Pancreatic Pathology: A Practical Review

Given advances in diagnostic imaging and surgical technique, a variety of neoplastic and non-neoplastic pancreatic lesions are increasingly encountered in clinical practice. The distinction of these lesions has significant therapeutic and prognostic implications. Herein, we review the major clinicoepidemiologic and pathologic features of ductal adenocarcinoma, pancreatic cystic neoplasia, pancreatic endocrine tumor, and related lesions. Emphasis is placed on frozen-section diagnosis and differential diagnostic features. Also, potential diagnostic pitfalls are highlighted, such that they may be avoided. After reading this article, readers should be able to discuss ductal adenocarcinoma, in particular histologic features useful in frozen section evaluation and in its distinction from chronic pancreatitis; recognize distinguishing features of neoplastic and non-neoplastic pancreatic cysts, particularly those useful in the separation of the mucin-producing cystic neoplasms; and describe the clinical, histologic, and immunophenotypic features of the cellular epithelioid tumors including pancreatic endocrine tumor, solid pseudopapillary tumor, acinar cell carcinoma, and pancreatoblastoma.