Well Differentiated Pancreatic Endocrine Neoplasm
Grading / Staging / Report
- Two currently accepted grading schemes for pancreatic endocrine tumors:
- WHO System
- Well-differentiated pancreatic endocrine tumor
- “Benign” behavior: confined to pancreas, no vascular or perineural invasion, <2 cm, and <2 MF/10 HPF
- Uncertain behavior: confined to pancreas, vascular and/or perineural invasion, >2cm, or 2-10 MF/10 HPF
- Well differentiated pancreatic endocrine carcinoma
- Gross local invasion or metastases
- Memorial Sloan Kettering System
- Low grade pancreatic endocrine neoplasm
- No necrosis and <2 MF/50 HPF
- Intermediate grade pancreatic endocrine neoplasm
- Necrosis or between 2 to 50 MF/50 HPF
- Same TNM staging as exocrine pancreas, based on:
- Size (2 cm)
- Extrapancreatic extension
- Invasion of adjacent structures
- Relevant prognostic features that should be reported
- Size
- 2 and 4 cm have been proposed as significant cutoffs
- Presence or absence of extra-pancreatic invasion
- Presence or absence of vascular invasion
- Lymph node status
- Functional status, if known
