TUMORS OF THE PANCREAS

by

ENRICO SOLCIA, M.D., Ph.D.
Professor of Pathology and Research Director
Department of Human Pathology and Genetics
University of Pavia and IRCCS
Policlinico San Matteo
I-27100 Pavia, Italy

CARLO CAPELLA, M.D., Ph.D.
Professor of Pathology and Chairman
Department of Clinical and Biological Sciences
University of Pavia at Varese
I-21100 Varese, Italy

GÜNTER KLÖPPEL, M.D., Ph.D.
Professor of Pathology and Chairman
Institute of Pathology
University of Kiel
D-24105 Kiel, Germany

Table of Contents 

1 Introduction and the Normal Pancreas
  1.1 Embryology and Differentiation
  1.2 Pancreas of Newborns and Infants
  1.3 Adult Pancreas
    1.3.1 Gross Anatomy
    1.3.2 Histology and Cytology
2 Classification of Pancreatic Tumors
3 General Considerations
4 Tumors of the Exocrine Pancreas
  4.1 Serous Cystic Tumors
  4.2 Serous Cystadenoma
    4.2.1 Serous Microcystic Adenoma
    4.2.2 Serous Oligocystic Adenoma
  4.3 Serous Cystadenocarcinoma
  4.4 Mucinous Cystic Tumor
  4.5 Intraductal Papillary-Mucinous Tumor
  4.6 Ductal Adenocarcinoma
  4.7 Ductal Adenocarcinoma Variants
    4.7.1 Mucinous Noncystic Adenocarcinoma
    4.7.2 Signet-Ring Cell Carcinoma
    4.7.3 Adenosquamous Carcinoma
    4.7.4 Undifferentiated (Anaplastic) Carcinoma
    4.7.5 Mixed Ductal-Endocrine Carcinoma
    4.7.6 Other Rare Carcinomas
  4.8 Osteoclast-Like Giant Cell Tumor
  4.9 Acinar Cell Carcinoma
  4.10 Acinar Cell Carcinoma Variants
    4.10.1 Acinar Cell Cystadenocarcinoma
    4.10.2 Mixed Acinar-Endocrine Carcinoma
  4.11 Pancreatoblastoma
  4.12 Solid-Pseudopapillary Tumor
  4.13 Miscellaneous Carcinomas
    4.13.1 Oncocytic Carcinoma
    4.13.2 Choriocarcinoma
    4.13.3 Nonmucinous, Glycogen-Poor Cystadenocarcinoma
  4.14 Mature Teratoma
5 Tumors of the Endocrine Pancreas
  5.1 Differentiated Endocrine Tumors
  5.2 Clinicopathologic Profiles of Well-Differentiated Endocrine Tumors
    5.2.1 Insulinoma
    5.2.2 Glucagonoma
    5.2.3 Somatostatinoma
    5.2.4 Gastrinoma
    5.2.5 VIPoma
    5.2.6 Enterochromaffin Cell Tumor Causing the Carcinoid Syndrome
    5.2.7 Tumors Producing Acromegaly, Cushing's Syndrome, or
          Hypercalcemia
    5.2.8 Tumors with Multiple Syndromes
    5.2.9 Nonfunctioning Tumors (Including PP-Cell Tumors)
  5.3 Multiple Endocrine Neoplasia Type
  5.4 Poorly Differentiated (Small Cell) Carcinoma
6 Nonepithelial and Secondary Tumors
  6.1 Nonepithelial Tumors
    6.1.1 Benign Soft Tissue Tumors
    6.1.2 Malignant Soft Tissue Tumors
    6.1.3 Malignant Lymphoma
  6.2 Secondary Tumors
7 Tumor-Like Lesions of the Exocrine Pancreas
  7.1 Chronic Pancreatitis
  7.2 Miscellaneous Inflammatory Changes
  7.3 Cysts
    7.3.1 Pseudocyst
    7.3.2 Retention Cyst
    7.3.3 Parasitic Cyst
    7.3.4 Congenital Cyst
    7.3.5 Para-ampullary Duodenal Wall Cyst
    7.3.6 Enterogenous Cyst
    7.3.7 Lymphoepithelial Cyst
    7.3.8 Endometrial Cyst
  7.4 Duct Changes
    7.4.1 Squamous Metaplasia
    7.4.2 Mucinous Cell Hypertrophy
    7.4.3 Ductal Papillary Hyperplasia
    7.4.4 Adenomatoid Ductal Hyperplasia
    7.4.5 Severe Ductal Dysplasia (Atypical Hyperplasia)
  7.5 Acinar Changes
    7.5.1 Focal Acinar Transformation
  7.6 Heterotopic Pancreas
  7.7 Heterotopic (Ectopic) Spleen
  7.8 Hamartoma and Pseudotumor
  7.9 Pseudolipomatous Hypertrophy
  7.10 Pseudolymphoma
8 Tumor-Like Lesions of the Endocrine Pancreas
  8.1 Islet Hyperplasia
  8.2 Nesidioblastosis
    8.2.1 Persistent Neonatal Hyperinsulinemic Hypoglycemia
    8.2.2 Persistent Hyperinsulinemic Hypoglycemia in Adults
  8.3 Dysplasia
9 Diagnosis of Pancreatic Tumors
  9.1 Clinical Laboratory, and Radiologic Evaluation
  9.2 Tissue Biopsies and Frozen Sections
  9.3 Fine-Needle Aspiration Cytology of the Pancreas: Preoperative or
      Percutaneous
  9.4 Pancreatic Juice Cytology
  9.5 Diagnostic Guidelines
  9.6 Procedures for Pathologic Examination
    9.6.1 Macroscopic
    9.6.2 Microscopic
  9.7 Staging and Grading of Carcinomas
10 Index
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