Pathology of the Pancreas: A Practical Approach 9783030498474, 9783030498481
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English Pages [438]
Table of contents :
Preface
Acknowledgements
Contents
Part I: General Principles
1: Embryology, Anatomy, and Histology
1.1 Introduction
1.2 Embryology
1.2.1 Development of the Ventral and Dorsal Pancreatic Primordia
1.2.2 Pancreatic Organogenesis
1.2.3 Lineage Commitment
1.3 Anatomy
1.3.1 Pancreas
1.3.1.1 General Considerations
1.3.1.2 Anatomical Relationship to Neighboring Structures
1.3.1.3 The Pancreatic Duct System
1.3.2 Common Bile Duct
1.3.3 Ampulla and Papilla of Vater
1.3.4 Minor Ampulla
1.3.5 Vasculature
1.3.6 Lymph Nodes
1.4 Histology
1.4.1 Pancreatic Lobules
1.4.2 Acinar Cells
1.4.3 Pancreatic Duct System
1.4.4 Endocrine Compartment: Islets of Langerhans and Extrainsular Endocrine Cells
1.4.5 Interstitium
1.4.6 Peripancreatic Soft Tissue
1.4.7 Major Ampulla and Papilla
1.4.8 Minor Ampulla and Papilla
1.4.9 Common Bile Duct
References
Further Reading
2: Pancreatic Specimen Types
2.1 Pancreatoduodenectomy Specimens
2.2 Distal Pancreatectomy Specimens
2.3 Total Pancreatectomy Specimens
2.4 Duodenum-Preserving Pancreatic Resection Specimens
2.5 Complex Multivisceral En Bloc Resection Specimens
2.6 Central Pancreatectomy Specimens
2.7 Enucleation Specimens
2.8 Specimens Following Frey, Beger, or Puestow Procedures
2.9 Laparoscopic and Robot-Assisted Resection Specimens
2.10 Pancreas Allograft
Further Reading
3: Specimen Dissection and Sampling
3.1 Handling of Fresh Specimens
3.2 Specimen Fixation
3.3 Macroscopic Examination of Pancreatoduodenectomy Specimens
3.3.1 Dissection Techniques
3.3.1.1 Bivalving or Multivalving Technique
3.3.1.2 Bread Loaf Slicing Technique
3.3.1.3 Axial Slicing Technique
3.3.2 Inking of Surfaces
3.3.3 Stents, Coils, and Glues
3.3.4 Axial Specimen Slicing
3.3.5 Identification of Anatomy and Margins in Axial Specimen Slices
3.3.5.1 Pancreatic Duct System, Bile Duct, and Ampullae
3.3.5.2 Arteries and Veins
3.3.5.3 Specimen Surfaces and Margins
3.3.5.4 Lymph Nodes
3.3.6 Photodocumentation
3.3.7 Macroscopic Description: How and What to Record
3.3.8 Tissue Sampling
3.4 Dissection of Distal Pancreatectomy Specimens
3.5 Dissection of Total Pancreatectomy Specimens
3.6 Dissection of Multivisceral En Bloc Resection Specimens
3.7 Dissection of Other Pancreatic Specimen Types
3.8 Handling of Pancreatic Biopsies
3.9 Reporting Checklist of Macroscopic Findings
References
4: The Pancreatic Multidisciplinary Team
4.1 Discussion of Postoperative Cases
4.2 Discussion of Pretreatment Cases
4.3 Other Roles and Responsibilities
Reference
Part II: Exocrine Pancreas: Non-Cystic
5: Common Minor Changes
5.1 Acinar Cell Nodules
5.2 Acinar Dilatation
5.3 Acinar to Ductal Metaplasia
5.4 Duct Epithelial Metaplasia
5.5 Lobulocentric Atrophy
5.6 Age-Related Alterations
5.7 Fatty Replacement
5.8 Changes in Islets
5.9 Autolytic Change
