Pathology of the Pancreas. A Practical Approach

Preface
Acknowledgements
Contents
Part I: General Principles
	1: Embryology, Anatomy, and Histology
		1.1	 Introduction
		1.2	 Embryology
			1.2.1	 Development of the Ventral and Dorsal Pancreatic Primordia
			1.2.2	 Pancreatic Organogenesis
			1.2.3	 Lineage Commitment
		1.3	 Anatomy
			1.3.1	 Pancreas
				1.3.1.1	 General Considerations
				1.3.1.2	 Anatomical Relationship to Neighboring Structures
				1.3.1.3	 The Pancreatic Duct System
			1.3.2	 Common Bile Duct
			1.3.3	 Ampulla and Papilla of Vater
			1.3.4	 Minor Ampulla
			1.3.5	 Vasculature
			1.3.6	 Lymph Nodes
		1.4	 Histology
			1.4.1	 Pancreatic Lobules
			1.4.2	 Acinar Cells
			1.4.3	 Pancreatic Duct System
			1.4.4	 Endocrine Compartment: Islets of Langerhans and Extrainsular Endocrine Cells
			1.4.5	 Interstitium
			1.4.6	 Peripancreatic Soft Tissue
			1.4.7	 Major Ampulla and Papilla
			1.4.8	 Minor Ampulla and Papilla
			1.4.9	 Common Bile Duct
		References
			Further Reading
	2: Pancreatic Specimen Types
		2.1	 Pancreatoduodenectomy Specimens
		2.2	 Distal Pancreatectomy Specimens
		2.3	 Total Pancreatectomy Specimens
		2.4	 Duodenum-Preserving Pancreatic Resection Specimens
		2.5	 Complex Multivisceral En Bloc Resection Specimens
		2.6	 Central Pancreatectomy Specimens
		2.7	 Enucleation Specimens
		2.8	 Specimens Following Frey, Beger, or Puestow Procedures
		2.9	 Laparoscopic and Robot-Assisted Resection Specimens
		2.10	 Pancreas Allograft
		Further Reading
	3: Specimen Dissection and Sampling
		3.1	 Handling of Fresh Specimens
		3.2	 Specimen Fixation
		3.3	 Macroscopic Examination of Pancreatoduodenectomy Specimens
			3.3.1	 Dissection Techniques
				3.3.1.1	 Bivalving or Multivalving Technique
				3.3.1.2	 Bread Loaf Slicing Technique
				3.3.1.3	 Axial Slicing Technique
			3.3.2	 Inking of Surfaces
			3.3.3	 Stents, Coils, and Glues
			3.3.4	 Axial Specimen Slicing
			3.3.5	 Identification of Anatomy and Margins in Axial Specimen Slices
				3.3.5.1	 Pancreatic Duct System, Bile Duct, and Ampullae
				3.3.5.2	 Arteries and Veins
				3.3.5.3	 Specimen Surfaces and Margins
				3.3.5.4	 Lymph Nodes
			3.3.6	 Photodocumentation
			3.3.7	 Macroscopic Description: How and What to Record
			3.3.8	 Tissue Sampling
		3.4	 Dissection of Distal Pancreatectomy Specimens
		3.5	 Dissection of Total Pancreatectomy Specimens
		3.6	 Dissection of Multivisceral En Bloc Resection Specimens
		3.7	 Dissection of Other Pancreatic Specimen Types
		3.8	 Handling of Pancreatic Biopsies
		3.9	 Reporting Checklist of Macroscopic Findings
		References
	4: The Pancreatic Multidisciplinary Team
		4.1	 Discussion of Postoperative Cases
		4.2	 Discussion of Pretreatment Cases
		4.3	 Other Roles and Responsibilities
		Reference
Part II: Exocrine Pancreas: Non-Cystic
