Hepatobiliary and Pancreatic Cancer (Cancer Dissemination Pathways)

This book describes the pathways of dissemination of primary liver, biliary, and pancreatic neoplasms and proposes a practical and clinically driven approach to their imaging. The typical dissemination pathways for hepatocellular carcinoma, cholangiocarcinoma, exocrine pancreatic carcinoma, and neuroendocrine pancreatic tumors are systematically reviewed, and more unusual pathways are also documented. The content is presented in an extremely schematic way, with numerous high-quality graphical illustrations and multimodality images (US, CT, MRI, and PET) that are accompanied by clear explanatory text. The clinical significance of findings and potential therapeutic options are explained whenever appropriate. In addition, relevant background information is provided on the role of morphopathological drivers of cancer spread and anatomy. Foreword 6 Abbreviations 10 Contents 7 Contributors 8 1: Mechanism of Tumour Dissemination in Hepatobiliary and Pancreatic Tumours 11 1.1 Local Spread 12 1.1.1 Expansive Growth 12 1.1.2 Infiltrative Growth 13 1.2 Metastases 14 1.2.1 Intravasation 15 1.2.1.1 Angiogenesis 15 1.2.1.2 Lymphangiogenesis 16 1.2.2 Circulation 17 1.2.3 Extravasation and Secondary Tumour Formation 18 1.2.4 Organ Specificity of Metastases 18 1.3 Perineural Invasion 18 1.4 Conclusions 20 References 20 2: Radiological Signs of Tumor Dissemination 23 2.1 Introduction 24 2.2 Local Spread 24 2.2.1 Expansive Growth 24 2.2.2 Infiltrative Growth 26 2.3 Vascular Invasion 29 2.4 Lymphatic Involvement 31 2.5 Perineural Invasion 32 2.6 Distant Metastases 33 References 33 3: Hepatocellular Carcinoma 36 3.1 Overview 37 3.1.1 Epidemiology 37 3.1.2 Risk Factors 37 3.1.3 Pathology 37 3.1.4 Staging 39 3.1.5 Treatment 39 3.1.5.1 Very Early Stage 39 3.1.5.2 Early Stage 39 3.1.5.3 Intermediate Stage 40 3.1.5.4 Advanced Stage 41 3.1.6 Prognosis 41 3.2 HCC: Imaging Features and Prognosis 41 3.2.1 Tumour Size 41 3.2.2 Intralesional Fat 41 3.2.3 Mosaic Architecture 42 3.2.4 Tumour Capsule 43 3.2.5 Corona Enhancement 43 3.2.6 Multifocality 44 3.3 HCC: Intrahepatic Dissemination 45 3.3.1 Microvascular Invasion 45 3.3.2 Intrahepatic Metastases 46 3.3.3 Macroscopic Vascular Invasion 46 3.3.4 Biliary Tumour Thrombus 49 3.4 HCC: Extrahepatic Metastasis 50 3.4.1 Lung 51 3.4.2 Lymph Nodes 52 3.4.3 Bone 53 3.4.4 Adrenal Glands 54 3.4.5 Other Metastatic Sites 55 References 56 4: Intrahepatic Cholangiocarcinoma 61 4.1 Overview 62 4.1.1 Epidemiology 62 4.1.2 Risk Factors 62 4.1.3 Pathology 62 4.1.4 Diagnosis 62 4.1.5 Staging 64 Box 4.1 Proposed Staging System for Patients with Mass-forming Intrahepatic Cholangiocarcinoma According to Okabayashi et al. [17] 64 Box 4.2 Proposed Staging System for Patients with Mass-forming Intrahepatic Cholangiocarcinoma According to Nathan et al. [18] 65 Box 4.3 Proposed Staging System for Patients with Mass-forming Intrahepatic Cholangiocarcinoma According to the 7th edition of the AJCC [19] 65 4.1.6 Treatment and Prognosis 66 4.2 Patterns of Local Spread 66 4.2.1 Parenchymal Dissemination 66 4.2.2 Vascular Invasion 67 4.3 Regional and Distal Spread 68 4.3.1 Lymph Node Involvement 68 4.3.2 Perineural Invasion 71 4.3.3 Distant Metastases 72 4.4 Conclusions 72 References 72 5: Bile Duct and Gallbladder Tumors 74 5.1 Overview 75 5.1.1 Epidemiology 75 5.1.2 Risk Factors 75 5.1.3 Pathology 75 5.1.4 Staging 76 5.1.5 Diagnosis 77 5.1.5.1 Bile Duct Carcinoma 77 5.1.5.2 Gallbladder Carcinoma 81 5.1.6 Treatment 84 Box 5.1 Criteria of Unresectability in Patients with Hilar