References
6: Hereditary Exocrine Disorders
6.1 Cystic Fibrosis
6.1.1 Macroscopy
6.1.2 Microscopy
6.2 Hereditary Hemochromatosis
6.2.1 Macroscopy
6.2.2 Microscopy
6.3 Hereditary Pancreatitis
6.3.1 Clinical Features
6.3.2 Diagnostic Criteria
6.3.3 Pathology
6.3.4 Cancer Risk
6.3.5 Management
6.4 Inherited Pancreatic Cancer
6.4.1 Pathology
6.5 Familial Pancreatic Cancer
6.5.1 Cancer Risk
6.5.2 Clinical Features, Pathology, and Prognosis
6.6 Screening High-Risk Individuals
References
7: Inflammatory Disorders
7.1 Acute Pancreatitis
7.1.1 Definition and Clinical Features
7.1.2 Etiology
7.1.3 Macroscopy
7.1.4 Microscopy
7.1.5 Complications
7.2 Chronic Pancreatitis
7.2.1 Definition and Clinical Features
7.2.2 Etiology
7.2.3 Macroscopy
7.2.4 Microscopy
7.2.5 Complications
7.2.6 Forms of Chronic Pancreatitis with Nonspecific Morphology
7.2.6.1 Alcohol-Related Pancreatitis
7.2.6.2 Hereditary Pancreatitis
7.2.6.3 Tropical Pancreatitis
7.2.6.4 Obstructive Pancreatitis
7.2.7 Autoimmune Pancreatitis
7.2.7.1 Definition, Epidemiology, and Clinical Features
7.2.7.2 Etiology
7.2.7.3 Macroscopy
7.2.7.4 Microscopy
7.2.7.5 Unusual Histological Features in AIP
7.2.7.6 AIP Not Otherwise Specified (NOS)
7.2.7.7 IgG4 Immunohistochemistry
7.2.7.8 Differential Diagnosis
7.2.7.9 Diagnostic Criteria and Algorithms
7.2.7.10 IgG4-Related Systemic Disease
7.2.8 Paraduodenal (Groove) Pancreatitis
7.2.8.1 Definition and Nomenclature
7.2.8.2 Etiopathogenesis
7.2.8.3 Clinical Findings
7.2.8.4 Macroscopy
7.2.8.5 Microscopy
7.2.8.6 Differential Diagnosis
7.2.9 Eosinophilic Pancreatitis
7.2.10 Chronic Pancreatitis and Pancreatic Cancer
7.3 Other Inflammatory Diseases of the Pancreas
7.3.1 Follicular Pancreatitis
7.3.2 Malakoplakia
7.3.3 Vasculitis and Vasculogenic Pancreatitis
7.3.4 Collagen Vascular Diseases
7.3.5 Sarcoidosis
7.4 Pancreatitis in Children
7.5 Reporting Checklist
References
8: Pancreatic Intraepithelial Neoplasia
8.1 WHO Classification
8.2 Classification and Microscopy
8.2.1 Low-grade PanIN (Figs. 8.1–8.3)
8.2.2 High-grade PanIN (Fig. 8.4)
8.3 Variants of PanIN
8.4 Associations
8.4.1 Hereditary Pancreatitis and Familial Pancreatic Cancer
8.5 Lobulocentric Atrophy
8.6 Differential Diagnosis
8.6.1 Intraductal Papillary Mucinous Neoplasm
8.6.2 Cancerization of Ducts
8.6.3 Intravascular Invasion of Pancreatic Ductal Adenocarcinoma
References
Further Reading
9: Ductal Adenocarcinoma
9.1 Definition and Terminology
9.2 Epidemiology
9.3 Etiology
9.4 Clinical Features
9.5 Macroscopy
9.6 Microscopy
9.6.1 Pancreatobiliary Type
9.6.2 Intestinal Type
9.6.3 Intratumor Heterogeneity
9.7 Grading
9.8 Morphological Patterns
9.8.1 Foamy Gland Pattern
9.8.2 Clear Cell Pattern
9.8.3 Large Duct Pattern
9.8.4 Cystic Papillary Pattern
9.9 Immunohistochemistry
9.9.1 Immunohistochemical Profile
9.9.2 Distinction from Other Pancreatic or Extrapancreatic Neoplasms
9.9.3 Distinction from Reactive Pancreatic Ductules
