Surgical Pathology Criteria–

Pancreatoblastoma

Differential Diagnosis

Acinar Cell Carcinoma of the Pancreas Pancreatoblastoma
Typically older patients (40-70 years), rare in children 2/3 <5 years, adult cases mean age 40
Lacks squamoid nests Squamoid nests present
Distinction may not be critical in adults as both are aggressive in adults

 

Pancreatoblastoma Adenosquamous Carcinoma of the Pancreas
Predominantly pediatric but 1/3 in adults Not reported under age 20
Prominent acinar differentiation No acinar differentiation
May have primitive round cell component No primitive round cell component

 

Pancreatoblastoma Solid Pseudopapillary Neoplasm of the Pancreas
Both male and female Overwhelmingly female
2/3 <5 years of age Very rare <5
Trypsin, chymotrypsin positive Trypsin, chymotrypsin negative
Keratin positive Keratin variable
Lacks pseudopapillary architecture Frequent pseudopapillary architecture
May have true lumens No true lumens
Squamoid nests always present Lacks squamous differentiation
Frequently increased mitotic figures Infrequent mitotic figures

 

Pancreatoblastoma Well Differentiated Pancreatic Neuroendocrine (Islet Cell) Tumor
Trypsin, chymotrypsin positive Trypsin, chymotrypsin negative
Squamoid nests always present Lacks squamous differentiation
Usually prominent nucleoli Salt and pepper chromatin
Chromogranin, synaptophysin scattered positive Chromogranin or synaptophysin widespread staining
Islet polypeptide markers negative or very focal Islet polypeptide markers frequently positive
Cellular stroma frequent Lacks cellular stroma

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