Reporting precursors to invasive pancreatic cancer: pancreatic intraepithelial neoplasia, intraductal neoplasms and mucinous cystic neoplasm Roeland.

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Reporting precursors to invasive pancreatic cancer: pancreatic intraepithelial neoplasia, intraductal neoplasms and mucinous cystic neoplasm Roeland F. de Wilde, Ralph H. Hruban, Anirban Maitra, G. Johan A. Offerhaus Diagnostic Histopathology Volume 18, Issue 1, Pages 17-30 (January 2012) DOI: 10.1016/j.mpdhp.2011.10.012 Copyright © 2011 Elsevier Ltd Terms and Conditions

Figure 1 Progression of pancreatic intraepithelial neoplasia (PanIN) lesions. (a) Normal pancreatic duct lined by cuboidal epithelium without atypia. (b) PanIN-1A lesion featuring flat columnar, mucinous epithelium with basally-oriented nuclei with only minimal cytological atypia. (c) PanIN-2 lesion with papillary architecture, pseudostratified tall columnar epithelium and moderate architectural and cytological atypia. (d) PanIN-3 lesion with significant architectural and cytological atypia, i.e. note the cribriform areas and budding off of clusters of cells as well as the enlarged, hyperchromatic nuclei with loss of polarity. (e) Moderately differentiated invasive pancreatic ductal adenocarcinoma (note the abundant stroma). (f) Lobulocentric atrophy surrounding a pancreatic duct with low-grade PanIN. Diagnostic Histopathology 2012 18, 17-30DOI: (10.1016/j.mpdhp.2011.10.012) Copyright © 2011 Elsevier Ltd Terms and Conditions

Figure 2 Branch-duct IPMN located in the body of the pancreas where a single cyst is visible with flat lining. The main pancreatic duct (arrows) is not involved and is dilated at the level of the IPMN. Note that the cyst wall is relatively simple without mural nodules. Diagnostic Histopathology 2012 18, 17-30DOI: (10.1016/j.mpdhp.2011.10.012) Copyright © 2011 Elsevier Ltd Terms and Conditions

Figure 3 Histology of intraductal papillary mucinous neoplasm (IPMN) lesions. (a) Low-grade gastric-type IPMN. (b) Intestinal-type IPMN with high-grade dysplasia. (c) High-grade pancreatobiliary IPMN with cuboidal neoplastic epithelium forming complex papillae. (d) An IOPN composed of cells with abundant cytoplasm. Diagnostic Histopathology 2012 18, 17-30DOI: (10.1016/j.mpdhp.2011.10.012) Copyright © 2011 Elsevier Ltd Terms and Conditions

Figure 4 Histologic feature of a high-grade ITPN with cribriform architecture and minimal mucin production. Diagnostic Histopathology 2012 18, 17-30DOI: (10.1016/j.mpdhp.2011.10.012) Copyright © 2011 Elsevier Ltd Terms and Conditions

Figure 5 A gross zoomed image of a sectioned mucinous cystic neoplasm (MCN) containing thick septae (arrows) and numerous cystic lesions containing mucinous nonhaemorrhagic fluid. Note the smooth glistering surface of the lesion and absence of papillary projections. Diagnostic Histopathology 2012 18, 17-30DOI: (10.1016/j.mpdhp.2011.10.012) Copyright © 2011 Elsevier Ltd Terms and Conditions

Figure 6 Histological features of different grades of dysplasia of mucinous cystic neoplasms (MCNs). (a) MCN with high-grade dysplasia (upper part) and adjacent low-grade dysplasia (asterisk in lumen). (b) Intermediate-grade MCN with prominent ovarian-type stroma (arrows). (c) MCN with high-grade dysplasia. Note the papillary architecture with significant nuclear atypia and loss of polarity. (d) Intermediate-grade (top cyst) and high-grade (lower cyst) dysplasia in one MCN. Diagnostic Histopathology 2012 18, 17-30DOI: (10.1016/j.mpdhp.2011.10.012) Copyright © 2011 Elsevier Ltd Terms and Conditions