Oncocytic Tumors of the Pancreas: A Tri-Focal Review - Integrated Cytopathological, Pathological, and Molecular Perspectives.

Abstract

Background: Oncocytic differentiation in pancreatic neoplasms is uncommon but can be seen in a wide range of neoplasms which range from borderline to highly aggressive behavior. Certain tumors, such as intraductal oncocytic papillary neoplasm (IOPN) of the pancreas, are oncocytic by default but many, such as pancreatic neuroendocrine tumors (PanNETs), can be oncocytic in a rare subset, often with clinical significance (like aggressive behavior). As such, the differential diagnosis can be broad and expertise is critical in teasing out the true diagnosis to guide treatment.

Summary: The differential diagnosis of an oncocytic neoplasm in the pancreas includes IOPN, acinar cell carcinoma, pancreatic ductal adenocarcinoma, PanNET, solid pseudopapillary neoplasms, and an array of other tumors (including metastatic disease). As the differential diagnosis is broad and diagnostic biopsies are often small, delineating these entities often requires examination of the clinical features, cytology, and immunohistochemistry, with molecular findings being useful in particularly difficult cases.

Key messages: Corroboration between clinical/radiology findings, cytologic features, histologic features, immunohistologic results, and molecular abnormalities is all extremely useful in delineating a specific entity among the broad differential diagnosis of entities with oncocytic differentiation in the pancreas.