	5: Common Minor Changes
		5.1	 Acinar Cell Nodules
		5.2	 Acinar Dilatation
		5.3	 Acinar to Ductal Metaplasia
		5.4	 Duct Epithelial Metaplasia
		5.5	 Lobulocentric Atrophy
		5.6	 Age-Related Alterations
		5.7	 Fatty Replacement
		5.8	 Changes in Islets
		5.9	 Autolytic Change
		References
	6: Hereditary Exocrine Disorders
		6.1	 Cystic Fibrosis
			6.1.1	 Macroscopy
			6.1.2	 Microscopy
		6.2	 Hereditary Hemochromatosis
			6.2.1	 Macroscopy
			6.2.2	 Microscopy
		6.3	 Hereditary Pancreatitis
			6.3.1	 Clinical Features
			6.3.2	 Diagnostic Criteria
			6.3.3	 Pathology
			6.3.4	 Cancer Risk
			6.3.5	 Management
		6.4	 Inherited Pancreatic Cancer
			6.4.1	 Pathology
		6.5	 Familial Pancreatic Cancer
			6.5.1	 Cancer Risk
			6.5.2	 Clinical Features, Pathology, and Prognosis
		6.6	 Screening High-Risk Individuals
		References
	7: Inflammatory Disorders
		7.1	 Acute Pancreatitis
			7.1.1	 Definition and Clinical Features
			7.1.2	 Etiology
			7.1.3	 Macroscopy
			7.1.4	 Microscopy
			7.1.5	 Complications
		7.2	 Chronic Pancreatitis
			7.2.1	 Definition and Clinical Features
			7.2.2	 Etiology
			7.2.3	 Macroscopy
			7.2.4	 Microscopy
			7.2.5	 Complications
			7.2.6	 Forms of Chronic Pancreatitis with Nonspecific Morphology
				7.2.6.1	 Alcohol-Related Pancreatitis
				7.2.6.2	 Hereditary Pancreatitis
				7.2.6.3	 Tropical Pancreatitis
				7.2.6.4	 Obstructive Pancreatitis
			7.2.7	 Autoimmune Pancreatitis
				7.2.7.1	 Definition, Epidemiology, and Clinical Features
				7.2.7.2	 Etiology
				7.2.7.3	 Macroscopy
				7.2.7.4	 Microscopy
				7.2.7.5	 Unusual Histological Features in AIP
				7.2.7.6	 AIP Not Otherwise Specified (NOS)
				7.2.7.7	 IgG4 Immunohistochemistry
				7.2.7.8	 Differential Diagnosis
				7.2.7.9	 Diagnostic Criteria and Algorithms
				7.2.7.10	 IgG4-Related Systemic Disease
			7.2.8	 Paraduodenal (Groove) Pancreatitis
				7.2.8.1	 Definition and Nomenclature
				7.2.8.2	 Etiopathogenesis
				7.2.8.3	 Clinical Findings
				7.2.8.4	 Macroscopy
				7.2.8.5	 Microscopy
				7.2.8.6	 Differential Diagnosis
			7.2.9	 Eosinophilic Pancreatitis
			7.2.10	 Chronic Pancreatitis and Pancreatic Cancer
		7.3	 Other Inflammatory Diseases of the Pancreas
			7.3.1	 Follicular Pancreatitis
			7.3.2	 Malakoplakia
			7.3.3	 Vasculitis and Vasculogenic Pancreatitis
			7.3.4	 Collagen Vascular Diseases
			7.3.5	 Sarcoidosis
		7.4	 Pancreatitis in Children
		7.5	 Reporting Checklist
		References
	8: Pancreatic Intraepithelial Neoplasia
		8.1	 WHO Classification
		8.2	 Classification and Microscopy
			8.2.1	 Low-grade PanIN (Figs. 8.1–8.3)
			8.2.2	 High-grade PanIN (Fig. 8.4)
		8.3	 Variants of PanIN
		8.4	 Associations
			8.4.1	 Hereditary Pancreatitis and Familial Pancreatic Cancer
		8.5	 Lobulocentric Atrophy
		8.6	 Differential Diagnosis
