Understanding pancreatic pathology

A diverse range of pathologies can be observed in the pancreas with pancreatic ductal adenocarcinoma taking centre stage. It is not only the commonest pancreatic neoplasm but carries a dismal prognosis with mortality equalling incidence and up to 85% of cases presenting at an advanced stage where curative surgery is no longer possible. Pathological tissue diagnoses allow distinction of pancreatic ductal adenocarcinoma from non-neoplastic disorders such as chronic pancreatitis but also facilitate the identification of rarer, less aggressive pancreatic neoplasms and radiologically detectable precursor lesions of pancreatic carcinoma, in particular mucinous cystic neoplasms and intraductal papillary mucinous neoplasms. In addition, pathological examination provides information on histological subtyping and grading. Assessment of pathological staging and resection margin status in resected neoplasms informs prognosis and treatment. Thus the examination of tissue specimens from the pancreas plays a vital part in the multidisciplinary care of patients with pancreatic diseases. This review gives an overview over types of tissue specimens obtained from the pancreas followed by a concise description of the most important non-neoplastic and neoplastic solid and cystic lesions focussing on epithelial neoplasms.