. · Department of Pathology, Kurashiki Central Hospital, Kurashiki. · Diagnostic Pathology Center, Hakujikai Memorial Hospital. · Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Hachioji. · Department of Pathology, Graduate School of Medicine, University of Tokyo. · Department of Pathology, Tokyo Medical University, Tokyo. · Department of Pathology, Kyoto Prefectural University of Medicine, Kyoto. · Department of Surgery, Kyorin University School of Medicine, Mitaka. · The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan. ·Pancreas · Pubmed #30946243.

ABSTRACT: OBJECTIVE: The grading and typing of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are challenging for pathologists. We aimed to clarify the points of consistency and disagreement in assessing the grades and types of IPMNs. METHODS: Digital slide images of 20 IPMNs were independently assessed by 10 Japanese pathologists, who then held a consensus meeting to discuss the points of disagreement and develop a consensus and recommendations. RESULTS: The average agreement rates for grade and type were 83.5% (range, 100%-40%) and 82.5% (range, 100%-50%) and the Fleiss' κ values were 0.567 and 0.636, respectively. CONCLUSIONS: The disagreement points and recommendations were as follows: destructed ductal walls with desquamated neoplastic epithelia or mucin lakes partially lined with neoplastic cells could be invasion; intraductal stromal invasion could be dismissed unless vascular or lymphatic invasion existed; elastica staining may help visualize ducts in colloidal nodules; high-grade can be distinguished from low/intermediate grade by marked nuclear disarrangements and complex architecture in the intestinal papillae; oncocytic papillae are characterized by eosinophilic cells with round disoriented nuclei; high-grade gastric papillae can be distinguished from pancreatobiliary papillae by relatively low but complex architecture; and the most dysplastic papillae should be used to assess type in mixed papillae types.

7 Article Serum and histological IgG4-negative type 1 autoimmune pancreatitis. 2019

Takano, Yuichi / Kobayashi, Takahiro / Niiya, Fumitaka / Yamamura, Eiichi / Maruoka, Naotaka / Yokomizo, Kazuaki / Mizukami, Hiroki / Tanaka, Jun-Ichi / Norose, Tomoko / Ohike, Nobuyuki / Nagahama, Masatsugu. ·Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan. yuichitakano1028@yahoo.co.jp. · Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan. · Department of Surgery, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan. · Department of Diagnostic Pathology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan. ·Clin J Gastroenterol · Pubmed #30414073.

ABSTRACT: A 66-year-old man who was on oral medication for type 2 diabetes experienced a rapid decline in glycemic control (increase in glycosylated hemoglobin level from 7.7 to 10.2% over 3 months). Abdominal ultrasonography revealed a 20-mm hypoechoic mass in the pancreatic tail. Serum tumor marker carbohydrate antigen 19-9 and DUPAN2 levels were within the respective normal ranges; serum IgG4 level was also normal at 21.8 mg/dL. Abdominal contrast computed tomography revealed a 26-mm tumor in the pancreatic tail. Magnetic resonance cholangiopancreatography revealed disruption of the main pancreatic duct and dilation of the caudal pancreatic duct. Endoscopic ultrasonography revealed a near-round-shaped hypoechoic mass with interspersed hyperechoic areas. Endoscopic ultrasonography-guided fine needle aspiration was performed using a 22-G needle, but no malignant findings were observed. There were no signs of sialadenitis, retroperitoneal fibrosis, nephropathy, or other conditions associated with IgG4-related diseases. Distal pancreatectomy was performed; a 23-mm white mass was resected from the pancreatic tail. A histopathological examination showed advanced inflammatory cell infiltration mainly involving lymphocytes/plasma cells along with storiform fibrosis and obliterative phlebitis. No more than five IgG4-positive cells were observed per high-power field. These were level 1 pathological findings, and a definitive diagnosis of type 1 autoimmune pancreatitis (AIP) was made according to the International Consensus Diagnostic Criteria. Type 1 AIP associated with normal serum IgG4 levels and absence of IgG4-positive cells on histological examination is a rare clinical entity, which is very difficult to distinguish from pancreatic cancer. Here we report such a case and present a review of the relevant literature.

8 Article Molecular alterations associated with metastases of solid pseudopapillary neoplasms of the pancreas. 2019

Amato, Eliana / Mafficini, Andrea / Hirabayashi, Kenichi / Lawlor, Rita T / Fassan, Matteo / Vicentini, Caterina / Barbi, Stefano / Delfino, Pietro / Sikora, Katarzyna / Rusev, Borislav / Simbolo, Michele / Esposito, Irene / Antonello, Davide / Pea, Antonio / Sereni, Elisabetta / Ballotta, Maria / Maggino, Laura / Marchegiani, Giovanni / Ohike, Nobuyuki / Wood, Laura D / Salvia, Roberto / Klöppel, Günter / Zamboni, Giuseppe / Scarpa, Aldo / Corbo, Vincenzo. ·ARC-Net Research Centre, University and Hospital Trust of Verona, Verona, Italy. · Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy. · Department of Pathology, Tokai University School of Medicine, Isehara, Japan. · Institute of Pathology, Heinrich-Heine-University and University Hospital of Düsseldorf, Düsseldorf, Germany. · Department of Surgery, General Surgery B, University of Verona, Verona, Italy. · Section of Anatomic Pathology, Azienda Ospedaliera Rovigo, Rovigo, Italy. · Department of Pathology and Laboratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan. · Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Pathology, Technical University Munich, Munich, Germany. · Division of Pathology, Sacro Cuore-Don Calabria Hospital, Negrar, Italy. ·J Pathol · Pubmed #30306561.