			8.6.1	 Intraductal Papillary Mucinous Neoplasm
			8.6.2	 Cancerization of Ducts
			8.6.3	 Intravascular Invasion of Pancreatic Ductal Adenocarcinoma
		References
			Further Reading
	9: Ductal Adenocarcinoma
		9.1	 Definition and Terminology
		9.2	 Epidemiology
		9.3	 Etiology
		9.4	 Clinical Features
		9.5	 Macroscopy
		9.6	 Microscopy
			9.6.1	 Pancreatobiliary Type
			9.6.2	 Intestinal Type
			9.6.3	 Intratumor Heterogeneity
		9.7	 Grading
		9.8	 Morphological Patterns
			9.8.1	 Foamy Gland Pattern
			9.8.2	 Clear Cell Pattern
			9.8.3	 Large Duct Pattern
			9.8.4	 Cystic Papillary Pattern
		9.9	 Immunohistochemistry
			9.9.1	 Immunohistochemical Profile
			9.9.2	 Distinction from Other Pancreatic or Extrapancreatic Neoplasms
			9.9.3	 Distinction from Reactive Pancreatic Ductules
		9.10	 Tumor Propagation
		9.11	 Staging
			9.11.1	 Staging of the Primary Tumor
			9.11.2	 Staging of Lymph Node Metastasis
			9.11.3	 Lymphatic, Vascular, and Perineural Tumor Spread
			9.11.4	 Resection Margin Status
		9.12	 Differential Diagnosis
			9.12.1	 Chronic Pancreatitis and Reactive Duct Changes
			9.12.2	 Other Pancreatic Neoplasms
				9.12.2.1	 Acinar Cell Carcinoma
				9.12.2.2	 Pancreatic Neuroendocrine Neoplasia
				9.12.2.3	 Solid Pseudopapillary Neoplasm
			9.12.3	 Adenocarcinoma of Ampullary, Distal Bile Duct, or Duodenal Origin
			9.12.4	 Metastasis from Extrapancreatic Primaries
		9.13	 Treatment and Prognosis
		9.14	 Histological Subtypes of Ductal Adenocarcinoma
			9.14.1	 Adenosquamous Carcinoma and Squamous Cell Carcinoma
			9.14.2	 Colloid Carcinoma
			9.14.3	 Signet-Ring Cell (Poorly Cohesive Cell) Carcinoma
			9.14.4	 Medullary Carcinoma
			9.14.5	 Hepatoid Carcinoma
			9.14.6	 Invasive Micropapillary Carcinoma
			9.14.7	 Undifferentiated Carcinoma
			9.14.8	 Undifferentiated Carcinoma with Osteoclast-Like Giant Cells
		9.15	 Carcinoma with Mixed Differentiation
			9.15.1	 Mixed Neuroendocrine— Non-Neuroendocrine Neoplasm (MiNEN)
		9.16	 Mixed Acinar-Ductal Carcinoma
		9.17	 Ductal Adenocarcinoma Following Neoadjuvant Treatment
			9.17.1	 Macroscopic Examination
			9.17.2	 Microscopic Examination
			9.17.3	 Vascular Resection
			9.17.4	 Staging
			9.17.5	 Tumor Regression Grading
		9.18	 Diagnostic Molecular Pathology
		9.19	 Reporting Checklist
		References
	10: Acinar Cell Carcinoma
		10.1	 WHO Classification
		10.2	 Terminology
		10.3	 Epidemiology
		10.4	 Clinical Features
			10.4.1 Associations
			10.4.2 Imaging
		10.5	 Macroscopy
			10.5.1 Sampling
		10.6	 Microscopy
		10.7	 Histochemistry
		10.8	 Immunohistochemistry
		10.9	 Molecular Pathology
		10.10	 Variants
			10.10.1 Intraductal Nodular and Papillary Variants
			10.10.2 Cystic Variant (Acinar Cell Cystadenocarcinoma)
			10.10.3 Mixed Acinar Carcinomas
		10.11	 Differential Diagnosis
