Surgical Pathology Criteria

Solid-pseudopapillary Neoplasm of the Pancreas

Differential Diagnosis

Well Differentiated Pancreatic Neuroendocrine (Islet Cell) Tumor Solid Pseudopapillary Neoplasm of the Pancreas
Lacks pseudopapillary architecture Frequent pseudopapillary architecture
Chromogranin usually strongly positive Chromogranin focal to negative
Keratin positive Keratin variable
Galectin 3 negative Galectin 3 positive (small numbers)
Vimentin, CD10 negative Vimentin, CD10 positive
Nuclear beta catenin negative Nuclear beta catenin positive
No PAS+ granules in cytoplasm PAS+ granules may be present
CD99 variable but not paranuclear dots CD99 paranuclear dots (one report)
Solid pseudopapillary neoplasm may be synaptophysin positive

Acinar Cell Carcinoma of the Pancreas Solid Pseudopapillary Neoplasm of the Pancreas
Predominantly male Overwhelmingly female
Granular PASd+ cytoplasm PASd+ only scattered globules
Beta-catenin/CD56/CD10 negative Beta-catenin/CD56/CD10 positive
BCL10, trypsin, chymotrypsin positive BCL10, trypsin, chymotrypsin negative
Alpha 1 antitrypsin negative Alpha 1 antitrypsin positive
Keratin positive Keratin variable
Usually infiltrative Usually circumscribed
Lacks pseudopapillary architecture Frequent pseudopapillary architecture
May have true lumens No true lumens
Frequently increased mitotic figures Infrequent mitotic figures
CD99 negative CD99 paranuclear dots (one report)

Serous Microcystic Adenoma Solid Pseudopapillary Neoplasm of the Pancreas
True cysts lined by a single layer of cells Variable thickness of lining of degenerate spaces
Occurs in males and females Nearly all female
Median age 60's Mean age 20's
Glycogen positive Glycogen negative
Keratin positive Keratin variable
Clear cell variant of solid pseudopapillary neoplasm is also reported to be glycogen negative

Serous Macrocystic / Oligocystic Adenoma Solid Pseudopapillary Neoplasm of the Pancreas
True cysts lined by a single layer of cells Variable thickness of lining of degenerate spaces
Occurs in males and females Nearly all female
Glycogen positive Glycogen negative
Keratin positive Keratin variable
Clear cell variant of solid pseudopapillary neoplasm is also reported to be glycogen negative

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