ABSTRACT: Solid pseudopapillary neoplasms (SPN) of the pancreas are rare, low-grade malignant neoplasms that metastasise to the liver or peritoneum in 10-15% of cases. They almost invariably present somatic activating mutations of CTNNB1. No comprehensive molecular characterisation of metastatic disease has been conducted to date. We performed whole-exome sequencing and copy-number variation (CNV) analysis of 10 primary SPN and comparative sequencing of five matched primary/metastatic tumour specimens by high-coverage targeted sequencing of 409 genes. In addition to CTNNB1-activating mutations, we found inactivating mutations of epigenetic regulators (KDM6A, TET1, BAP1) associated with metastatic disease. Most of these alterations were shared between primary and metastatic lesions, suggesting that they occurred before dissemination. Differently from mutations, the majority of CNVs were not shared among lesions from the same patients and affected genes involved in metabolic and pro-proliferative pathways. Immunostaining of 27 SPNs showed that loss or reduction of KDM6A and BAP1 expression was significantly enriched in metastatic SPNs. Consistent with an increased transcriptional response to hypoxia in pancreatic adenocarcinomas bearing KDM6A inactivation, we showed that mutation or reduced KDM6A expression in SPNs is associated with increased expression of the HIF1α-regulated protein GLUT1 at both primary and metastatic sites. Our results suggest that BAP1 and KDM6A function is a barrier to the development of metastasis in a subset of SPNs, which might open novel avenues for the treatment of this disease. © 2018 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.

9 Article Clinical and Pathological Features of Solid Pseudopapillary Neoplasms of the Pancreas: A Nationwide Multicenter Study in Japan. 2018

Hanada, Keiji / Kurihara, Keisuke / Itoi, Takao / Katanuma, Akio / Sasaki, Tamito / Hara, Kazuo / Nakamura, Masafumi / Kimura, Wataru / Suzuki, Yutaka / Sugiyama, Masanori / Ohike, Nobuyuki / Fukushima, Noriyoshi / Shimizu, Michio / Ishigami, Kousei / Gabata, Toshifumi / Okazaki, Kazuichi. ·Department of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima. · Department of Gastroenterology, Tokyo Medical University, Tokyo. · Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo. · Department of Gastroenterology, Hiroshima Prefectural Hospital, Hiroshima. · Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya. · Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka. · Faculty of Medicine, First Department of Surgery, Yamagata University, Yamagata. · Department of Surgery, Kyorin University School of Medicine. · Department of Pathology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa. · Department of Pathology, Jichi Medical University, Tochigi. · Diagnostic Pathology Center, Hakujikai Memorial Hospital, Tokyo. · Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka. · Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa. · Department of Gastroenterology, Kansai Medical University, Osaka, Japan. ·Pancreas · Pubmed #30059473.

ABSTRACT: OBJECTIVE: The aim of this study was to evaluate the clinicopathological features of solid pseudopapillary neoplasms (SPNs). METHODS: In this retrospective study, 288 SPNs were analyzed. RESULTS: Overall, 214 patients (74%) were female. Distant metastases occurred in 4 patients, and splenic vein tumor thrombus occurred in 1 patient. Although imaging findings showed large (>2.0 cm) SPNs with clear, regular border, and heterogeneous internal structure, small SPNs appeared as almost entirely solid. Surgical resection was performed in 278 cases. The 5-year survival rate was 98.8%. Six patients had tumor recurrence after the initial resection. The detection rate in typical pathological findings was low for small SPNs. Tumor extension to the pancreatic parenchyma was detected in greater than 70% of the cases. Tumor invasion to adjacent organs was detected in 13 cases. One was given a diagnosis of apparent high-grade malignant transformation. CONCLUSIONS: The proportion of male cases was higher than that in previous studies, and there were statistically significant differences in the onset age and tumor diameter between male and female patients. Therefore, women seemed to have an early occurrence of SPNs, suggesting a difference in the developmental stage between men and women. Images and pathological findings of SPNs varied according to tumor size. Our findings indicated that SPN patients have excellent survival after margin-negative surgical resection.

10 Article Mucinous Cystic Neoplasms Lined by Abundant Mucinous Epithelium Frequently Involve KRAS Mutations and Malignant Progression. 2017

Shibata, Hideki / Ohike, Nobuyuki / Norose, Tomoko / Isobe, Tomohide / Suzuki, Reika / Imai, Hideyuki / Shiokawa, Akira / Aoki, Takeshi / Murakami, Masahiko / Mizukami, Hiroki / Tanaka, Jun-Ichi / Takimoto, Masafumi. ·Department of Pathology, Showa University Hospital, Tokyo, Japan hshibata@med.showa-u.ac.jp. · Department of Pathology, Showa University Fujigaoka Hospital, Yokohama, Japan. · Division of General and Gastroenterological Surgery, Department of Surgery, Showa University Hospital, Tokyo, Japan. · Department of Gastroenterological Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan. · Department of Pathology, Showa University Hospital, Tokyo, Japan. ·Anticancer Res · Pubmed #29187496.

ABSTRACT: BACKGROUND: Pancreatic and hepatic mucinous cyst neoplasms (MCNs) have a malignant potential, but indolent MCNs are not uncommon. MATERIALS AND METHODS: The pathological and genetic characteristics of resected MCNs (n=15) categorized by the amount of mucin of the lining epithelium were investigated. RESULTS: MCNs were divided into two groups: (i) a rich (r)-MCN group (n=6), in which more than half of the epithelium was lined by abundant mucinous epithelium; and (ii) a poor (p)-MCN group (n=9), which consisted of the remaining cases. Three patients in the r-MCN group showed invasive carcinoma or high-grade dysplasia, whereas all patients in the p-MCN group showed low-grade dysplasia. Mutations of Kirsten rat sarcoma viral oncogene homolog (KRAS) were more frequent in the r-MCN group (83%) (p-MCN; 11%, p<0.05). CONCLUSION: Mucinous MCNs more frequently have KRAS mutations and higher risk of malignant progression.