			10.11.1 Pancreatic Neuroendocrine Neoplasia
			10.11.2 Solid Pseudopapillary Neoplasm
			10.11.3 Pancreatoblastoma
			10.11.4 Intraductal Papillary Neoplasms
		10.12	 Staging
		10.13	 Prognosis and Management
		10.14	 Reporting Checklist
		References
			Further Reading
	11: Non-Epithelial Neoplasia
		11.1	 Mesenchymal Neoplasms of the Pancreas
			11.1.1 Desmoplastic Small Round Cell Tumor
			11.1.2 Gastrointestinal Stromal Tumor
			11.1.3 Granular Cell Tumor
			11.1.4 Inflammatory Myofibroblastic Tumor
			11.1.5 Leiomyosarcoma
			11.1.6 Lipoma
			11.1.7 Lymphangioma
			11.1.8 Paraganglioma
			11.1.9 Perivascular Epithelioid Cell Neoplasm (PEComa)
			11.1.10 Primitive Neuroectodermal Tumor
			11.1.11 Schwannoma
			11.1.12 Solitary Fibrous Tumor
		11.2	 Lymphoma
		References
	12: Secondary Neoplasia
		12.1	 Definition
		12.2	 Clinical Features
		12.3	 Macroscopy
		12.4	 Microscopy
		12.5	 Differential Diagnosis
		12.6	 Synchronous Primary and Metastatic Cancer
		References
	13: Congenital and Developmental Abnormalities
		13.1	 Pancreas Annulare
		13.2	 Pancreas Divisum
		13.3	 Pancreatobiliary Maljunction
		13.4	 Pancreatic Heterotopia
		13.5	 Ectopic Tissue in the Pancreas
		13.6	 Benign Glandular Inclusions in Abdominal Lymph Nodes
		References
Part III: Exocrine Pancreas: Cystic
	14: Cystic Lesions: Classification and Sampling
		14.1	 Classification
		14.2	 Sampling of Cystic Lesions
		References
	15: Serous Cystic Neoplasia
		15.1	 WHO Classification
		15.2	 Terminology
		15.3	 Epidemiology
		15.4	 Clinical Features
			15.4.1 Associations
			15.4.2 Imaging
		15.5	 Classification
		15.6	 Macroscopy
			15.6.1 Microcystic Serous Cystadenoma
			15.6.2 Macrocystic Serous Cystadenoma
			15.6.3 Sampling
		15.7	 Microscopy
		15.8	 Histochemistry
		15.9	 Immunohistochemistry
		15.10	 Molecular Pathology
		15.11	 Rare Variants
			15.11.1 Solid Serous Adenoma
			15.11.2 von Hippel-Lindau Syndrome-Associated Serous Cystic Neoplasm
			15.11.3 Microcystic Serous Cystadenoma with Subtotal Cystic Degeneration
			15.11.4 Serous Cystic Neoplasm with Complex Florid Papillary Architecture
			15.11.5 Mixed Serous-Neuroendocrine Neoplasm
			15.11.6 Serous Cystadenocarcinoma
		15.12	 Differential Diagnosis
			15.12.1 Metastatic Renal Cell Carcinoma
			15.12.2 Lymphangioma
			15.12.3 Clear Cell Pancreatic Neuroendocrine Neoplasm
			15.12.4 Pseudocyst
			15.12.5 Mucinous Cystic Neoplasm
			15.12.6 Intraductal Papillary Mucinous Neoplasm
			15.12.7 PEComa (see Chap. 11, Sect. 11.1.9)
		15.13	 Prognosis and Management
		15.14	 Reporting Checklist
		References
			Further Reading
	16: Mucinous Cystic Neoplasia
		16.1	 WHO Classification
		16.2	 Terminology
		16.3	 Epidemiology
		16.4	 Clinical Features
			16.4.1 Associations
			16.4.2 Imaging
		16.5	 Macroscopy
			16.5.1 Sampling
