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Pancreatic Neoplasms: HELP
Articles by Takuma Tajiri
Based on 20 articles published since 2010
(Why 20 articles?)
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Between 2010 and 2020, Takuma Tajiri wrote the following 20 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 / Anonymous6190823. ·*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 Do Solid Pseudopapillary Neoplasms Shrink After Menopause?: Review of the Literature. 2015

Kurokawa, Sachiko / Hirabayashi, Kenichi / Hadano, Atsuko / Yamada, Misuzu / Tajiri, Takuma / Nakamura, Naoya. ·Department of Pathology Tokai University School of Medicine Kanagawa, Japan khira@is.icc.u-tokai.ac.jp Department of Gastroenterology Tokai University School of Medicine Kanagawa, Japan Department of Surgery Tokai University School of Medicine Kanagawa, Japan Department of Pathology Tokai University Hachioji Hospital Tokyo, Japan Department of Pathology Tokai University School of Medicine Kanagawa, Japan. ·Pancreas · Pubmed #26166473.

ABSTRACT: -- No abstract --

3 Review Intraductal tubulopapillary neoplasms of the pancreas: case report and review of the literature. 2013

Kasugai, Hisashi / Tajiri, Takuma / Takehara, Yusuke / Mukai, Shumpei / Tanaka, Jun-ichi / Kudo, Shin-ei. ·Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan. his-me@med.showa-u.ac.jp ·J Nippon Med Sch · Pubmed #23832407.

ABSTRACT: A 69-year-old woman was referred to our hospital after incidental identification of a pancreatic mass during follow-up for diabetes mellitus. Various imaging examinations showed a tumor in the main pancreatic duct, without apparent hypersecretion of mucin. Brush cytologic examination revealed class V disease (adenocarcinoma). Because preoperative examination suggested an intraductal neoplasm with associated invasive cancer, total pancreatectomy was performed. Histological examination, based on current World Health Organization classifications, suggested a diagnosis of intraductal tubulopapillary neoplasm. A small cystic lesion adjacent to the intraductal tubulopapillary neoplasm was incidentally diagnosed as serous cystadenoma. The patient has remained well without recurrence as of 24 months postoperatively. Computed tomography and magnetic resonance imaging of the intraductal tubulopapillary neoplasm suggested ductal cell carcinoma of the pancreas rather than intraductal papillary mucinous neoplasm. Distinguishing intraductal tubulopapillary neoplasm from ductal cell carcinoma is clinically important, as intraductal tubulopapillary neoplasm has a favorable prognosis after curative resection.

4 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.

5 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.

6 Article A case of high-grade pancreatic intraepithelial neoplasia concomitant with type 1 autoimmune pancreatitis: The process underlying both conditions. 2019

Sugiyama, Tomoko / Tajiri, Takuma / Hiraiwa, Shinichiro / Machida, Tomohisa / Ito, Hiroyuki / Yoshii, Hisanori / Izumi, Hideki / Nomura, Eiji / Mukai, Masaya / Nakamura, Naoya. ·Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo, Japan. · Department of Laboratory Medicine, Tokai University Hachioji Hospital, Tokyo, Japan. · Department of Gastroenterology, Tokai University Hachioji Hospital, Tokyo, Japan. · Department of Gastroenterologic Surgery, Tokai University Hachioji Hospital, Tokyo, Japan. · Department of Pathology, Tokai University School of Medicine, Isehara, Japan. ·Pathol Int · Pubmed #30719801.

ABSTRACT: We report a case of high-grade pancreatic intraepithelial neoplasia (PanIN) concomitant with lymphoplasmacytic sclerosing pancreatitis. The patient was an 82-year-old man in whom narrowing of the main pancreatic duct was detected incidentally by abdominal ultrasonography. Magnetic resonance cholangiopancreatography further revealed abrupt narrowing plus distal dilatation of the duct, from the pancreatic body to the tail. Distal pancreatectomy was performed under a preoperative diagnosis of intraductal papillary-mucinous neoplasm. Macroscopic examination of the surgical specimen showed an ill-demarcated, white-gray area and prominent pancreatic atrophy, while histological analysis detected small (<5 mm in diameter) cystic dilatations of the main pancreatic duct and some branch ducts plus pancreatic atrophy with fibrosis and fatty replacement of acinar cells. We also detected variously sized papillary projections, fused glands, and scattered focal papillary proliferation of columnar ductal epithelium comprising cells with elongated, mildly hyperchromatic nuclei, consistent with high-grade PanIN. In addition, we observed marked lymphoplasmacytic infiltration, periductal storiform fibrosis, and obliterative phlebitis. Immunohistochemical staining revealed abundant immunogloblin G4-positive plasma cells, indicative of type 1 autoimmune pancreatitis (AIP). The coexistence of high-grade PanIN and marked lymphoplasmacytic infiltration, typical of AIP, point to a close association between the former, as a carcinogenic process, and the latter, as an immune response.

