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 |