Intraductal Papillary Mucinous Neoplasm of the Pancreas
Grading / Staging / Report
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Grading
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IPMN adenoma grade
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Tall columnar cells
- Basal nucleli
- Abundant supranuclear mucin
- Usually gastric type epithelium
- Involves branch ducts more than main duct
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IPMN borderline grade
- Increased architectural complexity
- Maintains identifiable stroma cores in papillae
- Moderate loss of polarity and pseudostratification
- Moderate nuclear enlargement and hyperchromasia
- Usually intestinal or pancreato-biliary epithelium
- Commonly involves main duct
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IPMN carcinoma-in-situ grade
- Cribriform pattern
- Budding of small clusters of epithelial cells into the lumen
- Frequent lumenal necrosis
- Severe loss of nuclear polarity
- Celllular pleomorphism
- Lumenal mitotic activity
- Intracytoplasmic mucin may be depleted
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Usually lined by intestinal or pancreatobiliary epithelium
- Commonly involves main duct
- Staging is not relevant unless invasive carcinoma is present
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Report
- Grade
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Presence or absence of invasive carcinoma
- Margin status for both invasive carcinoma and IPMN
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For noninvasive lesions
- Note that there appears to be about a 5% risk of developing carcinoma even if margins negative
- Suggest clinical followup