		16.6	 Microscopy
			16.6.1 MCN with Low-Grade Dysplasia
			16.6.2 MCN with High-Grade Dysplasia
			16.6.3 MCN with Associated Invasive Carcinoma
		16.7	 Immunohistochemistry
		16.8	 Molecular Pathology
		16.9	 Variants
			16.9.1 MCN Involving the Main Pancreatic Duct
			16.9.2 MCN with Mesenchymal Overgrowth
			16.9.3 MCN with Sarcomatous Differentiation of the Stroma
		16.10	 Differential Diagnosis
			16.10.1 Intraductal Papillary Mucinous Neoplasm (IPMN) (see Chap. 17)
			16.10.2 Simple Mucinous Cyst (Mucinous Nonneoplastic Cyst) (see Chap. 19, Sect. 19.2.1)
			16.10.3 Retention Cyst (see Chap. 19, Sect. 19.3.1)
			16.10.4 Retroperitoneal Mucinous Cystic Tumor
			16.10.5 Pseudocyst or Macrocystic Serous Cystadenoma
		16.11	 Staging
		16.12	 Prognosis and Management
		16.13	 Reporting Checklist
		References
			Further Reading
	17: Intraductal Papillary Neoplasia
		17.1	 WHO Classification
		17.2	 Intraductal Papillary Mucinous Neoplasm (IPMN)
			17.2.1	 Terminology
			17.2.2	 Epidemiology
			17.2.3	 Clinical Features
				17.2.3.1	 Associations
				17.2.3.2	 Imaging
			17.2.4	 Classification
				17.2.4.1	 Site of Duct Involvement
				17.2.4.2	 Epithelial Subtype
				17.2.4.3	 Grade of Dysplasia
				17.2.4.4	 Invasive Carcinoma
			17.2.5	 Macroscopy
				17.2.5.1	 Main-Duct IPMN
				17.2.5.2	 Branch-Duct IPMN
				17.2.5.3	 Mixed-Duct IPMN
				17.2.5.4	 Invasive Carcinoma
			17.2.6	 Sampling
			17.2.7	 Microscopy
				17.2.7.1	 Epithelial Subtype
				17.2.7.2	 Grade of Dysplasia
				17.2.7.3	 Invasive Carcinoma
			17.2.8	 Immunohistochemistry
			17.2.9	 Molecular Pathology
			17.2.10	 Differential Diagnosis
				17.2.10.1	 Macrocystic Serous Cystadenoma (see Chap. 15, Sect. 15.6.2)
				17.2.10.2	 Mucinous Cystic Neoplasm (see Chap. 16)
				17.2.10.3	 Simple Mucinous Cysts (Mucinous Nonneoplastic Cysts)
				17.2.10.4	 Retention Cysts (see Chap. 19, Sect. 19.3.1)
				17.2.10.5	 Pancreatic Intraepithelial Neoplasia (PanIN) (see Chap. 8)
				17.2.10.6	 Extension of IPMN into Smaller Ducts
				17.2.10.7	 Mucus Extravasation
				17.2.10.8	 Concomitant Pancreatic Ductal Adenocarcinoma
				17.2.10.9	 Cystic Papillary Growth Pattern in Pancreatic Ductal Adenocarcinoma
				17.2.10.10	 Intraductal Papillary Neoplasm of the Bile Ducts
				17.2.10.11	 Intraductal Growth by Other Neoplasms
		17.3	 Intraductal Oncocytic Papillary Neoplasm (IOPN)
			17.3.1	 Epidemiology and Clinical Features
			17.3.2	 Macroscopy
			17.3.3	 Microscopy
			17.3.4	 Immunohistochemistry
			17.3.5	 Molecular Pathology
		17.4	 Intraductal Tubulopapillary Neoplasm (ITPN)
			17.4.1	 Epidemiology and Clinical Features
			17.4.2	 Macroscopy
			17.4.3	 Microscopy
			17.4.4	 Variants
			17.4.5	 Immunohistochemistry
			17.4.6	 Molecular Pathology
		17.5	 Staging
		17.6	 Prognosis
		17.7	 Management
