Histogenesis of pancreatic carcinomas: a study based on 248 cases

Primary pancreatic carcinomas were studied histologically and histochemically, to assess the frequency of ductal hyperplasia in tissue adjacent to malignant neoplasms. Hyperplasia was divided into four types: simple, papillary, atypical and ductular, affecting large, medium and small ducts (ductules). All types of hyperplasia were frequently seen in areas adjacent to carcinomas, including ductal, pleomorphic, mucinous, adenosquamous, small and spindle cell and cystadenocarcinomas. In contrast, acinar cell carcinoma and microadenocarcinoma were less frequently associated with ductal hyperplasia. Mucin histochemistry revealed differences in types of mucin between the normal ducts and hyperplastic pancreatic ducts and carcinomas. The former group contained small amounts of sulphated mucin while the latter showed a marked increase in neutral and sialomucins. Our study also suggests that both papillary and atypical hyperplasia are precancerous lesions, supporting an hypothesis of ductal origin of pancreatic carcinomas.