Pathologic complete response to neoadjuvant therapy in patients with pancreatic ductal adenocarcinoma is associated with a better prognosis Qing Zhao,

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Pathologic complete response to neoadjuvant therapy in patients with pancreatic ductal adenocarcinoma is associated with a better prognosis Qing Zhao, MD, PhD, Asif Rashid, MD, PhD, Yun Gong, MD, PhD, Matthew H. Katz, MD, Jeffrey E. Lee, MD, Robert Wolf, MD, Aparna Balachandran, MD, Gauri R. Varadhachary, MD, Peter W. Pisters, MD, Hua Wang, MD, PhD, Henry F. Gomez, MD, James L. Abbruzzese, MD, Jason B. Fleming, MD, Huamin Wang, MD, PhD Annals of Diagnostic Pathology Volume 16, Issue 1, Pages 29-37 (January 2012) DOI: 10.1016/j.anndiagpath.2011.08.005 Copyright © 2012 Elsevier Inc. Terms and Conditions

Fig. 1 Pretherapy and posttherapy CT scans of patients 9 (A and B) and 11 (C and D). (A and C) Pretreatment CT scans. (B and D) Posttreatment scans. Both patients show a marked tumor shrinkage as indicated by the arrow after neoadjuvant chemoradiation. Annals of Diagnostic Pathology 2012 16, 29-37DOI: (10.1016/j.anndiagpath.2011.08.005) Copyright © 2012 Elsevier Inc. Terms and Conditions

Fig. 2 Representative micrographs of the pretreatment FNA specimens from the pancreas and the subcarinal lymph node of patient 9. Papanicolaou cell smear (A and E), cell block (B and F), and immunohistochemical staining for cytokeratin 7 (CK7; C and G) and PSA (D and H) are shown. The pancreatic carcinoma stains for CK7 (C) but does not stain for PSA (D), TTF-1, and PAP (not shown). In contrast, the metastatic prostatic adenocarcinoma in subcarinal lymph node does not stain for CK 7 (G) and TTF-1 (not shown) but stains for PSA (H) and PAP (not shown). Annals of Diagnostic Pathology 2012 16, 29-37DOI: (10.1016/j.anndiagpath.2011.08.005) Copyright © 2012 Elsevier Inc. Terms and Conditions

Fig. 3 Representative micrographs show the posttreatment tumor bed and PanIN lesions but no residual invasive adenocarcinoma. Tumor bed of patient 9 shows fibrosis, chronic pancreatitis, and acellular mucin pools in the pancreas (A) and perineural spaces (B). Tumor bed from patients 7 shows a large area of fibrosis with foreign body giant cell reactions and cholesterol clefts (C). Tumor bed from patient 4 shows a collection of histiocytes associated with a scar (D). Pancreatic intraepithelial neoplasia 2 lesion with chronic pancreatitis from patients 10 (E) and PanIN3/carcinoma in situ from patient 3 (F). Original magnification ×40 (A-C, E, and F) and ×100 (D). Annals of Diagnostic Pathology 2012 16, 29-37DOI: (10.1016/j.anndiagpath.2011.08.005) Copyright © 2012 Elsevier Inc. Terms and Conditions

Fig. 4 Kaplan-Meier estimates of a disease-specific OS in patients with pCR (n = 10), patients with posttreatment stage I PDA (ypT1 and ypT2; n = 15), and patients with posttreatment stage IIA PDA (ypT3; n = 85) who received neoadjuvant chemoradiation and posttherapy pancreaticoduodenectomy. Annals of Diagnostic Pathology 2012 16, 29-37DOI: (10.1016/j.anndiagpath.2011.08.005) Copyright © 2012 Elsevier Inc. Terms and Conditions