9.10 Tumor Propagation
9.11 Staging
9.11.1 Staging of the Primary Tumor
9.11.2 Staging of Lymph Node Metastasis
9.11.3 Lymphatic, Vascular, and Perineural Tumor Spread
9.11.4 Resection Margin Status
9.12 Differential Diagnosis
9.12.1 Chronic Pancreatitis and Reactive Duct Changes
9.12.2 Other Pancreatic Neoplasms
9.12.2.1 Acinar Cell Carcinoma
9.12.2.2 Pancreatic Neuroendocrine Neoplasia
9.12.2.3 Solid Pseudopapillary Neoplasm
9.12.3 Adenocarcinoma of Ampullary, Distal Bile Duct, or Duodenal Origin
9.12.4 Metastasis from Extrapancreatic Primaries
9.13 Treatment and Prognosis
9.14 Histological Subtypes of Ductal Adenocarcinoma
9.14.1 Adenosquamous Carcinoma and Squamous Cell Carcinoma
9.14.2 Colloid Carcinoma
9.14.3 Signet-Ring Cell (Poorly Cohesive Cell) Carcinoma
9.14.4 Medullary Carcinoma
9.14.5 Hepatoid Carcinoma
9.14.6 Invasive Micropapillary Carcinoma
9.14.7 Undifferentiated Carcinoma
9.14.8 Undifferentiated Carcinoma with Osteoclast-Like Giant Cells
9.15 Carcinoma with Mixed Differentiation
9.15.1 Mixed Neuroendocrine— Non-Neuroendocrine Neoplasm (MiNEN)
9.16 Mixed Acinar-Ductal Carcinoma
9.17 Ductal Adenocarcinoma Following Neoadjuvant Treatment
9.17.1 Macroscopic Examination
9.17.2 Microscopic Examination
9.17.3 Vascular Resection
9.17.4 Staging
9.17.5 Tumor Regression Grading
9.18 Diagnostic Molecular Pathology
9.19 Reporting Checklist
References
10: Acinar Cell Carcinoma
10.1 WHO Classification
10.2 Terminology
10.3 Epidemiology
10.4 Clinical Features
10.4.1 Associations
10.4.2 Imaging
10.5 Macroscopy
10.5.1 Sampling
10.6 Microscopy
10.7 Histochemistry
10.8 Immunohistochemistry
10.9 Molecular Pathology
10.10 Variants
10.10.1 Intraductal Nodular and Papillary Variants
10.10.2 Cystic Variant (Acinar Cell Cystadenocarcinoma)
10.10.3 Mixed Acinar Carcinomas
10.11 Differential Diagnosis
10.11.1 Pancreatic Neuroendocrine Neoplasia
10.11.2 Solid Pseudopapillary Neoplasm
10.11.3 Pancreatoblastoma
10.11.4 Intraductal Papillary Neoplasms
10.12 Staging
10.13 Prognosis and Management
10.14 Reporting Checklist
References
Further Reading
11: Non-Epithelial Neoplasia
11.1 Mesenchymal Neoplasms of the Pancreas
11.1.1 Desmoplastic Small Round Cell Tumor
11.1.2 Gastrointestinal Stromal Tumor
11.1.3 Granular Cell Tumor
11.1.4 Inflammatory Myofibroblastic Tumor
11.1.5 Leiomyosarcoma
11.1.6 Lipoma
11.1.7 Lymphangioma
11.1.8 Paraganglioma
11.1.9 Perivascular Epithelioid Cell Neoplasm (PEComa)
11.1.10 Primitive Neuroectodermal Tumor
11.1.11 Schwannoma
11.1.12 Solitary Fibrous Tumor
11.2 Lymphoma
References
12: Secondary Neoplasia
12.1 Definition
12.2 Clinical Features
12.3 Macroscopy
12.4 Microscopy
12.5 Differential Diagnosis
12.6 Synchronous Primary and Metastatic Cancer
References
13: Congenital and Developmental Abnormalities
13.1 Pancreas Annulare
13.2 Pancreas Divisum
13.3 Pancreatobiliary Maljunction
13.4 Pancreatic Heterotopia
13.5 Ectopic Tissue in the Pancreas