7 Article An autopsy case of primary extranodal NK/T cell lymphoma (extranodal NK/T-cell lymphoma) of the bile duct. 2019

Ito, Hiroyuki / Hiraiwa, Shin-Ichiro / Sugiyama, Tomoko / Tajiri, Takuma / Yamaji, Yoko / Kaneko, Motoki / Tsuda, Shingo / Ichikawa, Hitoshi / Nagata, Junko / Kojima, Seiichiro / Takashimizu, Shinji / Shirai, Takayuki / Watanabe, Norihito. ·Department of Gastroenterology, Tokai University Hachioji Hospital, Tokyo, Japan. hito@is.icc.u-tokai.ac.jp. · Department of Pathology, Tokai University Hachioji Hospital, Tokyo, Japan. · Department of Gastroenterology, Tokai University Hachioji Hospital, Tokyo, Japan. ·Clin J Gastroenterol · Pubmed #30603836.

ABSTRACT: We reported the case of a 50-year-old man diagnosed with extrinsic NK/T-cell lymphoma. He was initially diagnosed with locally advanced unresected pancreatic duct carcinoma and was treated with combination chemotherapy using gemcitabine and nabpaclitaxel. One month after treatment, he developed bleeding. Upper gastrointestinal endoscopy showed a deep ulcer lesion from the duodenal bulb to the inner wall of the descending section that was not observed before treatment. Coil embolization was performed, but the necrotic area widened after treatment; the patient died of disseminated intravascular coagulation after 1 week. Autopsy showed a soft white-tone lesion that extended from the ulcer wall to the gallbladder wall and around the intrahepatic bile duct. Lesions were also found in the spleen, lungs, kidney, and bone marrow, and immunohistochemistry confirmed extrinsic NK/T-cell lymphoma (extranodal NK/T-cell lymphoma, nasal type). In conclusion, histological diagnosis of NK/T-cell lymphoma is difficult at an early stage, and the clinical course often shows rapid tumor progression, particularly bleeding in the digestive organs or widespread perforation and penetration. NK/T-cell lymphoma should be ruled out in patients with bile duct and pancreatic tumors in whom tissue diagnosis via biopsy cannot be performed.

8 Article High-grade PanIN presenting with localised stricture of the main pancreatic duct: A clinicopathological and molecular study of 10 cases suggests a clue for the early detection of pancreatic cancer. 2018

Yokode, Masataka / Akita, Masayuki / Fujikura, Kohei / Kim, Mi-Ju / Morinaga, Yukiko / Yoshikawa, Seiichi / Terada, Takuro / Matsukiyo, Hiroshi / Tajiri, Takuma / Abe-Suzuki, Shiho / Itoh, Tomoo / Hong, Seung-Mo / Zen, Yoh. ·Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan. · Department of Gastroenterology and Hepatology, Kobe City Medical Center West Hospital, Kobe, Japan. · Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. · Department of Gastroenterology, Nagaoka Red Cross Hospital, Nagaoka, Japan. · Department of Surgery, Fukuiken Saiseikai Hospital, Fukui, Japan. · Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan. · Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo, Japan. ·Histopathology · Pubmed #29660164.