11 Article A resected case of two branch duct-type intraductal papillary mucinous neoplasms showing different clinical courses after a two-year follow-up. 2017

Shibata, Hideki / Ohike, Nobuyuki / Norose, Tomoko / Isobe, Tomohide / Suzuki, Reika / Imai, Hideyuki / Shiokawa, Akira / Takimoto, Masafumi / Tabuchi, Akihiro / Takano, Yuichi / Yamamura, Eiichi / Nagahama, Masatsugu / Takeyama, Nobuyuki / Yokomizo, Kazuaki / Mizukami, Hiroki / Tanaka, Jun-Ichi / Aoki, Takeshi / Murakami, Masahiko. ·Department of Pathology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Kanagawa, Japan. hshibata@med.showa-u.ac.jp. · Department of Pathology, Showa University Hospital, Shinagawa, Tokyo, Japan. hshibata@med.showa-u.ac.jp. · Department of Gastroenterological and General Surgery, Showa University Hospital, Shinagawa, Tokyo, Japan. hshibata@med.showa-u.ac.jp. · Department of Pathology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Kanagawa, Japan. · Department of Pathology, Showa University Hospital, Shinagawa, Tokyo, Japan. · Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan. · Department of Radiology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan. · Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan. · Department of Gastroenterological and General Surgery, Showa University Hospital, Shinagawa, Tokyo, Japan. ·Clin J Gastroenterol · Pubmed #28258561.

ABSTRACT: The patient was a 60-year-old man without any particular complaints, but he underwent abdominal computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) due to a fatty liver, which revealed two similar cystic lesions regarded as branch duct-type intraductal papillary mucinous neoplasm (BD-IPMN) in the pancreatic body [BD-IPMN (b), 16 mm in size] and tail [BD-IPMN (t), 13 mm in size] without a "high-risk stigmata" or "worrisome features". He subsequently received follow-up by MRCP every 6 months. Two years later, MRCP showed prominent dilation of the main pancreatic duct (MPD) and mural nodule formation within the dilated MPD adjacent to the BD-IPMN (b). Distal pancreatectomy specimens revealed that the BD-IPMN (b) was lined by low-papillary gastric mucinous epithelium with low-to-intermediate-grade dysplasia and involved the MPD, forming a malignant mural nodule showing pancreatobiliary-type IPMN. In contrast, the BD-IPMN (t) was lined by flat, monolayer columnar gastric mucinous epithelium without atypia, which suggested the possibility of a "simple mucinous cyst". A genetic analysis showed KRAS mutation only in BD-IPMN (b). Differences in the histological and genetic findings between two similar BD-IPMNs in the present case may suggest what kinds of examinations should be performed in patients with BD-IPMNs without any worrisome features.

12 Article Ampullary carcinoma is often of mixed or hybrid histologic type: an analysis of reproducibility and clinical relevance of classification as pancreatobiliary versus intestinal in 232 cases. 2016

Reid, Michelle D / Balci, Serdar / Ohike, Nobuyuki / Xue, Yue / Kim, Grace E / Tajiri, Takuma / Memis, Bahar / Coban, Ipek / Dolgun, Anil / Krasinskas, Alyssa M / Basturk, Olca / Kooby, David A / Sarmiento, Juan M / Maithel, Shishir K / El-Rayes, Bassel F / Adsay, Volkan. ·Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA. · Department of Pathology, Showa University Fujigaoka Hospital, Yokohama, Japan. · Department of Pathology, University of California, San Francisco, San Francisco, CA, USA. · Department of Pathology, Tokai University Hachioji Hospital, Tokyo, Japan. · Department of Pathology, Istanbul Bilim University, Florence Nightingale Hospital, Istanbul, Turkey. · Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey. · Department of Pathology, Wayne State University, Detroit, MI, USA. · Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. · Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA. ·Mod Pathol · Pubmed #27586202.

ABSTRACT: Histologic classification of ampullary carcinomas as intestinal versus pancreatobiliary is rapidly becoming a part of management algorithms, with immunohistochemical classification schemes also being devised using this classification scheme as their basis. However, data on the reproducibility and prognostic relevance of this classification system are limited. In this study, five observers independently evaluated 232 resected ampullary carcinomas with invasive component >3 mm. Overall interobserver agreement was 'fair' (κ 0.39; P<0.001) with complete agreement in 23%. Using agreement by 3/5 observers as 'consensus' 40% of cases were classified as 'mixed' pancreatobiliary and intestinal. When observers were asked to provide a final diagnosis based on the predominant pattern in cases initially classified as mixed, there was 'moderate' agreement (κ 0.44; P<0.0001) with 5/5 agreeing in 35%. Cases classified as pancreatobiliary by consensus (including those with pure-pancreatobiliary or mixed-predominantly pancreatobiliary features) had shorter overall (median 41 months) and 5-year survival (38%) than those classified as pure-intestinal/mixed-predominantly intestinal (80 months and 57%, respectively; P=0.026); however, on multivariate analysis this was not independent of established prognostic parameters. Interestingly, when compared with 476 cases of pancreatic ductal adenocarcinomas, the pancreatobiliary-type ampullary carcinomas had better survival (16 versus 41 months, P<0.001), even when matched by size and node status. In conclusion, presumably because of the various cell types comprising the region, ampullary carcinomas frequently show mixed phenotypes and intratumoral heterogeneity, which should be considered when devising management protocols. Caution is especially warranted when applying this histologic classification to biopsies and tissue microarrays. While ampullary carcinomas with more pancreatobiliary morphology have a worse prognosis than intestinal ones this does not appear to be an independent prognostic factor. However, pancreatobiliary-type ampullary carcinomas have a much better prognosis than their pancreatic counterparts.

