title: Clinicopathological Features of 15 Occult and 178 Clinical Pancreatic Ductal Adenocarcinomas in 8339 Autopsied Elderly Patients.
abstract: OBJECTIVE
  The aim of the study was to investigate the clinicopathological features of pancreatic cancer at different stages using autopsy results.
  
  
  METHODS
  We retrospectively evaluated 8399 consecutive cases of autopsy performed between 1972 and 2013 at our geriatric hospital.
  
  
  RESULTS
  Macroscopic pancreatic lesions were detected in 6.13% of the cases. Primary and secondary pancreatic tumors were observed in 2.88% and 2.10% of the cases, respectively. Most primary tumors were invasive ductal adenocarcinomas (193 cases [2.31%]; mean patient age, 78.09 years) with a peak incidence at 50 to 59 years. Occult invasive ductal adenocarcinoma was discovered incidentally in 15 cases, with distant metastasis present in 26.67% of those. Microscopically, occult and advanced tumors exhibited similar characteristics such as hyalinized fibrous stroma, necrosis, invasion into vessels, peripancreatic fat tissues, and extrapancreatic nerve plexus. Mucin 1 and 2 immunohistochemical expression levels were also similar. Occult cancer incidence increased with age. Patients aged 85 years or older had shorter survival, a small tumor size, and a low incidence of lymph node metastasis. Approximately 8% of pancreatic invasive ductal adenocarcinomas progressed asymptomatically and were discovered incidentally at autopsy.
  
  
  CONCLUSIONS
  Pancreatic cancers in elderly patients tend to progress asymptomatically, but once symptoms develop, they are more often fatal than those in younger patients.
authors.affiliation: From the *Department of Pathology, Tokyo Metropolitan Geriatric Hospital, Itabashi-ku; †Department of Pathology and Integrative Oncological Pathology, Nippon Medical School, Bunkyo-ku; ‡Division of Cancer Genomics, National Cancer Center Research Institute, Chuo-ku; and §Research Team for Geriatric Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Ishiwata
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yachida
authors.forename: Akemi
authors.initials: A
authors.lastname: Suzuki
authors.forename: Yuri
authors.initials: Y
authors.lastname: Hamashima
authors.forename: Hideki
authors.initials: H
authors.lastname: Hamayasu
authors.forename: Hisashi
authors.initials: H
authors.lastname: Yoshimura
authors.forename: Naoko
authors.initials: N
authors.lastname: Honma
authors.forename: Junko
authors.initials: J
authors.lastname: Aida
authors.forename: Kaiyo
authors.initials: K
authors.lastname: Takubo
authors.forename: Tomio
authors.initials: T
authors.lastname: Arai
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy / Q000706:statistics & numerical data*; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010179:Pancreas / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D016019:Survival Analysis; D047368:Tumor Burden