13.6 Benign Glandular Inclusions in Abdominal Lymph Nodes
References
Part III: Exocrine Pancreas: Cystic
14: Cystic Lesions: Classification and Sampling
14.1 Classification
14.2 Sampling of Cystic Lesions
References
15: Serous Cystic Neoplasia
15.1 WHO Classification
15.2 Terminology
15.3 Epidemiology
15.4 Clinical Features
15.4.1 Associations
15.4.2 Imaging
15.5 Classification
15.6 Macroscopy
15.6.1 Microcystic Serous Cystadenoma
15.6.2 Macrocystic Serous Cystadenoma
15.6.3 Sampling
15.7 Microscopy
15.8 Histochemistry
15.9 Immunohistochemistry
15.10 Molecular Pathology
15.11 Rare Variants
15.11.1 Solid Serous Adenoma
15.11.2 von Hippel-Lindau Syndrome-Associated Serous Cystic Neoplasm
15.11.3 Microcystic Serous Cystadenoma with Subtotal Cystic Degeneration
15.11.4 Serous Cystic Neoplasm with Complex Florid Papillary Architecture
15.11.5 Mixed Serous-Neuroendocrine Neoplasm
15.11.6 Serous Cystadenocarcinoma
15.12 Differential Diagnosis
15.12.1 Metastatic Renal Cell Carcinoma
15.12.2 Lymphangioma
15.12.3 Clear Cell Pancreatic Neuroendocrine Neoplasm
15.12.4 Pseudocyst
15.12.5 Mucinous Cystic Neoplasm
15.12.6 Intraductal Papillary Mucinous Neoplasm
15.12.7 PEComa (see Chap. 11, Sect. 11.1.9)
15.13 Prognosis and Management
15.14 Reporting Checklist
References
Further Reading
16: Mucinous Cystic Neoplasia
16.1 WHO Classification
16.2 Terminology
16.3 Epidemiology
16.4 Clinical Features
16.4.1 Associations
16.4.2 Imaging
16.5 Macroscopy
16.5.1 Sampling
16.6 Microscopy
16.6.1 MCN with Low-Grade Dysplasia
16.6.2 MCN with High-Grade Dysplasia
16.6.3 MCN with Associated Invasive Carcinoma
16.7 Immunohistochemistry
16.8 Molecular Pathology
16.9 Variants
16.9.1 MCN Involving the Main Pancreatic Duct
16.9.2 MCN with Mesenchymal Overgrowth
16.9.3 MCN with Sarcomatous Differentiation of the Stroma
16.10 Differential Diagnosis
16.10.1 Intraductal Papillary Mucinous Neoplasm (IPMN) (see Chap. 17)
16.10.2 Simple Mucinous Cyst (Mucinous Nonneoplastic Cyst) (see Chap. 19, Sect. 19.2.1)
16.10.3 Retention Cyst (see Chap. 19, Sect. 19.3.1)
16.10.4 Retroperitoneal Mucinous Cystic Tumor
16.10.5 Pseudocyst or Macrocystic Serous Cystadenoma
16.11 Staging
16.12 Prognosis and Management
16.13 Reporting Checklist
References
Further Reading
17: Intraductal Papillary Neoplasia
17.1 WHO Classification
17.2 Intraductal Papillary Mucinous Neoplasm (IPMN)
17.2.1 Terminology
17.2.2 Epidemiology
17.2.3 Clinical Features
17.2.3.1 Associations
17.2.3.2 Imaging
17.2.4 Classification
17.2.4.1 Site of Duct Involvement
17.2.4.2 Epithelial Subtype
17.2.4.3 Grade of Dysplasia
17.2.4.4 Invasive Carcinoma
17.2.5 Macroscopy
17.2.5.1 Main-Duct IPMN
17.2.5.2 Branch-Duct IPMN
17.2.5.3 Mixed-Duct IPMN
17.2.5.4 Invasive Carcinoma
17.2.6 Sampling
17.2.7 Microscopy
17.2.7.1 Epithelial Subtype
17.2.7.2 Grade of Dysplasia
17.2.7.3 Invasive Carcinoma
17.2.8 Immunohistochemistry
17.2.9 Molecular Pathology
17.2.10 Differential Diagnosis
