Surgical Pathology Criteria

Pancreatic Intraepithelial Neoplasia

Differential Diagnosis

Normal Duct PanIN
Cuboidal to low columnar lining Tall columnar lining
Amphophilic cytoplasm Abundant supranuclear mucin
Regular bland nuclei May show nuclear crowding and atypia

Reactive Duct PanIN
Round smooth nuclei Nuclei may show irregularity
Basally oriented nuclei May have pseudostratified or stratified nuclei
Eosinophilic cytoplasm Abundant supranuclear mucin
No micropapillary architecture May be micropapillary

Cancerization of Duct by Invasive Ductal Carcinoma PanIN, Grade 3
Abrupt transition of neoplastic to normal Gradual transition
May be continuous with invasive carcinoma Not continuous with invasive carcinoma

Intraductal Papillary Mucinous Neoplasm PanIN
Usually clinically detectable Usually not clinically detectable
Grossly visible Not grossly visible
May have well formed papillae No well formed papillae
May be associated with colloid carcinoma No association with colloid carcinoma
MUC2 or CDX2 may be positive MUC2 and CDX2 negative

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