13 Article Intrapancreatic distal common bile duct carcinoma: Analysis, staging considerations, and comparison with pancreatic ductal and ampullary adenocarcinomas. 2016

Gonzalez, Raul S / Bagci, Pelin / Basturk, Olca / Reid, Michelle D / Balci, Serdar / Knight, Jessica H / Kong, So Yeon / Memis, Bahar / Jang, Kee-Taek / Ohike, Nobuyuki / Tajiri, Takuma / Bandyopadhyay, Sudeshna / Krasinskas, Alyssa M / Kim, Grace E / Cheng, Jeanette D / Adsay, N Volkan. ·Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA. · Department of Pathology, Marmara University, Istanbul, Turkey. · Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. · Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA. · Department of Epidemiology, Emory University, Atlanta, GA, USA. · Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. · Department of Pathology, Showa University School of Medicine, Tokyo, Japan. · Department of Pathology, Tokai University Hachiouji Hospital, Tokyo, Japan. · Department of Pathology, Wayne State University, Detroit, MI, USA. · Department of Pathology, University of California, San Francisco, San Francisco, CA, USA. · Department of Pathology, Piedmont Hospital, Atlanta, GA, USA. ·Mod Pathol · Pubmed #27469329.

ABSTRACT: Distal common bile duct carcinoma is a poorly characterized entity for reasons such as variable terminology and difficulty in determining site of origin of intrapancreatic lesions. We compared clinicopathologic features of pancreatobiliary-type adenocarcinomas within the pancreas, but arising from the distal common bile duct, with those of pancreatic and ampullary origin. Upon careful review of 1017 pancreatoduodenectomy specimens with primary adenocarcinoma, 52 (5%) qualified as intrapancreatic distal common bile duct carcinoma. Five associated with an intraductal papillary neoplasm were excluded; the remaining 47 were compared to 109 pancreatic ductal adenocarcinomas and 133 ampullary carcinomas. Distal common bile duct carcinoma patients had a younger median age (58 years) than pancreatic ductal adenocarcinoma patients (65 years) and ampullary carcinoma patients (68 years). Distal common bile duct carcinoma was intermediate between pancreatic ductal adenocarcinoma and ampullary carcinoma with regard to tumor size and rates of node metastases and margin positivity. Median survival was better than for pancreatic ductal adenocarcinoma (P=0.0010) but worse than for ampullary carcinoma (P=0.0006). Distal common bile duct carcinoma often formed an even band around the common bile duct and commonly showed intraglandular neutrophil-rich debris and a small tubular pattern. Poor prognostic indicators included node metastasis (P=0.0010), lymphovascular invasion (P=0.0299), and margin positivity (P=0.0069). Categorizing the tumors based on size also had prognostic relevance (P=0.0096), unlike categorization based on anatomic structures invaded. Primary distal common bile duct carcinoma is seen in younger patients than pancreatic ductal adenocarcinoma or ampullary carcinoma. Its prognosis is significantly better than pancreatic ductal adenocarcinoma and worse than ampullary carcinoma, at least partly because of differences in clinical presentation. Use of size-based criteria for staging appears to improve its prognostic relevance. Invasive pancreatobiliary-type distal common bile duct carcinomas are uncommon in the West and have substantial clinicopathologic differences from carcinomas arising from the pancreas and ampulla.

14 Article [The clinico-pathological character of pancreatic adenosquamous carcinoma]. 2015

Ohkawa, Shinichi / Ohike, Nobuyuki. · ·Nihon Rinsho · Pubmed #25857012.

ABSTRACT: -- No abstract --

15 Article Substaging Nodal Status in Ampullary Carcinomas has Significant Prognostic Value: Proposed Revised Staging Based on an Analysis of 313 Well-Characterized Cases. 2015

Balci, Serdar / Basturk, Olca / Saka, Burcu / Bagci, Pelin / Postlewait, Lauren M / Tajiri, Takuma / Jang, Kee-Taek / Ohike, Nobuyuki / Kim, Grace E / Krasinskas, Alyssa / Choi, Hyejeong / Sarmiento, Juan M / Kooby, David A / El-Rayes, Bassel F / Knight, Jessica H / Goodman, Michael / Akkas, Gizem / Reid, Michelle D / Maithel, Shishir K / Adsay, Volkan. ·Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA. · Department of Pathology, New York University, New York, NY, USA. · Department of Pathology, İstanbul Medipol University, İstanbul, Turkey. · Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, GA, USA. · Department of Pathology, Tokai University Hachiouji Hospital, Tokyo, Japan. · Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. · Department of Pathology, Showa University Fujigaoka Hospital, Tokyo, Japan. · Department of Pathology, University of California San Francisco, San Francisco, CA, USA. · Division of General and Gastrointstinal Surgery, Emory University, Atlanta, GA, USA. · Department of Oncology, Emory University, Atlanta, GA, USA. · Department of Epidemiology, Emory University, Atlanta, GA, USA. · Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA. volkan.adsay@emory.edu. ·Ann Surg Oncol · Pubmed #25783680.

ABSTRACT: BACKGROUND: Current nodal staging (N-staging) of ampullary carcinoma in the TNM staging system distinguishes between node-negative (N0) and node-positive (N1) disease but does not consider the metastatic lymph node (LN) number. METHODS: Overall, 313 patients who underwent pancreatoduodenectomy for ampullary adenocarcinoma were categorized as N0, N1 (1-2 metastatic LNs), or N2 (≥3 metastatic LNs), as proposed by Kang et al. Clinicopathological features and overall survival (OS) of the three groups were compared. RESULTS: The median number of LNs examined was 11, and LN metastasis was present in 142 cases (45 %). When LN-positive cases were re-classified according to the proposed staging system, 82 were N1 (26 %) and 60 were N2 (19 %). There was a significant correlation between proposed N-stage and lymphovascular invasion, perineural invasion, increased tumor size (each p < 0.001), and surgical margin positivity (p = 0.001). The median OS in LN-negative cases was significantly longer than that in LN-positive cases (107.5 vs. 32 months; p < 0.001). Patients with N1 and N2 disease had median survivals of 40 and 24.5 months, respectively (p < 0.0001). In addition, 1-, 3-, and 5-year survivals were 88, 76, 62 %, respectively, for N0; 90, 55, 31.5 %, respectively, for N1; and 68, 34, 30 %, respectively for N2 (p < 0.001). Even with multivariate modeling, the association between higher proposed N stage and shorter survival persisted (hazard ratio 1.6 for N1 and 1.9 for N2; p = 0.018). CONCLUSIONS: Classification of nodal status in ampullary carcinomas based on the number of metastatic LNs has a significant prognostic value. A revised N-staging classification system should be incorporated into the TNM staging of ampullary cancers.

