Diffuse intraductal papillary adenocarcinoma of the pancreas

The incidence of multicentricity in pancreatic cancer has been reported to be as high as 38%. Recent surgical and autopsy series have documented multicentric disease and the presence of carcinoma in situ in association with invasive carcinoma. Described are the clinical and pathologic findings in a 41-year-old woman who had total pancreatectomy for diffuse ductal transformation to papillary adenocarcinoma associated with a wide spectrum of extensive ductal epithelial changes. The significance of epithelial abnormalities as they relate to the occurrence of multicentric tumor is discussed, and the findings in this patient are compared with those of other distinctive clinicopathologic entities. Despite an apparently favorable outcome and 20-month disease-free follow-up in this patient, no good evidence indicates that age, extent of procedure, or lack of tumor invasion has prognostic significance in pancreatic cancer.