ABSTRACT: AIMS: This study aimed to identify the pathological features of high-grade PanIN that presents with imaging-detectable abnormalities. METHODS AND RESULTS: Ten cases of isolated, main-duct, high-grade PanIN as the primary clinical presentation were identified. All patients presented with stenosis of the main pancreatic duct, with two being associated with extensive upstream duct dilatation (>5 mm in diameter). Pancreatic juice cytology suggested adenocarcinoma in all seven cases examined. In resected specimens, high-grade PanIN was present chiefly in the main pancreatic duct, with longitudinal extension ranging between 3 and 40 mm in length (median = 18 mm). In four cases, in which hypoechoic or hypovascular masses were observed on imaging, radiopathology correlations suggested that they represented parenchymal atrophy and subsequent fibrosis around affected ducts, but not invasive malignancy. On immunohistochemistry, the loss of p16 expression was found in five (50%), p53 overexpression in two (20%) and loss of SMAD4 expression in none (0%). KRAS mutations were detected in nine cases, with two dominant clones being found in three by ultrasensitive droplet digital polymerase chain reaction, suggesting the genetic heterogeneity of dysplastic cells composing individual lesions. Mutant GNAS was also observed in one case. CONCLUSIONS: Isolated high-grade PanIN may present with pancreatic duct stenosis. Therefore, intensive investigations including pancreatic juice cytology will be required for patients with unexplained pancreatic duct stenosis. The abnormal expression of p53 and SMAD4 is infrequent, while GNAS may be mutated in premalignant lesions mainly affecting the main pancreatic duct, similar to KRAS.

9 Article Non-ampullary-duodenal carcinomas: clinicopathologic analysis of 47 cases and comparison with ampullary and pancreatic adenocarcinomas. 2017

Xue, Yue / Vanoli, Alessandro / Balci, Serdar / Reid, Michelle M / Saka, Burcu / Bagci, Pelin / Memis, Bahar / Choi, Hyejeong / Ohike, Nobuyike / Tajiri, Takuma / Muraki, Takashi / Quigley, Brian / El-Rayes, Bassel F / Shaib, Walid / Kooby, David / Sarmiento, Juan / Maithel, Shishir K / Knight, Jessica H / Goodman, Michael / Krasinskas, Alyssa M / Adsay, Volkan. ·Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA. · Department of Molecular Medicine, San Matteo Hospital, University of Pavia, Pavia, Italy. · Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea. · Department of Pathology, Showa University Fujigaoka Hospital, Yokohama, Japan. · Department of Pathology, Tokai University Hachioji Hospital, Tokyo, Japan. · Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA. · Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. · Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA. ·Mod Pathol · Pubmed #27739441.

ABSTRACT: Literature on non-ampullary-duodenal carcinomas is limited. We analyzed 47 resected non-ampullary-duodenal carcinomas. Histologically, 78% were tubular-type adenocarcinomas mostly gastro-pancreatobiliary type and only 19% pure intestinal. Immunohistochemistry (n=38) revealed commonness of 'gastro-pancreatobiliary markers' (CK7 55, MUC1 50, MUC5AC 50, and MUC6 34%), whereas 'intestinal markers' were relatively less common (MUC2 36, CK20 42, and CDX2 44%). Squamous and mucinous differentiation were rare (in five each); previously, unrecognized adenocarcinoma patterns were noted (three microcystic/vacuolated, two cribriform, one of comedo-like, oncocytic papillary, and goblet-cell-carcinoid-like). An adenoma component common in ampullary-duodenal cancers was noted in only about a third. Most had plaque-like or ulcerating growth. Mismatch repair protein alterations were detected in 13% (all with plaque-like growth and pushing-border infiltration). When compared with ampullary (n=355) and pancreatic ductal (n=227) carcinomas, non-ampullary-duodenal carcinomas had intermediary pathologic features with mean invasive size of 2.9 cm (vs 1.9, and 3.3) and 59% nodal metastasis (vs 45, and 77%). Its survival (3-, 5-year rates of 57 and 57%) was similar to that of ampullary-duodenal carcinomas (59 and 52%; P=0.78), but was significantly better than the ampullary ductal (41 and 29%, P<0.001) and pancreatic (28 and 18%, P<0.001) carcinomas. In conclusion, non-ampullary-duodenal carcinomas are more histologically heterogeneous than previously appreciated. Their morphologic versatility (commonly showing gastro-pancreatobiliary lineage and hitherto unrecognized patterns), frequent plaque-like growth minus an adenoma component, and frequent expression of gastro-pancreatobiliary markers suggest that many non-ampullary-duodenal carcinomas may arise from Brunner glands or gastric metaplasia or heterotopic pancreatobiliary epithelium. The clinical behavior of non-ampullary-duodenal carcinoma is closer to that of ampullary-duodenal subset of ampullary carcinomas, but is significantly better than that of ampullary ductal and pancreatic cancers. The frequency of mismatch repair protein alterations suggest that routine testing should be considered, especially in the non-ampullary-duodenal carcinomas with plaque-like growth and pushing-border infiltration.

10 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.

11 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.