16 Article Whole exome sequencing reveals recurrent mutations in BRCA2 and FAT genes in acinar cell carcinomas of the pancreas. 2015

Furukawa, Toru / Sakamoto, Hitomi / Takeuchi, Shoko / Ameri, Mitra / Kuboki, Yuko / Yamamoto, Toshiyuki / Hatori, Takashi / Yamamoto, Masakazu / Sugiyama, Masanori / Ohike, Nobuyuki / Yamaguchi, Hiroshi / Shimizu, Michio / Shibata, Noriyuki / Shimizu, Kyoko / Shiratori, Keiko. ·1] Institute for Integrated Medical Sciences, Tokyo Women's Medical University, Tokyo, Japan [2] Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan. · 1] Institute for Integrated Medical Sciences, Tokyo Women's Medical University, Tokyo, Japan [2] Department of Surgery, Kyorin University School of Medicine, Mitaka, Japan. · Institute for Integrated Medical Sciences, Tokyo Women's Medical University, Tokyo, Japan. · 1] Institute for Integrated Medical Sciences, Tokyo Women's Medical University, Tokyo, Japan [2] Department of Gastroenterology, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. · Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. · Department of Surgery, Kyorin University School of Medicine, Mitaka, Japan. · Department of Pathology, Showa University School of Medicine, Tokyo, Japan. · Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Japan. · Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan. · Department of Gastroenterology, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. ·Sci Rep · Pubmed #25743105.

ABSTRACT: Acinar cell carcinoma of the pancreas is a rare tumor with a poor prognosis. Compared to pancreatic ductal adenocarcinoma, its molecular features are poorly known. We studied a total of 11 acinar cell carcinomas, including 3 by exome and 4 by target sequencing. Exome sequencing revealed 65 nonsynonymous mutations and 22 indels with a mutation rate of 3.4 mutations/Mb per tumor, on average. By accounting for not only somatic but also germline mutations with loss of the wild-type allele, we identified recurrent mutations of BRCA2 and FAT genes. BRCA2 showed somatic or germline premature termination mutations, with loss of the wild-type allele in 3 of 7 tumors. FAT1, FAT3, and FAT4 showed somatic or germline missense mutations in 4 of 7 tumors. The germline FAT mutations were with loss of the wild-type allele. Loss of BRCA2 expression was observed in 5 of 11 tumors. One patient with a BRCA2-mutated tumor experienced complete remission of liver metastasis following cisplatinum chemotherapy. In conclusion, acinar cell carcinomas show a distinct mutation pattern and often harbor somatic or germline mutations of BRCA2 and FAT genes. This result may warrant assessment of BRCA2 abrogation in patients with the carcinoma to determine their sensitivity to chemotherapy.

17 Article Calculation of the Ki67 index in pancreatic neuroendocrine tumors: a comparative analysis of four counting methodologies. 2015

Reid, Michelle D / Bagci, Pelin / Ohike, Nobuyuki / Saka, Burcu / Erbarut Seven, Ipek / Dursun, Nevra / Balci, Serdar / Gucer, Hasan / Jang, Kee-Taek / Tajiri, Takuma / Basturk, Olca / Kong, So Yeon / Goodman, Michael / Akkas, Gizem / Adsay, Volkan. ·Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA. · Department of Pathology, Marmara University, Istanbul, Turkey. · Department of Pathology, Showa University School of Medicine, Tokyo, Japan. · Department of Pathology, Medipol University, Istanbul, Turkey. · Department of Pathology, Istanbul Education and Training Hospital, Istanbul, Turkey. · Department of Pathology, Yildirim Beyazit University, Ankara, Turkey. · Department of Pathology, RTE University, Rize, Turkey. · Department of Pathology, Samsung Medical Center, Seoul, Korea. · Department of Pathology, Tokai University Hachiouji Hospital, Tokyo, Japan. · Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. · Department of Pathology, Department of Epidemiology, Emory University, Atlanta, GA, USA. ·Mod Pathol · Pubmed #25412850.

ABSTRACT: Ki67 index is now an essential part of classification of pancreatic neuroendocrine tumors. However, its adaptation into daily practice has been fraught with challenges related to counting methodology. In this study, three reviewers used four counting methodologies to calculate Ki67 index in 68 well-differentiated pancreatic neuroendocrine tumors: (1) 'eye-ball' estimation, which has been advocated as reliable and is widely used; (2) automated counting by image analyzer; (3) manual eye-counting (eye under a microscope without a grid); and (4) manual count of camera-captured/printed image. Pearson's correlation (R) was used to measure pair-wise correlation among three reviewers using all four methodologies. Average level of agreement was calculated using mean of R values. The results showed that: (1) 'eye-balling' was least expensive and fastest (average time <1 min) but had poor reliability and reproducibility. (2) Automated count was the most expensive and least practical with major impact on turnaround time (limited by machine and personnel accessibility), and, more importantly, had inaccuracies in overcounting unwanted material. (3) Manual eye count had no additional cost, averaged 6 min, but proved impractical and poorly reproducible. (4) Camera-captured/printed image was most reliable, had highest reproducibility, but took longer than 'eye-balling'. In conclusion, based on its comparatively low cost/benefit ratio and reproducibility, camera-captured/printed image appears to be the most practical for calculating Ki67 index. Although automated counting is generally advertised as the gold standard for index calculation, in this study it was not as accurate or cost-effective as camera-captured/printed image and was highly operator-dependent. 'Eye-balling' produces highly inaccurate and unreliable results, and is not recommended for routine use.

