There are numerous primary pancreatic neoplasms, in part due to the mixed endocrine and exocrine components.
Classification
Classification based on function
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exocrine: ~99% of all primary pancreatic neoplasms
pancreatic ductal adenocarcinoma (commonly known as pancreatic cancer) 90-95%
cystic neoplasm
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endocrine: were previously referred to as islet cell tumors because they were thought to have originated from the islets of Langerhans, however, new evidence suggests that these tumors originate from pluripotential stem cells in ductal epithelium 6
non-syndromic
syndromic
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mesenchymal tumors
although the great majority of both benign and malignant pancreatic neoplasms arise from pancreatic epithelial cells, mesenchymal tumors, while rare, can derive from the connective, lymphatic, vascular, and neuronal tissues of the pancreas 7
they account for 1-2% of all pancreatic tumors and are classified according to their histologic origin 7
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other
Exocrine tumors
ductal adenocarcinoma is by far the most common primary tumor, usually of the head (65%) and has a very poor prognosis
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cystic neoplasms are further divided into (with some overlap):
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unilocular
serous cystadenoma uncommonly uni/macrolocular
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macrocystic multilocular
mucinous cystic neoplasm: usually body and tail
serous cystadenoma uncommonly uni/macrolocular
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microcystic
serous cystadenoma: usually head; 30% have a central scar
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cystic with a solid component
macrocystic tumors can have a solid component as well
pancreatic adenocarcinoma may undergo cystic degeneration (8%) 6
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generally solid
See also: cystic pancreatic mass: differential diagnosis
Endocrine tumors
Endocrine tumors of the pancreas are divided into:
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functional: ~85%
insulinoma: most common, 10% are malignant
gastrinoma: second most common, 60% malignant
glucagonoma: 80% malignant
VIPoma: 75% malignant
somatostatinoma: 75% malignant
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non-functional: ~15%
third most common
85-100% malignant
usually larger, as a result of lack of hormonal activity, the clinical presentations are usually delayed till they become large
Mesenchymal tumors
Account for 1-2% of all pancreatic tumors and are classified according to their histologic origin 7. These are further discussed in pancreatic mesenchymal neoplasms.
Classification based on location
Head
pancreatoblastoma (rare and in children)
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