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Review
. 2022 Mar 4:13:856803.
doi: 10.3389/fphys.2022.856803. eCollection 2022.

Updates in the Diagnosis of Intraductal Neoplasms of the Pancreas

Naziheh Assarzadegan  1 , Sepideh Babaniamansour  1 , Jiaqi Shi  1
Affiliations
Review

Updates in the Diagnosis of Intraductal Neoplasms of the Pancreas

Naziheh Assarzadegan et al. Front Physiol. .

Erratum in

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest types of cancer worldwide. There are many reasons for this dismal prognosis, including the advanced stage at the time of diagnosis and the lack of effective therapeutic approaches. Intraductal papillary mucinous neoplasms (IPMNs) represent detectable and treatable precursor lesions of PDAC. Our understanding of the pathology of IPMNs has evolved over the past few decades, and new advances in diagnostic tools have emerged. The new World Health Organization (WHO) classification scheme now recognizes the previously considered variants of IPMNs, such as intraductal oncocytic papillary neoplasms (IOPNs) and intraductal tubulopapillary neoplasms (ITPNs), as distinct neoplasms. New imaging and molecular diagnostic tests are being developed to recognize these PDAC precursor lesions better. Here, we review the advances in diagnostic tools for IPMNs, IOPNs, and ITPNs, emphasizing the new (5th edition, 2019) WHO classification for pathological diagnosis, molecular markers, new laboratory tests, and imaging tools.

Keywords: classification; intraductal oncocytic papillary neoplasm; intraductal papillary mucinous neoplasm; intraductal tubulopapillary neoplasm; pancreatic ductal adenocarcinoma.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Representative histological pictures of intraductal papillary mucinous neoplasm (IPMN). (A) IPMN with gastric-foveolar differentiation. The epithelium is flattened with basally placed nuclei and abundant mucin cap resembling gastric-foveolar epithelium. (B) An IPMN with intestinal differentiation forming villous papillae resembling villous adenoma of the colon. The cells have basophilic cytoplasm with enlarged oval and hyperchromatic nuclei and scattered goblet cells. (C) IPMN with pancreatobiliary differentiation. The neoplastic cells are cuboidal, have enlarged nuclei with amphophilic cytoplasm. (A–C) Original magnification 200×.
Figure 2
Figure 2
Representative histological pictures of intraductal oncocytic papillary neoplasm (IOPN). (A) Low magnification shows intraductal papillary proliferation. (B) Intermediate magnification shows the thick, complex papillae. (C) Higher magnification shows that the neoplastic cells have abundant and distinctly oncocytic (eosinophilic) cytoplasm. The nuclei are round and often contain prominent nucleoli. (A) Original magnification 10×. (B) Original magnification 100×. (C) Original magnification 200×.
Figure 3
Figure 3
Representative histological pictures of intraductal tubulopapillary neoplasm (ITPN). (A) Low magnification shows small, tightly packed glands forming intraductal nodules. (B) Higher magnification shows the cuboidal neoplastic cells with no significant mucin. (C) Another case of ITPN showing foci of comedo-type necrosis resembling intraductal carcinoma of the breast. (A) Original magnification 10×. (B) Original magnification 200×. (C) Original magnification 100×.
Figure 4
Figure 4
Representative histological pictures of retention cyst, simple mucinous cyst, and mucinous cystic neoplasm. (A) Retention cyst. Low magnification shows a dilated pancreatic duct. (B) Higher magnification shows a flattened epithelium with no papillary projections. Note the background pancreas with extensive atrophy and fibrosis. No ovarian-type stroma is seen. (C) Simple mucinous cyst. The cyst is lined by a benign mucinous epithelium and lacks an ovarian stroma. (D) Mucinous cystic neoplasm. The cyst is lined by mucinous epithelium and unlike simple mucinous cyst or a retention cyst is associated with an ovarian-type stroma. (A) Original magnification 10×; (B) Original magnification 100×; and (C,D) Original magnification 200×.
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