Pancreatic Pathology Online

Pathology of Pancreatic Intraepithelial Neoplasia  

Dr Sampurna Roy MD    


Noninvasive precursors of invasive ductal adenocarcinoma of the pancreas include pancreatic intraepithelial neoplasias (PanINs), intraductal papillary mucinous tumours and mucinous cystic neoplasms

Pancreatic intraepithelial neoplasias (PanIN) are histological precursor lesions to pancreatic adenocarcinoma.

PanIN grade I to III represent stepwise morphological alterations in the pancreatic ductal epithelium, from early neoplasia (PanIN I and II), via carcinoma in situ (PanIN III) to the development of invasive ductal adenocarcinoma.


PanIN grade 1A:  Flat epithelial lesions ; composed of tall columnar cells ; basally located nuclei ; abundant supranuclear mucin.

PanIN grade 1B: Papillary, micropapillary or basally pseudostratified architecture.

PanIN grade 2: May be flat or papillary ; nuclear abnormalities include loss of polarity, nuclear crowding, enlarged nuclei, pseudo-stratification and hyperchromatism ; mitoses are rare.

PanIN grade 3:  Papillary or micropapillary ; these are rarely flat ; true cribriforming, luminal necrosis and marked cytologic abnormalities are present ; cytologic abnormalities include loss of nuclear polarity, dystrophic goblet cells (goblet cells with nuclei oriented towards the lumen  and mucinous cytoplasm oriented toward the basement membrane ; occasionally abnormal mitotic figures are present.


Histology of Pancreatic intraepithelial neoplasia (PanIN). Representative images of PanIN-1A, PanIN-1B, and PanIN-3 are shown. Hematoxylin and eosin staining.

Representative images of histochemical and immunohistochemical staining. The results of mucin staining with Alcian blue (pH 2.5) and immunostaining of MUC1, MUC2, MUC5AC, cyclin D1, p21, p53, and S100P for biliary intraepithelial neoplasia (BilIN) and pancreatic intraepithelial neoplasia (PanIN) are shown.

Images from article: Yasunori Sato, Kenichi Harada, Motoko Sasaki, and Yasuni Nakanuma, “Histological Characterization of Biliary Intraepithelial Neoplasia with respect to Pancreatic Intraepithelial Neoplasia,” International Journal of Hepatology, vol. 2014, Article ID 678260, 7 pages, 2014. doi:10.1155/2014/678260

Histological Characterization of Biliary Intraepithelial Neoplasia with respect to Pancreatic Intraepithelial Neoplasia


Further reading:

Identification and analysis of precursors to invasive pancreatic cancer.

Classification, morphology and molecular pathology of premalignant lesions of the pancreas.

Intraepithelial neoplasms (PanIN) and intraductal papillary-mucinous neoplasms (IPMN) of the pancreas as precursor lesions of pancreatic carcinoma.

Pancreatic intraepithelial neoplasia (PanIN) and intraductal papillary mucinous neoplasms (IPMN).

Precursors of Pancreatic cancer: Intraepithelial Neoplasia (PanIN) and Intraductal Papillary Mucinous Neoplasms (IPMN). 

Molecular genetics of pancreatic intraepithelial neoplasia.

Precursors to pancreatic cancer.

Current topics on precursors to pancreatic cancer.

Histopathological diagnosis of pancreatic intraepithelial neoplasia and intraductal papillary-mucinous neoplasms: interobserver agreement.

Precursors to invasive pancreatic cancer.

Proliferative activity in pancreatic intraepithelial neoplasias of chronic pancreatitis resection specimens: detection of a high-risk lesion.

Intraepithelial neoplasm of the pancreas.

An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms.




Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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