Pathology of exocrine pancreatic neoplasms
- Daniel S Longnecker, MD
Daniel S Longnecker, MD
- Professor Emeritus
- Dartmouth Medical School
The pancreas gives rise to several malignant and benign neoplasms. At the histologic level, neoplasms of the pancreas can resemble normal ductal cells, acinar cells, or islet cells. In addition, some pancreatic neoplasms appear to arise from primitive cells that have the potential to differentiate along several lines, giving rise to complex tumors with mixed cell types (eg, pancreatoblastoma).
Pancreatic cancer ranks fourth among cancers as a cause of death (both sexes) in the United States, surpassed only by lung, colon, and breast cancers . The commonly used terms "carcinoma of the pancreas" or "pancreatic cancer" usually refer to ductal adenocarcinoma (including its subtypes), which represents approximately 85 percent of all pancreatic neoplasms. Of the several subtypes of ductal adenocarcinoma, most share a similar poor long-term prognosis, with the exception of colloid carcinomas, which have a somewhat better prognosis.
The more inclusive term "exocrine pancreatic neoplasms" includes all tumors that are related to the pancreatic ductal and acinar cells and their stem cells (including pancreatoblastoma). More than 95 percent of malignant neoplasms of the pancreas arise from the exocrine elements. Neoplasms arising from the endocrine pancreas (ie, islet cell tumors) comprise no more than 5 percent of pancreatic neoplasms .
Although the incidence of pancreatic cancer has been relatively stable over time, the increasing use of imaging techniques such as endoscopic ultrasound and helical (spiral) abdominal computed tomography (CT) scans has revealed an increasing number of incidentally found cystic lesions in the pancreas, many of which are neoplasms. This has focused attention on the diagnosis and management of cystic neoplasms of the pancreas.
Of the cystic neoplasms that arise in the pancreas, some (eg, intraductal papillary mucinous neoplasms [IPMN]) have a significant malignant potential (30 to 40 percent in reported series) while others (eg, serous cystadenomas) almost always remain benign. The distinction on clinical grounds between these two types of neoplasms, other cystic neoplasms, and other nonneoplastic cystic pancreatic masses (pseudocysts and developmental cysts) can be difficult. The exclusion of malignancy in a cystic pancreatic lesion often requires surgical resection and histopathological evaluation . (See "Classification of pancreatic cysts" and "Intraductal papillary mucinous neoplasm of the pancreas (IPMN): Pathophysiology and clinical manifestations".)
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- Premalignant lesions
- PANCREATIC DUCTAL ADENOCARCINOMA
- Gross pathology
- Histology and grading
- Patterns of local spread
- PANCREATIC INTRAEPITHELIAL NEOPLASIA
- OTHER NEOPLASMS
- Intraductal papillary-mucinous neoplasms (IPMN)
- - Histology and grading
- Mucinous cystic neoplasms (MCN)
- - Histology and grading
- Serous cystadenoma
- Solid pseudopapillary neoplasms (SPN)
- Acinar cell carcinoma
- Other rare types