Pancreatic Intraepithelial Neoplasia
Vikram Deshpande, MD
Key Facts
Terminology
Noninvasive ductal epithelial proliferations associated with pancreatic ductal adenocarcinoma
Clinical Issues
High-grade PanIN, particularly PanIN-3, indicates elevated risk for pancreatic adenocarcinoma
Microscopic Pathology
Ducts are lined by mucinous epithelium, either flat or papillary
PanIN-1: Lacks cytologic atypia
PanIN-2: Nuclear atypia is always present
PanIN-3: Atypia parallels that seen in pancreatic ductal adenocarcinoma
 This example of PanIN-1 shows a pancreatic duct lined by a single layer of epithelium with abundant apical mucinous cytoplasm and basal nuclei that lack atypia. |
 This example of PanIN-2 shows a pancreatic duct lined by a micropapillary proliferation of mucinous epithelial cells. Focally, a loss of nuclear polarity is present  . |
TERMINOLOGY
Abbreviations
Pancreatic intraepithelial neoplasia (PanIN)
Synonyms
Metaplasia, dysplasia, carcinoma in situ
Definitions
Noninvasive pancreatic ductal epithelial proliferations that are associated with pancreatic ductal adenocarcinoma
CLINICAL ISSUES
Natural History
PanIN-1: Commonly found in resected pancreata; significance unclear
PanIN-3: Associated with significant risk of progression to pancreatic ductal adenocarcinoma
Treatment
High-grade PanIN, particularly PanIN-3, indicates elevated risk for pancreatic adenocarcinoma
Surveillance of these patients is warranted
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