18 Article Diagnostic challenge: intraductal neoplasms of the pancreatobiliary system. 2012

Tajiri, Takuma / Tate, Genshu / Matsumoto, Koshi / Hoshino, Hiroki / Iwamura, Taro / Kodaira, Yuzo / Takahashi, Ken / Ohike, Nobuyuki / Kunimura, Toshiaki / Mitsuya, Toshiyuki / Morohoshi, Toshio. ·Department of Diagnostic Pathology, Showa University Fujigaoka Hospital, Yokohama, Japan; Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo, Japan. takumatajiri1003@yahoo.co.jp ·Pathol Res Pract · Pubmed #23057996.

ABSTRACT: To help pathologists avoid misdiagnosis of intraductal neoplasms arising from the pancreatobiliary system, we report two cases that illustrate diagnostic pitfalls. The first is of a 66-year-old man who complained of appetite loss. An early examination led to a diagnosis of intraductal papillary mucinous neoplasm. Macroscopically, a multilocular cyst without visible mucin was identified. Histologically, the compartments consisted of complex fusion of tubular glands surrounded by dilated pancreatic duct. The neoplasm resembled an acinar cell cystadenocarcinoma. However, the neoplastic cells were negative for trypsin. Thus, the final histopathologic diagnosis was an unusual cystic variant of intraductal tubulopapillary neoplasm (ITPN) of the pancreas. The second case is of a 71-year-old man who complained of right upper quadrant pain. Although bile duct stone was suspected, a polypoid nodule was extracted. Histologically, the nodule was composed of tubular glands, with some complex fusion and focal dysplasia, consistent with carcinoma. In addition, lack of MUC-5AC expression led to an initial impression of ITPN of the bile duct. However, the neoplasm showed dysplastic cells based on the columnar cells resembling pyloric glands, indicating the sequential progression. Thus, the final histopathological diagnosis was intraductal papillary neoplasm of the bile duct with high-grade intraepithelial neoplasia. Because phenotypic variants of intraductal neoplasms of the pancreatobiliary system exist, ITPN and ITPN-mimicking tumor must be carefully differentiated from other intraductal neoplasms.

19 Article Ampullary region carcinomas: definition and site specific classification with delineation of four clinicopathologically and prognostically distinct subsets in an analysis of 249 cases. 2012

Adsay, Volkan / Ohike, Nobuyuki / Tajiri, Takuma / Kim, Grace E / Krasinskas, Alyssa / Balci, Serdar / Bagci, Pelin / Basturk, Olca / Bandyopadhyay, Sudeshna / Jang, Kee-Taek / Kooby, David A / Maithel, Shishir K / Sarmiento, Juan / Staley, Charles A / Gonzalez, Raul S / Kong, So Yeon / Goodman, Michael. ·Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322, USA. volkan.adsay@emory.edu ·Am J Surg Pathol · Pubmed #23026934.

ABSTRACT: Ampullary (AMP) carcinomas comprise a heterogeneous group of cancers lacking adequate subcategorization. In the present study, 249 strictly defined primary AMP carcinomas (ACs) identified in 1469 malignant pancreatoduodenectomy specimens were analyzed for defining features. Gross and microscopic findings were used to determine tumor epicenter and extent of preinvasive component. ACs were classified into 4 distinct subtypes based on location: (1) Intra-AMP (25%): Invasive carcinomas arising in intra-ampullary papillary-tubular neoplasms with zero to minimal, duodenal surface involvement (<25% of the tumor). These tumors were more commonly found in men, they had a relatively large overall size (mean, 2.9 cm) but had smaller invasive component (mean, 1.5 cm), and were predominantly of a lower TNM stage (85%, T1/2; and 72% N0). They carried the best prognosis among the 4 groups (3-y survival, 73%). (2) AMP-ductal (15%): These were tumors forming constrictive, sclerotic, plaque-like thickening of the walls of the common bile duct and/or pancreatic duct resulting in mucosa-covered, button-like elevations of the papilla into the duodenal lumen. There was no significant exophytic (preinvasive) growth. These were the smallest tumors (mean overall size, 1.9 cm; mean invasion size 1.7 cm), but carried the worst prognosis (3-y survival, 41%), presumably due to the pancreatobiliary histology/origin (in 86%); however, even this group had significantly better prognosis when compared with 113 ordinary pancreatic ductal adenocarcinomas (3 y, 11%; P<0.0001). (3) Peri-AMP-duodenal (5%): Massive exophytic, ulcero-fungating tumors growing into the duodenal lumen and eccentrically encasing the ampullary orifice with only minimal intra-ampullary luminal involvement. These were mostly of intestinal phenotype (75%) and some had mucinous features. Although these tumors were the largest (mean overall size 4.7 cm; and mean invasion size 3.4 cm), and had the highest incidence of lymph node metastasis (50%), they carried an intermediate prognosis (3-y survival, 69%) to that seen among a group of 55 nonampullary duodenal carcinoma controls. (4) AC-not otherwise specified ("papilla of Vater"; 55%): Ulcero-nodular tumors located at the papilla of Vater, which do not show the specific characteristics identified among the other 3 subtypes. In conclusion, ACs comprise 4 clinicopathologic subtypes that are prognostically distinct.

20 Article Gastric- and intestinal-type marker expression in invasive ductal adenocarcinoma of the pancreas. 2012

Takano, Yuichi / Ohike, Nobuyuki / Tajiri, Takuma / Asonuma, Kunio / Harada, Kenji / Takahashi, Hiroshi / Morohoshi, Toshio. ·First Department of Pathology, Showa University School of Medicine, Tokyo 142-8555, Japan. yuichitakano1028@yahoo.co.jp ·Hepatobiliary Pancreat Dis Int · Pubmed #22893471.