17.2.10.1 Macrocystic Serous Cystadenoma (see Chap. 15, Sect. 15.6.2)
17.2.10.2 Mucinous Cystic Neoplasm (see Chap. 16)
17.2.10.3 Simple Mucinous Cysts (Mucinous Nonneoplastic Cysts)
17.2.10.4 Retention Cysts (see Chap. 19, Sect. 19.3.1)
17.2.10.5 Pancreatic Intraepithelial Neoplasia (PanIN) (see Chap. 8)
17.2.10.6 Extension of IPMN into Smaller Ducts
17.2.10.7 Mucus Extravasation
17.2.10.8 Concomitant Pancreatic Ductal Adenocarcinoma
17.2.10.9 Cystic Papillary Growth Pattern in Pancreatic Ductal Adenocarcinoma
17.2.10.10 Intraductal Papillary Neoplasm of the Bile Ducts
17.2.10.11 Intraductal Growth by Other Neoplasms
17.3 Intraductal Oncocytic Papillary Neoplasm (IOPN)
17.3.1 Epidemiology and Clinical Features
17.3.2 Macroscopy
17.3.3 Microscopy
17.3.4 Immunohistochemistry
17.3.5 Molecular Pathology
17.4 Intraductal Tubulopapillary Neoplasm (ITPN)
17.4.1 Epidemiology and Clinical Features
17.4.2 Macroscopy
17.4.3 Microscopy
17.4.4 Variants
17.4.5 Immunohistochemistry
17.4.6 Molecular Pathology
17.5 Staging
17.6 Prognosis
17.7 Management
17.8 Reporting Checklist
References
Further Reading
18: Solid Pseudopapillary Neoplasia
18.1 WHO Classification
18.2 Terminology
18.3 Epidemiology
18.4 Clinical Features
18.4.1 Associations
18.4.2 Imaging
18.5 Macroscopy
18.5.1 Sampling
18.6 Microscopy
18.7 Immunohistochemistry
18.8 Molecular Pathology
18.9 Variants
18.10 Differential Diagnosis
18.10.1 Pseudocyst
18.10.2 Pancreatic Endocrine Neoplasm
18.10.3 Acinar Cell Carcinoma
18.11 Staging
18.12 Prognosis and Management
18.13 Reporting Checklist
References
Further Reading
19: Other Cystic Lesions
19.1 Acinar Cystic Transformation (Acinar Cell Cystadenoma)
19.1.1 Macroscopy
19.1.2 Microscopy
19.1.3 Histochemistry and Immunohistochemistry
19.1.4 Differential Diagnosis
19.1.5 Prognosis and Management
19.2 Mucinous Epithelium-Lined Cysts
19.2.1 Simple Mucinous Cyst (Mucinous Nonneoplastic Cyst)
19.3 Pancreatobiliary Epithelium-Lined Cysts
19.3.1 Retention Cyst
19.3.2 Choledochal Cyst
19.4 Squamous Epithelium-Lined Cysts
19.4.1 Lymphoepithelial Cyst
19.4.1.1 Differential Diagnosis
19.4.2 Mature Cystic Teratoma (Dermoid Cyst)
19.4.3 Squamous Epithelial (Epidermoid) Cyst in Intrapancreatic Heterotopic Spleen
19.4.4 Squamoid Cyst of Pancreatic Ducts
19.4.5 Squamous Metaplasia in a Cystic Lesion
19.5 Other Cystic Lesions
19.5.1 Cystic Hamartoma
19.5.2 Duodenal Diverticulum
19.5.3 Endometriotic Cyst
19.5.4 Foregut (Duplication) Cyst
19.5.5 Parasitic Cyst
References
Part IV: Endocrine Pancreas
20: Endocrine Neoplasia
20.1 Terminology and Classification
20.2 Epidemiology
20.3 Clinical Features
20.4 Macroscopy
20.5 Microscopy
20.5.1 Pancreatic Neuroendocrine Tumors (Grade 1–3)
20.5.2 Pancreatic Neuroendocrine Carcinomas
20.6 Classification
20.7 Immunohistochemistry
20.7.1 Confirmation of Neuroendocrine Differentiation
20.7.2 Evaluation of Hormonal Production
20.7.3 Ki67 Immunostaining
20.7.4 Other Prognostic Factors
