Surgical Pathology Criteria

Intraductal Tubular Carcinoma of the Pancreas

Differential Diagnosis

Intraductal Tubular Adenoma Intraductal Tubular Carcinoma
Composed of mucin positive pyloric type cells Generally mucin poor or negative
Frequent goblet cells No goblet cells
Low grade atypia High grade atypia
Mitotic rate 1-5/50 hpf Mitotic rate frequently >5/50 hpf
No necrosis Frequent necrosis
Not associated with invasive carcinoma May have associated invasive carcinoma
Intraductal tubular adenoma and carcinoma do not appear to be related

Intraductal Tubular Carcinoma Mucinous Cystic Neoplasm of the Pancreas
Nodular intraductal growth Mucin filled cyst or cysts
Males and females affected Nearly all female
Involves segments of ducts Does not communicate with ducts
Extensive tubule formation No tubules
No ovarian type stroma Ovarian type stroma

Intraductal Tubular Carcinoma PanIN
Usually clinically detectable Usually not clinically detectable
Grossly visible Not grossly visible
Well formed tubules No well formed tubules

Intraductal Tubular Carcinoma Intraductal Papillary Mucinous Neoplasm
Nodular indtraductal growth dilates duct locally Distended ducts filled with mucin
Tubular or tubulopapillary pattern Papillary pattern
Cuboidal to columnar cells without cytoplasmic mucin Columnar mucin filled cells (may lose mucin if high grade)
Uniform high grade atypia Atypia may vary from low to high
Necrosis common Necrosis rare
No goblet, neuroendocrine or paneth cells May have scattered goblet, neuroendocrine or paneth cells
MUC2, MUC5AC, Fascin negative MUC2, MUC5AC, Fascin positive
KRAS wild type KRAS frequently mutated

Intraductal Tubular Carcinoma Intraductal Oncocytic Papillary Neoplasm
Tubular or tubulopapillary pattern Papillary and solid patterns
Lacks granular cytoplasm Eosinophilic granular cytoplasm
No goblet cells Goblet cells frequently present
PASd negative or weak PASd positive
MUC2, MUC5AC negative MUC2, MUC5AC positive

Intraductal Tubular Adenoma Acinar Cell Carcinoma of the Pancreas (Intraductal Variant)
Trypsin negative Trypsin positive
PASd negative to weak/focal PASd positive
These may be indistinguishable by standard microscopy

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