ABSTRACT: BACKGROUND: Although invasive ductal adenocarcinoma of the pancreas (PDAC) manifests as a relatively uniform histomorphological feature of the pancreatobiliary type, it may be complicated by metaplastic changes and heterogeneous gastric and intestinal elements. This study aimed to investigate the complication rate and clinicopathological significance of such heterogeneous elements. METHODS: Fifty-nine patients who underwent resection of PDAC were examined in this study. Immunohistochemically, tumors showing high expression (>25%) of the intestinal-type (INT) marker CDX2 were classified as PDAC with INT. Those with high expression (>25%) of the gastric-type (GAS) marker MUC5AC were classified as PDAC with GAS, while those with high expression of both markers were classified as PDAC with INT/GAS. These patients were compared with those with PDAC of the negative group in which neither markers was highly expressed to examine their clinicopathological significance. RESULTS: In the 59 patients, 31 (52.5%) showed high CDX2 or MUC5AC expression. Twenty-eight patients (47.5%) belonged to a negative group, 11 (18.6%) to a PDAC with INT group, 15 (25.4%) to a PDAC with GAS group, and 5 (8.5%) to a PDAC with INT/GAS group. No significant differences were observed for age, gender, size, localization, T classification, or prognosis among the four groups. Although the PDAC with GAS group had well differentiated types significantly more than the other groups, the rate of lymph node metastasis in this group was significantly higher (PDAC with GAS: 73%; other groups: 36%). CONCLUSION: Complications with heterogeneous elements are not uncommon in PDAC, and this should be considered during the diagnosis and treatment of PDAC along with histogenesis of the disease.

21 Article Multicenter study of serous cystic neoplasm of the Japan pancreas society. 2012

Kimura, Wataru / Moriya, Toshiyuki / Hirai, Ichiro / Hanada, Keiji / Abe, Hideki / Yanagisawa, Akio / Fukushima, Noriyoshi / Ohike, Nobuyuki / Shimizu, Michio / Hatori, Takashi / Fujita, Naotaka / Maguchi, Hiroyuki / Shimizu, Yasuhiro / Yamao, Kenji / Sasaki, Tamito / Naito, Yoshiki / Tanno, Satoshi / Tobita, Kosuke / Tanaka, Masao. ·First Department of Surgery (Gastroenterological, General, Breast and Thyroid Surgery), Yamagata University Faculty of Medicine, Yamagata, Japan. wkimura@med.id.yamagata-u.ac.jp ·Pancreas · Pubmed #22415666.

ABSTRACT: OBJECTIVES: There have been only a few reports on follow-up results of serous cystic neoplasm (SCN) of the pancreas. The frequency of malignancy and surgical indication of SCN are not determined yet. METHODS: In this multi-institutional study of the Japan Pancreas Society, a total of 172 patients with SCN were enrolled. The mean follow-up period was 4.5 years. Surgical resection was performed in 90 patients, whereas the remaining 82 were simply observed. RESULTS: Of all patients, 20% were symptomatic. The tumor was located in the pancreatic head (39%), body (35%), and tail (22%). The mean diameter of the tumor was 4.1 cm. None of the patients showed distant or lymph node metastasis except for liver metastasis found in 2 patients (1.2%). No patient died during the follow-up. The preoperative diagnosis did not correctly identify SCN in 57 (63%) of 90 resected cases. A honeycomb appearance, which is one of the most characteristic findings of SCN, could be diagnosed better by endoscopic ultrasonography than by other imaging diagnostic modalities. CONCLUSIONS: Surgical resection should be considered only when clear distinction from other surgical diseases is difficult, when symptoms or mass effects are present, and when the tumor size is large.

22 Article Prognostic relevance of morphological types of intraductal papillary mucinous neoplasms of the pancreas. 2011

Furukawa, Toru / Hatori, Takashi / Fujita, Izumi / Yamamoto, Masakazu / Kobayashi, Makio / Ohike, Nobuyuki / Morohoshi, Toshio / Egawa, Shinichi / Unno, Michiaki / Takao, Sonshin / Osako, Masahiko / Yonezawa, Suguru / Mino-Kenudson, Mari / Lauwers, Gregory Y / Yamaguchi, Hiroshi / Ban, Shinichi / Shimizu, Michio. ·Institute for Integrated Medical Sciences, Tokyo Women's Medical University 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. toru.furukawa@twmu.ac.jp ·Gut · Pubmed #21193453.

ABSTRACT: OBJECTIVE: The clinicopathological significance of four morphological types of intraductal papillary mucinous neoplasms of the pancreas (IPMNs; gastric, intestinal, pancreatobiliary and oncocytic) was assessed. DESIGN: Retrospective multicentre analysis of 283 surgically resected IPMNs. RESULTS: Of the 283 IPMNs, 139 were of the gastric type, 101 were intestinal, 19 were pancreatobiliary and 24 were oncocytic. These types were significantly associated with clinicopathological factors including sex (p = 0.0032), age (p = 0.00924), ectatic duct size (p = 0.0245), detection of mural nodules (p = 4.09 × 10⁻⁶), histological grade (p < 2.20 × 10⁻¹⁶), macroscopic types with differential involvement of the pancreatic duct system (p = 3.91 × 10⁻⁵), invasive phenotypes (p = 3.34 × 10⁻¹²), stage (p < 2.20 × 10⁻¹⁶) and recurrence (p = 0.00574). Kaplan-Meier analysis showed significant differences in patient survival by morphological type (p = 5.24 × 10⁻⁶). Survival rates at 5 and 10 years, respectively, were 0.937 (95% CI 0.892 to 0.984) for patients with gastric-type IPMNs; 0.886 (95% CI 0.813 to 0.965) and 0.685 (95% CI 0.553 to 0.849) for those with intestinal-type IPMNs; 0.839 (95% CI 0.684 to 1.000) and 0.734 (95% CI 0.526 to 1.000) for those with oncocytic-type IPMNs; and 0.520 (95% CI 0.298 to 0.909) and undetermined for those with pancreatobiliary-type IPMNs. Analysis by the Cox proportional hazards model comparing prognostic risks determined by stage and the morphological and macroscopic types indicated that staging was the most significant predictor of survival (p = 3.68×10⁻⁸) followed by the morphological type (p = 0.0435). Furthermore, the morphological type remained a significant predictor in a subcohort of invasive cases (p = 0.0089). CONCLUSION: In this multicentre retrospective analysis, the morphological type of IPMN appears to be an independent predictor of patient prognosis.

