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 |
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 |
These may be indistinguishable by standard microscopy
