... Distant metastasis M1a Metastases confined to the liver M1b Metastases in at least one extrahepatic site (e.g., lung, ovary, nonregional lymph node, peritoneum, bone) M1c Both hepatic and extrahepatic metastases a If the number of tumors is known, use T(#); e.g., pT3(4)N0M0...

...: Computerized tomography (CT) scan shows a heterogeneous, circumscribed tumor in the head of the pancreas (arrow). Right: Large mass with solid and irregular cystic regions in the pancreatic tail. Magnetic resonance imaging (MRI) shows variable signal intensity, with solid areas similar to liver on T1-weighted...

... cystadenocarcinoma. Aggressive local behavior is associated with large size and localization in the head of the pancreas ( 38 ). In mixed serous-neuroendocrine neoplasms, the prognosis (i.e., risk for lymph node and liver metastases), is related to size, angioinvasion, and grading of the neuroendocrine tumor...

... syndrome. There are also no reported extrapancreatic manifestations. It is not clear how the hyperglucagonemia causes neoplastic changes in α cells. It is speculated that inactivation of the protein mediating glu-cagon receptor signaling in the liver releases a humoral factor that, together with elevated...

... in the liver or very large primary tumors. Serum lipase levels in excess of 10,000 U/L ( 14 – 18 ) lead to nodular foci of subcutaneous fat necrosis, often affecting the lower extremities ( fig. 9-1 ). Polyarthralgia and peripheral eosinophilia also occur. Cushing syndrome, due to adrenocorticotropic hormone...

... gland, spleen, and transverse colon. Lymph node metastases are identified in about 25 percent of resected MCNs with an associated invasive carcinoma, and the liver is usually the first organ involved by distant metastases. Metastases consist only of the invasive epithelial component, including in those...

... epithelial cells is appreciated ( fig. 7-16B,C ) ( 219 ). Since veins directly drain into the liver, this propensity for venous invasion may contribute to the high prevalence of liver metastasis seen in patients with pancreatic cancer ( 200 , 219 , 221 , 222 ). Most infiltrating adenocarcinomas...

... and proliferation may be associated with recurrence ( 55 ). There are two reports of malignant pancreatic PEComa metastasizing to the liver ( 50 , 52 ). Since these lesions often harbor TSC1 or TSC2 gene mutations, mTOR inhibitors have been given to some patients, with reported efficacy ( 56...

... embryologic relationship of the pancreas and the liver, pancreatoblastomas, like hepatoblastomas, can produce alpha-fetoprotein (AFP), with serum elevations in 25 to 35 percent of patients ( 12 , 18 , 39 – 44 ). Serum AFP levels can serve as a biomarker of therapeutic effect in these patients. Other serum...

..., including neoplasms of the soft tissues, esophagus, prostate gland, uterine cervix, liver, thyroid gland, biliary tract, small intestine, head and neck, salivary gland, urinary tract, adrenal gland, vulva, ovary, pleura, and skin. Table 14-2 ORIGIN OF PANCREATIC METASTASES IN SURGICAL SERIES...

..., intraductal oncocytic papillary neoplasms (IOPNs), IOPNs with an associated infiltrating oncocytic carcinoma, germ cell neoplasms, acinar cell carcinoma, solid pseudopapillary neoplasms, and pancreatoblastomas ( 61a ). Metastasis from a liver primary is best ruled out clinically. IOPNs have abundant pink...

... (particularly within Meckel diverticula), liver (around bile ducts), and gallbladder ( 103 , 104 ). More distant sites have been reported and include the esophagus, lung, mediastinum, kidney, and thyroid gland ( 105 ). Theories about the origin of heterotopic pancreas include displaced parenchyma during...

... . Chromatin “prepattern” and histone modifiers in a fate choice for liver and pancreas . Science   2011 ; 332 : 963 - 6 . 19. Lynn   FC , Skewes-Cox   P , Kosaka   Y , McManus   MT , Harfe   BD , German   MS . MicroRNA expression is required for pancreatic islet cell genesis...

... percent of surgically resected invasive ductal adenocarcinomas not associated with an IPMN. The liver and lung are the most common sites of more distant metastases. Staging. High-grade IPMNs without invasive carcinoma are staged as pTis. When there is an invasive carcinoma, staging should be based...

... extraembryonic differentiation (yolk sac or allantois) or endodermal somatic structures (intestine, liver, and mesenchyme). Clinical Features. Primary vaginal yolk sac tumors are rare. They typically occur in infants or children younger than 3 years of age (mean, 11 months) ( 209 ). Bleeding is a common...

... and hyperkalemia, are present in most patients ( 341 , 348 ). The hyponatremia is related to aldosterone deficiency from the zona glomerulosa. Liver aspartate transaminase levels may be abnormal but usually return to normal after glucocorticoid therapy. Gross Findings. The pathologic changes in autoimmune adrenal...