23 Article Clinicopathological features and prognosis of mucinous cystic neoplasm with ovarian-type stroma: a multi-institutional study of the Japan pancreas society. 2011

Yamao, Kenji / Yanagisawa, Akio / Takahashi, Kuniyuki / Kimura, Wataru / Doi, Ryuichiro / Fukushima, Noriyoshi / Ohike, Nobuyuki / Shimizu, Michio / Hatori, Takashi / Nobukawa, Bunsei / Hifumi, Michio / Kobayashi, Yuji / Tobita, Kosuke / Tanno, Satoshi / Sugiyama, Masanori / Miyasaka, Yoshihiro / Nakagohri, Toshio / Yamaguchi, Taketo / Hanada, Keiji / Abe, Hideki / Tada, Minoru / Fujita, Naotaka / Tanaka, Masao. ·Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan. kyamao@aichi-cc.jp ·Pancreas · Pubmed #20924309.

ABSTRACT: OBJECTIVE: The aim of this study was to elucidate the clinicopathological features and prognosis of mucinous cystic neoplasms (MCNs). MATERIALS AND METHODS: We performed a multi-institutional, retrospective study on a collected series of patients with MCN pathologically defined by ovarian-type stroma. Clinicopathological features and prognosis were investigated. RESULT: Mucinous cystic neoplasm was confirmed in 156 cases, including 129 adenomas (82.7%) and 21 noninvasive (13.4%) and 6 invasive carcinomas (3.9%). Patients with MCN were exclusively women (98.1%) with the mean age of 48.1 years. All but 1 MCN were in the pancreatic body/tail region with a mean size of 65.3 mm. Communication between the cyst and the pancreatic duct was found in 18.1%. The 3-, 5-, and 10-year survival rates were 97.6%, 96.6%, and 96.6%, respectively. A significant difference in the survival rates was observed between adenomas and carcinomas and between minimally invasive carcinomas and invasive carcinomas. Cyst diameter and presence of mural nodule were predictive of malignant MCN. CONCLUSIONS: Mucinous cystic neoplasm is a rare but distinctive pancreatic cystic neoplasm with a favorable overall prognosis. All MCNs should be resected to prevent malignant changes but can be observed for an appropriate time when the lesion is small without the presence of mural nodules.

24 Article Mixed acinar-endocrine carcinoma of the pancreas with intraductal growth into the main pancreatic duct: Report of a case. 2010

Kobayashi, Shinjiro / Asakura, Takeshi / Ohike, Nobuyuki / Enomoto, Takeharu / Sakurai, Joe / Koizumi, Satoshi / Watanabe, Taiji / Nakano, Hiroshi / Otsubo, Takehito. ·Division of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan. ·Surg Today · Pubmed #20339996.

ABSTRACT: The patient was a 75-year-old asymptomatic man, in whom a tumor mass in the pancreatic tail had been found 6 months earlier. Computed tomography revealed a mass 7 cm in diameter, and an enhancement with contrast medium was observed at the periphery and partially inside the mass, but not in most parts of the tumor. Endoscopic retrograde cholangiopancreatography showed a filling defect in the main pancreatic duct. A distal pancreatectomy was performed because of the possibility of a malignant tumor. The tumor consisted of a lobular invasive growth component and a component with intraductal growth into the main pancreatic duct, and histologically the tumor cells had solid acinar to partially trabecular/tubular patterns. Trypsin (an acinic cell marker) expression was widely observed, followed by the expression of chromogranin A (an endocrine cell marker) in about 30% of the tumor cells. The tumor was diagnosed as mixed acinar-endocrine carcinoma according to the WHO classification.

25 Article Intraductal oncocytic papillary carcinoma of the pancreas showing numerous hyaline globules in the lumen. 2010

Tajiri, Takuma / Inagaki, Tomoko / Ohike, Nobuyuki / Omatsu, Mutsuko / Kasugai, Hisashi / Kunimura, Toshiaki / Shiokawa, Akira / Mitsuya, Toshiyuki / Morohoshi, Toshio. ·Department of Diagnostic Pathology, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan. takumatajiri1003@yahoo.co.jp ·Pathol Int · Pubmed #20055952.

ABSTRACT: Two cases of intraductal oncocytic papillary carcinoma (IOPC) treated surgically were analyzed on light microscopy and immunohistochemistry: that of a 61-year-old man and that of a 55-year-old man. There were no clinical symptoms in either case. Pancreatic abnormalities were discovered incidentally on CT. Various clinical examinations were carried out, and the preoperative diagnosis was intraductal papillary mucinous carcinoma (IPMC) in both cases. Surgery was performed. Macroscopic observation of tissue cross-sections indicated multilocular cystic mass containing polypoid lesions encapsulated by the dilated pancreatic duct. Histologically, the cyst walls were lined by columnar epithelial cells with complex papillary projections associated with oxyphilic cytoplasm, and they were strongly immunoreactive with anti-mitochondrial antibody in the cytoplasm. Electron microscopy showed numerous mitochondria in the cytoplasm. IOPC was diagnosed. Interestingly, amorphous hyaline globules were produced from the oxyphilic cells, which exhibited a bud-like appearance. The hyaline globules were not positive for mucin staining. No case of IPMC with hyaline globules has been reported to date. The production of hyaline globules may be related to oncocytic differentiation. It is suggested that hyaline globules should be regarded as a characteristic of IOPC.