20.7.5 Biopsy Diagnosis of Liver Metastasis
20.8 Staging
20.8.1 Primary Tumor
20.8.2 Tumor Propagation and Metastasis
20.8.3 Resection Margins
20.9 Differential Diagnosis
20.9.1 Neuroendocrine Tumors of the Pancreas (Grade 1–3)
20.9.2 Neuroendocrine Carcinoma of the Pancreas
20.9.3 Neuroendocrine Neoplasms of the Ampulla, Common Bile Duct, and Duodenum
20.10 Mixed Neuroendocrine—Non-Neuroendocrine Neoplasm (MiNEN)
20.11 Prognosis
20.12 Inherited Syndromes
20.13 Glucagon Cell Hyperplasia and Neoplasia
20.14 Insulinomatosis
20.15 Endocrine Microadenoma and Endocrine Microadenomatosis
20.16 Reporting Checklist
References
Further Reading
21: Endocrine Cell Hyperplasia
21.1 Definition
21.2 Beta-Cell Hyperplasia
21.3 Alpha-Cell Hyperplasia
21.4 PP-Cell Hyperplasia
References
Part V: Transplant Pathology
22: Pathology of Pancreas Transplantation
22.1 Introduction
22.1.1 History and Outcomes of Pancreas Transplantation
22.1.2 Indications for Pancreas Transplantation
22.1.3 Alternatives to Whole Pancreas Transplantation
22.1.3.1 Islet Cell Transplantation
22.1.3.2 Living Donor Transplantation
22.2 Role of the Pathologist in Pancreas Transplantation
22.3 Pathologic Alterations Related to Operative Complications, and Examination and Findings in Failed Allografts
22.3.1 Surgical Procedure of Pancreas Transplantation
22.3.2 Surgical Complications of Pancreas Transplantation
22.3.3 Vascular Thrombosis
22.3.4 Examination of the Failed Allograft
22.3.4.1 Macroscopic Examination
22.3.4.2 Macroscopic Pathologic Findings in Vascular Thrombosis
22.3.4.3 Histopathologic Findings in Vascular Thrombosis
22.3.5 Post-Transplant Ischemic and Infectious Pancreatitis
22.3.6 Post-Transplant Ischemia/Reperfusion Injury
22.4 Core Biopsy Specimens in Pancreas Transplantation: Procedures and Technical Aspects
22.4.1 Surrogate Biopsy Options to Assess Rejection in the Pancreas Allograft
22.4.2 Protocol or Surveillance, and Post-Therapy Core Biopsies
22.4.3 Pancreas Allograft Core Biopsy: Handling and Processing
22.4.3.1 Adequacy of the Pancreas Allograft Core Biopsy
22.5 Pancreas Allograft Rejection
22.5.1 Antibody-Mediated Rejection (AMR)
22.5.1.1 Hyperacute Rejection
22.5.1.2 Acute Antibody-Mediated Rejection AMR
Pathologic Features of Acute AMR
Histopathologic Grading of Acute AMR
Immunohistochemistry for C4d in Pancreas Allografts
Reporting Nomenclature for AMR
22.5.1.3 Chronic Active Antibody-Mediated Rejection
22.5.1.4 Mixed AMR and ACR
22.5.2 Acute Cellular Rejection (ACR)
22.5.2.1 Clinical and Laboratory Features of ACR
22.5.2.2 Histopathologic Findings of ACR in the Pancreas Allograft
22.5.2.3 Grading of ACR in the Pancreas Allograft
22.5.2.4 Chronic Active Cell-Mediated Rejection
22.5.3 Chronic Rejection or graft sclerosis in the pancreas allograft
22.5.3.1 Clinical and Laboratory Features of Cellular Rejection (CR)
22.5.3.2 Histopathologic Features of CR
22.5.3.3 Staging of CR in the Pancreas Allograft