		17.8	 Reporting Checklist
		References
			Further Reading
	18: Solid Pseudopapillary Neoplasia
		18.1	 WHO Classification
		18.2	 Terminology
		18.3	 Epidemiology
		18.4	 Clinical Features
			18.4.1 Associations
			18.4.2 Imaging
		18.5	 Macroscopy
			18.5.1 Sampling
		18.6	 Microscopy
		18.7	 Immunohistochemistry
		18.8	 Molecular Pathology
		18.9	 Variants
		18.10	 Differential Diagnosis
			18.10.1 Pseudocyst
			18.10.2 Pancreatic Endocrine Neoplasm
			18.10.3 Acinar Cell Carcinoma
		18.11	 Staging
		18.12	 Prognosis and Management
		18.13	 Reporting Checklist
		References
			Further Reading
	19: Other Cystic Lesions
		19.1	 Acinar Cystic Transformation (Acinar Cell Cystadenoma)
			19.1.1	 Macroscopy
			19.1.2	 Microscopy
			19.1.3	 Histochemistry and Immunohistochemistry
			19.1.4	 Differential Diagnosis
			19.1.5	 Prognosis and Management
		19.2	 Mucinous Epithelium-Lined Cysts
			19.2.1	 Simple Mucinous Cyst (Mucinous Nonneoplastic Cyst)
		19.3	 Pancreatobiliary Epithelium-Lined Cysts
			19.3.1	 Retention Cyst
			19.3.2	 Choledochal Cyst
		19.4	 Squamous Epithelium-Lined Cysts
			19.4.1	 Lymphoepithelial Cyst
				19.4.1.1	 Differential Diagnosis
			19.4.2	 Mature Cystic Teratoma (Dermoid Cyst)
			19.4.3	 Squamous Epithelial (Epidermoid) Cyst in Intrapancreatic Heterotopic Spleen
			19.4.4	 Squamoid Cyst of Pancreatic Ducts
			19.4.5	 Squamous Metaplasia in a Cystic Lesion
		19.5	 Other Cystic Lesions
			19.5.1	 Cystic Hamartoma
			19.5.2	 Duodenal Diverticulum
			19.5.3	 Endometriotic Cyst
			19.5.4	 Foregut (Duplication) Cyst
			19.5.5	 Parasitic Cyst
		References
Part IV: Endocrine Pancreas
	20: Endocrine Neoplasia
		20.1	 Terminology and Classification
		20.2	 Epidemiology
		20.3	 Clinical Features
		20.4	 Macroscopy
		20.5	 Microscopy
			20.5.1	 Pancreatic Neuroendocrine Tumors (Grade 1–3)
			20.5.2	 Pancreatic Neuroendocrine Carcinomas
		20.6	 Classification
		20.7	 Immunohistochemistry
			20.7.1	 Confirmation of Neuroendocrine Differentiation
			20.7.2	 Evaluation of Hormonal Production
			20.7.3	 Ki67 Immunostaining
			20.7.4	 Other Prognostic Factors
			20.7.5	 Biopsy Diagnosis of Liver Metastasis
		20.8	 Staging
			20.8.1	 Primary Tumor
			20.8.2	 Tumor Propagation and Metastasis
			20.8.3	 Resection Margins
		20.9	 Differential Diagnosis
			20.9.1	 Neuroendocrine Tumors of the Pancreas (Grade 1–3)
			20.9.2	 Neuroendocrine Carcinoma of the Pancreas
			20.9.3	 Neuroendocrine Neoplasms of the Ampulla, Common Bile Duct, and Duodenum
		20.10	 Mixed Neuroendocrine—Non-Neuroendocrine Neoplasm (MiNEN)
		20.11	 Prognosis
		20.12	 Inherited Syndromes
		20.13	 Glucagon Cell Hyperplasia and Neoplasia
		20.14	 Insulinomatosis
		20.15	 Endocrine Microadenoma and Endocrine Microadenomatosis
		20.16	 Reporting Checklist
		References
			Further Reading
