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Table 1 Differential diagnosis of malignant pancreatic neoplasms. Overview of pancreatic neoplasms with their relative prevalence, direction of differentiation, macroscopic and microscopic appearance, and immunohistochemical markers

From: Surgical and molecular pathology of pancreatic neoplasms

  Prevalence (% of all malignant pancreatic tumors) Mean Age (SD) in years Sex predominance Direction of differentiation Ductal/acinar/endocrine Gross: Solid/solid and cystic/cystic Microscopic Immunohistochemical
Pancreatic ductal adenocarcinoma 90 % 66 (11) Male (3:2) Ductal Solid • Glandular and ductal structures
• Abundant desmoplastic stroma
• Eosinophilic to clear cytoplasm and enlarged pleomorphic nuclei
• Perineural, lymphatic and blood vessel invasion
Aberrant TP53 expression, SMAD4 loss, expression of MUC1, MUC3, MUC4, MUC5AC, CA19-9
Pancreatic neuroendocrine tumor/carcinoma 5 % 58 (15) Male (3:2) Endocrine Solid, sometimes cystic degeneration • Nested or trabecular growth pattern
• Granular amphophilic to eosinophilic cytoplasm
• “Salt and pepper” chromatin
Expression of synaptophysin and chromogranin, peptide hormones (e.g. insulin and glucagon), aberrant nuclear TP53 expression in PanNECs
Solid-pseudopapillary neoplasm 1–2 % 29 (14) Female (9:1) Uncertain Solid and cystic • Poorly cohesive uniform cells
• Extensive degenerative changes.
• Eosinophilic or clear vacuolated cytoplasm Round to oval nuclei, often grooved or indented.
• Eosinophilic globules and foamy macrophages
Abnormal nuclear labeling for β-catenin, expression of CD10, paranuclear dot-like CD99 labeling or lymphoid enhancer-binding factor 1 (LEF1). Loss of membranous E-cadherin
Acinar cell Carcinoma 1–2 % 56 (15) 6 % between 8 and 15 Male (2:1) Acinar Solid, sometimes cystic degeneration • Enlarged uniform nuclei with prominent nucleoli
• Finely granular eosinophilic cytoplasm.
• Small acinar units or sheets
BCL10, expression of pancreatic exocrine enzymes: trypsin, chymotrypsin, lipase
Pancreatoblastoma <1 % 5 (2), second peak around 40 Slightly male Acinar Solid, cystic in BWS a • Similar to ACC
• Squamoid nests required for diagnosis
• Neuroendocrine or ductal component.
Expression of pancreatic exocrine enzymes, BCL10, SMAD4 loss, Abnormal nuclear labeling for β-catenin
  1. a BWS Beckwith-Wiedemann syndrome