22.5.3.4 Chronic Allograft Arteriopathy in the Pancreas Allograft
22.5.4 Differential Diagnosis of Forms of Rejection, and Distinction from Other Entities Encountered in Core Biopsies
22.6 Infections in Pancreas Allografts
22.7 Recurrent Autoimmune Isletitis (Insulitis) and Diabetes Mellitus
22.7.1 Pathologic Findings in Recurrent Autoimmune Isletitis
22.8 Acute Islet Cell Toxicity from Calcineurin Inhibitors
22.9 Reporting Checklists
References
Part VI: Frozen Section
23: The Role of Frozen Section
23.1 Excluding a Metastasis
23.1.1 Liver Lesions
23.1.1.1 Bile Duct Hamartoma
23.1.1.2 Bile Duct Adenoma (Peribiliary Gland Hamartoma)
23.1.1.3 Focal Nodular Hyperplasia
23.1.1.4 Reactive Ductular Proliferation
23.1.1.5 Metastatic Pancreatic Adenocarcinoma
23.2 Pancreatic Ductal Adenocarcinoma Versus Chronic Pancreatitis
23.2.1 Major Criteria
23.2.1.1 Nuclear Size Variation Equal to, or Greater than, 4:1
23.2.1.2 Incomplete Glandular Lumina
23.2.1.3 Disorganized Duct Distribution
23.2.2 Minor Criteria
23.2.2.1 Huge Irregular Epithelial Nucleoli
23.2.2.2 Necrotic Glandular Debris
23.2.2.3 Glandular Mitoses
23.2.2.4 Glands Unaccompanied by Stroma in Smooth Muscle Fascicles
23.2.2.5 Perineural Invasion
23.3 Assessing Margin Status
23.3.1 Transection Margin for Pancreatic Ductal Adenocarcinoma
23.3.2 Margin Status for Intraductal Papillary Mucinous Neoplasia (see Chap. 17)
23.3.3 Margin Status for Other Pancreatic Neoplasms
References
Part VII: Cytology
24: The Role of Cytology
24.1 Tissue Acquisition
24.1.1 EUS-Guided Tissue Acquisition
24.1.2 ERCP-Guided Tissue Acquisition
24.1.3 The Non-Diagnostic FNA
24.1.4 Rapid On-Site Evaluation (ROSE)
24.2 Sample Preparation
24.2.1 Cyst Fluids
24.2.2 Solid Lesions
24.2.3 Brush Cytology Specimens
24.3 Microscopic Evaluation
24.3.1 Terminology
24.3.2 Contaminants
24.3.3 Solid Lesions
24.3.3.1 Pancreatic Ductal Adenocarcinoma (see Chap. 9)
24.3.3.2 Pancreatic Neuroendocrine Tumor (see Chap. 20)
24.3.3.3 Acinar Cell Carcinoma (see Chap. 10)
24.3.3.4 Solid Pseudopapillary Neoplasm (see Chap. 18)
24.3.3.5 Autoimmune Pancreatitis (see Chap. 7)
24.3.3.6 Chronic Pancreatitis (see Chap. 7)
24.3.3.7 Paraduodenal (Groove) Pancreatitis (see Chap. 7, Sect. 7.2.8)
24.3.3.8 Intrapancreatic Common Bile Duct Carcinoma
24.3.4 Cystic Lesions (see Chaps. 14 and 19)
24.3.4.1 Mucinous Cystic Lesions
Low-Grade Neoplastic Mucinous Cysts
High-Grade Neoplastic Mucinous Cysts
High-Grade Neoplastic Mucinous Cysts with Invasive Carcinoma
24.3.4.2 Nonmucinous Cysts (Fig. 24.17)
Serous Cystic Neoplasms (see Chap. 15)
Other Types of Cysts (see Chap. 19)
24.4 Metastases
24.5 Molecular Testing in Pancreatobiliary Cytology
References
Appendix: WHO Classification of Tumors of the Pancreas 2019
Benign Epithelial Tumors and Precursors
Malignant Epithelial Tumors
Pancreatic Neuroendocrine Neoplasms
Index
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