	21: Endocrine Cell Hyperplasia
		21.1	 Definition
		21.2	 Beta-Cell Hyperplasia
		21.3	 Alpha-Cell Hyperplasia
		21.4	 PP-Cell Hyperplasia
		References
Part V: Transplant Pathology
	22: Pathology of Pancreas Transplantation
		22.1	 Introduction
			22.1.1	 History and Outcomes of Pancreas Transplantation
			22.1.2	 Indications for Pancreas Transplantation
			22.1.3	 Alternatives to Whole Pancreas Transplantation
				22.1.3.1	 Islet Cell Transplantation
				22.1.3.2	 Living Donor Transplantation
		22.2	 Role of the Pathologist in Pancreas Transplantation
		22.3	 Pathologic Alterations Related to Operative Complications, and Examination and Findings in Failed Allografts
			22.3.1	 Surgical Procedure of Pancreas Transplantation
			22.3.2	 Surgical Complications of Pancreas Transplantation
			22.3.3	 Vascular Thrombosis
			22.3.4	 Examination of the Failed Allograft
				22.3.4.1	 Macroscopic Examination
				22.3.4.2	 Macroscopic Pathologic Findings in Vascular Thrombosis
				22.3.4.3	 Histopathologic Findings in Vascular Thrombosis
			22.3.5	 Post-Transplant Ischemic and Infectious Pancreatitis
			22.3.6	 Post-Transplant Ischemia/Reperfusion Injury
		22.4	 Core Biopsy Specimens in Pancreas Transplantation: Procedures and Technical Aspects
			22.4.1	 Surrogate Biopsy Options to Assess Rejection in the Pancreas Allograft
			22.4.2	 Protocol or Surveillance, and Post-Therapy Core Biopsies
			22.4.3	 Pancreas Allograft Core Biopsy: Handling and Processing
				22.4.3.1	 Adequacy of the Pancreas Allograft Core Biopsy
		22.5	 Pancreas Allograft Rejection
			22.5.1	 Antibody-Mediated Rejection (AMR)
				22.5.1.1	 Hyperacute Rejection
				22.5.1.2	 Acute Antibody-Mediated Rejection AMR
					Pathologic Features of Acute AMR
					Histopathologic Grading of Acute AMR
					Immunohistochemistry for C4d in Pancreas Allografts
					Reporting Nomenclature for AMR
				22.5.1.3	 Chronic Active Antibody-Mediated Rejection
				22.5.1.4	 Mixed AMR and ACR
			22.5.2	 Acute Cellular Rejection (ACR)
				22.5.2.1	 Clinical and Laboratory Features of ACR
				22.5.2.2	 Histopathologic Findings of ACR in the Pancreas Allograft
				22.5.2.3	 Grading of ACR in the Pancreas Allograft
				22.5.2.4	 Chronic Active Cell-Mediated Rejection
			22.5.3	 Chronic Rejection or graft sclerosis in the pancreas allograft
				22.5.3.1	 Clinical and Laboratory Features of Cellular Rejection (CR)
				22.5.3.2	 Histopathologic Features of CR
				22.5.3.3	 Staging of CR in the Pancreas Allograft
				22.5.3.4	 Chronic Allograft Arteriopathy in the Pancreas Allograft
			22.5.4	 Differential Diagnosis of Forms of Rejection, and Distinction from Other Entities Encountered in Core Biopsies
		22.6	 Infections in Pancreas Allografts
		22.7	 Recurrent Autoimmune Isletitis (Insulitis) and Diabetes Mellitus