Cholangiocarcinoma 85 5.1.7 Prognosis 85 5.2 Patterns of Local Spread and Implications to Treatment 85 5.2.1 Local Spread of Gallbladder Carcinoma 85 5.2.2 Local Spread of Hilar Cholangiocarcinoma 85 5.3 Vessel Infiltration and Resectability 86 5.4 Involvement of Adjacent Organs 86 5.5 Lymph Node Involvement 86 5.5.1 Gallbladder Carcinoma 86 5.5.2 Hilar Cholangiocarcinoma 87 5.6 Perineural Invasion 87 5.7 Metastatic Spread 87 References 87 6: Pancreatic Adenocarcinoma 90 6.1 Overview 91 6.1.1 Epidemiology 91 6.1.2 Risk Factors 91 6.1.3 Pathology 91 6.1.4 Staging 91 6.1.5 Treatment 92 6.1.6 Prognosis 92 6.2 Patterns of Local Spread 93 6.2.1 Introduction 93 6.3 Vessel Infiltration and Resectability 94 6.3.1 Splenic Vessels Infiltration 95 6.4 Involvement of Adjacent Organs 97 6.5 Lymph Node Involvement 98 6.5.1 Anatomical Aspects: Tumors of the Pancreatic Head 98 6.5.2 The Uncinate Process: A Ventral Enclave in the Dorsal Pancreas 99 6.5.3 Anatomical Aspects: Tumors of the Distal Pancreas 100 6.5.4 Surgical Implications 100 6.6 Extrapancreatic Nerve Plexus Invasion 101 6.6.1 Surgical Implications 102 6.7 Metastatic Spread 102 References 103 7: Neuroendocrine Pancreatic Tumors 105 7.1 Overview 106 7.1.1 Epidemiology 106 7.1.2 Risk Factors 106 7.1.3 Pathology 106 7.1.4 Clinical Presentation 107 7.1.5 Classification and Staging 107 7.1.6 Treatment 107 7.1.6.1 Surgery 107 7.1.6.2 Local Ablative and Locoregional Techniques 108 7.1.6.3 Medical Therapy 109 7.1.7 Prognosis 109 7.2 Patterns of Local Spread 109 7.2.1 Introduction 109 7.3 Vessel Infiltration and Resectability 109 7.4 Involvement of Adjacent Organs 110 7.5 Lymphnode Involvement 111 7.6 Extrapancreatic Nerve Plexus Invasion 111 7.7 Metastatic Spread 112 7.7.1 Liver Metastases 112 7.7.1.1 Pattern of Metastases 112 7.7.1.2 Predisposing/Predictive Factors of Metastasis 113 7.7.2 PNETs Metastatic to Other Organs 113 7.7.2.1 Bone Metastases 113 7.7.2.2 Lung Metastases 113 7.7.2.3 Cardiac Metastases 113 7.7.2.4 Ovarian Metastases 114 References 114 8: Mucinous Carcinoma and IPMN 116 8.1 Mucinous Adenocarcinoma 117 8.1.1 Epidemiology 117 8.1.2 Pathology 117 8.1.3 Clinical Management 119 8.2 Patterns of Local Spread 119 8.2.1 Introduction 119 8.2.2 Vessel Infiltration 120 8.2.3 Lymph Node Metastases 120 8.2.4 Neural Infiltration 120 8.2.5 Peritoneal Dissemination 120 8.3 Intraductal Papillary Mucinous Neoplasms 120 8.3.1 Epidemiology 120 8.3.2 Pathology 121 8.3.3 Clinical Management 122 8.4 Patterns of Local Spread 123 8.4.1 Invasive Cancer and IPMN 123 8.4.2 Vessel Infiltration 124 8.4.3 Lymph Node Involvement 125 8.4.4 Neural Infiltration 125 8.4.5 Peritoneal Dissemination 125 References 126 Front Matter ....Pages I-X Mechanism of Tumour Dissemination in Hepatobiliary and Pancreatic Tumours (Daniele Regge, Giovanni Cappello, Alberto Pisacane)....Pages 1-12 Radiological Signs of Tumor Dissemination (Daniele Regge, Giovanni Cappello, Giulia Zamboni)....Pages 13-25 Hepatocellular Carcinoma (Irene Bargellini, Laura Coletti, Giulia Lorenzoni)....Pages 27-51 Intrahepatic Cholangiocarcinoma (Maxime Ronot, Valérie Vilgrain)....Pages 53-65 Bile Duct and Gallbladder Tumors (Stefano Cirillo, Alessandro Ferrero, Teresa Gallo, Nadia Russolillo, Stefano Cavanna)....Pages 67-82 Pancreatic Adenocarcinoma (Giulia Zamboni, Maria Chiara Ambrosetti, Laura Maggino, Giuseppe Malleo)....Pages 83-97 Neuroendocrine Pancreatic Tumors (Marco Miotto, Giovanni Marchegiani, Giulia Zamboni)....Pages 99-109 Mucinous Carcinoma and IPMN (Maria Chiara Ambrosetti, Matilde Bacchion, Alex Borin, Roberto Pozzi Mucelli)....Pages 111-122