Giuseppe Zamboni

Università di VeronaOspedale S.Cuore-Don Calabria, Negrar

giuseppe.zamboni@univr.it

TUMORI DELLA PAPILLA

E DELLA

TESTA DEL PANCREAS

PANCREAS PAPILLA

PERIAMPOLLARE

TUMORI DELLA PAPILLA / TESTA DEL PANCREAS

Comune derivazione embriogenetica

Diagnosi Istologica/Citologica per tuttiDiagnosi Istologica/Citologica per tutti

1 CARCINOMA DEL PANCREAS1

ADENOCARCINOMA

Hruban, Pitman, KlimstraAFIP, 2007

Klöppel, KlimstraFletcher, 2007

NON RESECTABLE80-90%

RESECTABLE10-20%

Tissue diagnosisTissue diagnosis

1Percutaneous-US

Higher resolution (0.5 cm)

Lower neoplastic seeding

Sensitivity: 74% with pancreatitis

91% no pancreatitis

** Epithelial contamination

FNA-CytologyEndoscopic-US

CT Laparotomy

ADENOCARCINOMA

DIAGNOSI DIFFERENZIALE1

PANCREATITE

1. Endocrine Neoplasms

2. Solid Pseudopapillary Tumor

3. Acinar-cell Carcinoma

4. Pancreatoblastoma

NON-ADENOCARCINOMA SOLID NEOPLASMS

Metastases

ADENOCARCINOMA

Vs

MASS-FORMING AIP

1. There are no specific cytologic criteria

2. Dx may be suggested in correlation with clinical and radiological features

AIP-EUS-FNA Cytology

AIP: FNA-Core Biopsy

IGg4

AIP-Biopsy

71% of AIP cases are recognized (4/6 criteria) (sensitivity of 76%, with GEL 86%)

Non-AIP-CP: specificity of 100% (<3 criteria)

2 Carcinoma della Papilla

Adenocarcinoma variants

Papillary carcinoma

Mucinous carcinoma

Signet ring cell carcinoma

Clear cell carcinoma

Adenosquamous/Squamous cell carcinoma

Undifferentiated carcinoma

Undifferentiated carcinoma with Osteoclast-Like-GC

Neuroendocrine carcinoma

Intestinal Adenocarcinoma

Pancreatobiliary Adenocarcinoma

Westgaard et al, BMC Cancer-2008

1. BIOPSY

Histologic grade3

Histologic type2

Diagnosis of neoplasia12

2. SURGICAL PAPILLECTOMY

Resection margins4

Histologic grade3

Histologic type2

Recognition of anatomical structures12

PANCREATICODUODENECTOMY

1. Tumor

a) locationb) size / appearancec) histologic typed) histologic gradee) tumor spread

Howe et al Ann Surg, 1998