Surgical Pathology Criteria

Ductal Adenocarcinoma of the Pancreas

Differential Diagnosis

Chronic Pancreatitis Ductal Adenocarcinoma of the Pancreas
Lobular architecture preserved Haphazard infiltrative pattern
Tubular or oval shape of ducts Irregularly shaped ducts
Ductal epithelial lining intact Partial / incomplete ducts may be seen
Ducts accompanied by islets and/or thick fibrous tisue Bare ducts in fat with only thin rim of fibromuscular tissue
Acini or stroma between ducts and muscular vessels Ducts adjacent to muscular vessels
Perineural invasion very rare Perineural invasion may be present
Little variation in nuclear size Nuclear size variation of >4:1 may be seen
Nucleoli may be moderately enlarged Nucleoli may exceed 1/4 of nuclear diameter


Lymphoplasmacytic Sclerosing Pancreatitis (Autoimmune Type 1) Ductal Adenocarcinoma of the Pancreas
Prominent lymphoplasmacytic infiltrate Inflammation not a prominent part of mass
No infiltrative pattern of ducts Infiltrative pattern prominent
Elevated serum IgG4 No elevation of IgG4
Immunohistologic demonstration of >30 IgG4 plasma cells per hpf Few IgG4 plasma cells
More of a gross problem than a microscopic problem


Acinar Cell Carcinoma of the Pancreas Ductal Adenocarcinoma of the Pancreas
Granular cytoplasm Mucinous cytoplasm
Nuclei round, usually basal, at most moderately pleomorphic Pleomorphic nuclei, may be variably located
Usually solid or acinar formations Large, irregular open ductal formations
Lobular pattern without desmoplastic stroma Desmoplastic stroma
Single, large, central nucleoli Nucleoli variable
BCL10, trypsin, chymotrypsin positive BCL10, trypsin, chymotrypsin negative
Mixed patterns may occur


Pancreatoblastoma Ductal Adenocarcinoma of the Pancreas
Predominantly pediatric but 1/3 in adults Very rare under age 20
Foci of squamoid nests No squamoid nests
Prominent acinar differentiation No acinar differentiation
Ductal differentiation usually focal Predominant ductal differentiation
May have primitive round cell component No primitive round cell component


Medullary Carcinoma of the Pancreas Poorly Differentiated Ductal Adenocarcinoma of the Pancreas
Pushing border Infiltrative border
Syncitial pattern Usually has more distinct cell borders
May show microsatellite instability and/or mismatch repair deficiency Not associated with mismatch repair defects


Other periampullary carcinomas

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