			22.7.1	 Pathologic Findings in Recurrent Autoimmune Isletitis
		22.8	 Acute Islet Cell Toxicity from Calcineurin Inhibitors
		22.9	 Reporting Checklists
		References
Part VI: Frozen Section
	23: The Role of Frozen Section
		23.1	 Excluding a Metastasis
			23.1.1	 Liver Lesions
				23.1.1.1	 Bile Duct Hamartoma
				23.1.1.2	 Bile Duct Adenoma (Peribiliary Gland Hamartoma)
				23.1.1.3	 Focal Nodular Hyperplasia
				23.1.1.4	 Reactive Ductular Proliferation
				23.1.1.5	 Metastatic Pancreatic Adenocarcinoma
		23.2	 Pancreatic Ductal Adenocarcinoma Versus Chronic Pancreatitis
			23.2.1	 Major Criteria
				23.2.1.1	 Nuclear Size Variation Equal to, or Greater than, 4:1
				23.2.1.2	 Incomplete Glandular Lumina
				23.2.1.3	 Disorganized Duct Distribution
			23.2.2	 Minor Criteria
				23.2.2.1	 Huge Irregular Epithelial Nucleoli
				23.2.2.2	 Necrotic Glandular Debris
				23.2.2.3	 Glandular Mitoses
				23.2.2.4	 Glands Unaccompanied by Stroma in Smooth Muscle Fascicles
				23.2.2.5	 Perineural Invasion
		23.3	 Assessing Margin Status
			23.3.1	 Transection Margin for Pancreatic Ductal Adenocarcinoma
			23.3.2	 Margin Status for Intraductal Papillary Mucinous Neoplasia (see Chap. 17)
			23.3.3	 Margin Status for Other Pancreatic Neoplasms
		References
Part VII: Cytology
	24: The Role of Cytology
		24.1	 Tissue Acquisition
			24.1.1	 EUS-Guided Tissue Acquisition
			24.1.2	 ERCP-Guided Tissue Acquisition
			24.1.3	 The Non-Diagnostic FNA
			24.1.4	 Rapid On-Site Evaluation (ROSE)
		24.2	 Sample Preparation
			24.2.1	 Cyst Fluids
			24.2.2	 Solid Lesions
			24.2.3	 Brush Cytology Specimens
		24.3	 Microscopic Evaluation
			24.3.1	 Terminology
			24.3.2	 Contaminants
			24.3.3	 Solid Lesions
				24.3.3.1	 Pancreatic Ductal Adenocarcinoma (see Chap. 9)
				24.3.3.2	 Pancreatic Neuroendocrine Tumor (see Chap. 20)
				24.3.3.3	 Acinar Cell Carcinoma (see Chap. 10)
				24.3.3.4	 Solid Pseudopapillary Neoplasm (see Chap. 18)
				24.3.3.5	 Autoimmune Pancreatitis (see Chap. 7)
				24.3.3.6	 Chronic Pancreatitis (see Chap. 7)
				24.3.3.7	 Paraduodenal (Groove) Pancreatitis (see Chap. 7, Sect. 7.2.8)
				24.3.3.8	 Intrapancreatic Common Bile Duct Carcinoma
			24.3.4	 Cystic Lesions (see Chaps. 14 and 19)
				24.3.4.1	 Mucinous Cystic Lesions
					Low-Grade Neoplastic Mucinous Cysts
					High-Grade Neoplastic Mucinous Cysts
					High-Grade Neoplastic Mucinous Cysts with Invasive Carcinoma
				24.3.4.2	 Nonmucinous Cysts (Fig. 24.17)
					Serous Cystic Neoplasms (see Chap. 15)
					Other Types of Cysts (see Chap. 19)
		24.4	 Metastases
		24.5	 Molecular Testing in Pancreatobiliary Cytology
		References
Appendix: WHO Classification of Tumors of the Pancreas 2019
	Benign Epithelial Tumors and Precursors
	Malignant Epithelial Tumors
	Pancreatic Neuroendocrine Neoplasms
Index