Surgical Pathology Criteria

Mucinous Cystic Neoplasm of the Pancreas

Grading / Staging / Report
  • Grading
    • Adenoma grade
      • Single layer of mucinous columnar cells
      • Flat or irregular undulations
        • No well formed papillae
      • No cytologic atypia
    • Borderline grade
      • Papillary projections
      • Pseudostratification
      • Nuclear crowding
      • Moderate cytologic atypia
        • Irregular hyperchromatic nuclei
        • One or more nucleoli
      • May be focal
    • Carcinoma in situ grade
      • Multilayered epithelium
      • Cribriform architecture
      • Marked nuclear pleomorphism
      • Frequent mitotic figures
      • Loss of intracytoplasmic mucin
      • May be focal
  • Staging is not relevant unless invasive carcinoma is present
    • If present, follow TNM staging for carcinoma
  • Report
    • Grade
    • Presence or absence of invasive carcinoma
      • Give type and size
    • For noninvasive lesions
      • Note that there appears to be about a 5% risk of developing carcinoma even if margins negative
      • Suggest clinical followup

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