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  • Surgical Pathology Criteria

    Intraductal Oncocytic Papillary Neoplasm of the Pancreas


    • Cystic lesion of the pancreatic ducts containing papillary proliferations of oncocytic cells

    Alternate/Historical Names

    Diagnostic Criteria

    • Unilocular or multilocular cysts formed by dilated ducts
      • Communication with ducts may be difficult to identify
    • Variably complex intraluminal papillary proliferations
      • Usually complex arborizing branching
      • Usually with thin fibrovascular cores
    • Lining ranges from simple to stratified to fused solid areas
      • Non-papillary areas lined by flattened or cuboidal epithelium
    • Cysts and papillae lined by oncocytic cells
      • Oxyphilic granular cytoplasm
      • Scattered goblet cells frequently seen
    • Intracytoplasmic lumens frequent
      • Lumens in solid areas create a cribriform pattern
    • Large round uniform nuclei
      • Prominent nucleoli
      • Mitotic figures may be up to 5/hpf
    • Paucicellular stroma
      • Frequently hyalinized
    • Infrequent findings
      • Psammoma bodies
      • Focal squamous metaplasia
      • Acellular mucin lakes
      • Focal severe cytologic atypia
    • Locally invasive carcinoma reported in 2/11 cases
      • Composed of similar cells
      • No cancer related deaths yet reported
    • Age range 39-78

    Robert V Rouse MD
    Department of Pathology
    Stanford University School of Medicine
    Stanford CA 94305-5342

    Original posting/updates: 1/3/09, 1/2/12

    Supplemental studies


    PASd or mucicarmine Intracytoplasmic lumens and goblet cells positive
    PTAH or Novelli stain Positive (mitochondria)
    B72.3 Positive
    MUC1, MUC2, MUC5AC Positive
    CEA Occasional weak staining of intracytoplasmic lumens
    Synaptophysin 1/11 positive
    Chromogranin 1/11 positive
    CA19-9 1/11 positive

    Genetic studies

    • IOPN lacks the KRAS mutation frequently found in IPMN

    Differential Diagnosis

    Mucinous Cystic Neoplasm of the Pancreas Intraductal Oncocytic Papillary Neoplasm
    Lacks oncocytic epithelium Oncocytic epithelium
    Lacks intracytoplasmic lumens and cribriform pattern Prominent cribriform pattern formed by intracytoplasmic lumens
    Complex papillae not seen Complex arborizing papillae
    Cellular ovarian type stroma Paucicellular stroma
    No communication with ducts Communicates with duct system


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