12 Article [Clinico-pathological findings of mucinous cystic neoplasm (MCN)]. 2015

Tajiri, Takuma / Sugiyama, Tomoko. · ·Nihon Rinsho · Pubmed #25857031.

ABSTRACT: -- No abstract --

13 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.

14 Article Sex differences in immunohistochemical expression and capillary density in pancreatic solid pseudopapillary neoplasm. 2015

Hirabayashi, Kenichi / Kurokawa, Sachiko / Maruno, Atsuko / Yamada, Misuzu / Kawaguchi, Yoshiaki / Nakagohri, Toshio / Mine, Tetsuya / Sugiyama, Tomoko / Tajiri, Takuma / Nakamura, Naoya. ·Department of Pathology, Tokai University School of Medicine, Isehara, Kanagawa, Japan. Electronic address: khira@is.icc.u-tokai.ac.jp. · Tokai University School of Medicine, Isehara, Kanagawa, Japan. · Department of Gastroenterology, Tokai University School of Medicine, Isehara, Kanagawa, Japan. · Department of Pathology, Tokai University School of Medicine, Isehara, Kanagawa, Japan; Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan. · Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan. · Department of Pathology, Tokai University Hachioji Hospital, Isehara, Kanagawa, Japan. · Department of Pathology, Tokai University School of Medicine, Isehara, Kanagawa, Japan. ·Ann Diagn Pathol · Pubmed #25744912.

ABSTRACT: Solid pseudopapillary neoplasm (SPN) is a rare and low-grade malignant pancreatic neoplasm. Solid pseudopapillary neoplasm is rare in men, and most SPN cases are in young women. This study aimed to investigate sex differences in SPN clinical histopathology including capillary density and expression of immunochemical markers, including glypican 3. A total of 22 resected tumors from pancreatic SPN patients, including 16 women (73%) and 6 men (27%), were analyzed histopathologically and immunohistochemically for synaptophysin, β-catenin, estrogen receptor, progesterone receptor, Ki-67, CD10, CD31, and glypican 3. The median age was 52.5 years in men and 24 years in women (P = .046). The median tumor size was 22.5 mm in men and 40 mm in women (P = .337). In 11 of the 16 women (69%), but in none of the men, tumors showed complete or incomplete fibrous cap`sules (P = .006). Cholesterol clefts were observed in tumors from 10 women (63%) but in none from the men (P = .012). No significant sex differences were noted in tumor characteristics, including size, macroscopic cystic degeneration, necrosis, lymphovascular involvement, and perineural invasion. The SPNs were weakly positive for glypican 3, although there was no significant difference between sexes. Capillary density tended to be lower in tumors from men than in those from women, but not significantly. Thus, except for the fibrous capsule and cholesterol clefts often found in tumors and the younger age of the women, there were no significant sex differences in histopathologic or immunohistochemical features of SPN, despite its markedly higher occurrence in women.

15 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.

16 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.

17 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.

18 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.

19 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.

20 Unspecified An Autopsy Case of Anaplastic Pancreatic Ductal Carcinoma (Spindle Cell Type) Multiple Onset in the Pancreas. 2019

Ito, Hiroyuki / Hiraiwa, Shin-Ichiro / Sugiyama, Tomoko / Tajiri, Takuma / Yoshii, Hisamichi / Izumi, Hideki / Yamaji, Yoko / Kaneko, Motoki / Tsuda, Shingo / Ichikawa, Hitoshi / Nagata, Junko / Kojima, Seiichiro / Takashimizu, Shinji / Shirai, Takayuki / Watanabe, Norihito. ·Department of Gastroenterology, Tokai University Hachioji Hospital, Tokyo, Japan. · Department of Pathology, Tokai University Hachioji Hospital, Tokyo, Japan. · Department of Surgery, Tokai University Hachioji Hospital, Tokyo, Japan. ·Case Rep Oncol · Pubmed #31123460.

ABSTRACT: This is a case of a 75-year-old man who was diagnosed with anaplastic pancreatic ductal carcinoma (spindle cell type). His image findings showed pancreatic head cysts and pancreatic head, body, and tail tumors respectively. EUS-FNA was performed to the pancreatic head and pancreatic body tumors, and the same high atypical type cells suspected of cancer were obtained from either specimen, and finally total pancreatectomy was performed. On the specimen, there were 4 lesions in the pancreas; histology showed that the same anaplastic pancreatic ductal carcinoma (spindle cell type) was obtained from the pancreatic head cyst and the pancreatic tumors.