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This second edition updates the "WHO Classification of Endocrine
Tumours" proposed in 1980 and incorporates many new tumour entities
and pertinent concepts that have developed since that time. It is
the result of a collaborative effort between 9 pathologists from
different countries, in addition to informal contributions and
discussions by many other colleagues. In particular, efforts have
been made to integrate into the fundamental backbone of the
histologic classification a number of prognostic and functional
parameters now essential for appropriate diagnosis and
clinicopathologic evaluation of endocrine tumours.
This is a histological classification of tumours and tumour-like
lesions of the exocrine pancreas which also includes those tu-
mours showing a mixture of exocrine and endocrine elements. The
classification is based principally on standard microscopic
observations, but whenever indicated it incorporates diagnosti-
cally valuable immunohistological findings. In addition, the most
important immunohistological findings which are helpful in cat-
egorizing pancreatic tumours are summarised in Table 1. The major
guideline of this classification scheme is the group- ing of the
pancreatic exocrine tumours according to their biologi- cal
behaviour. Thus, the neoplasms are broadly divided into benign
(adenoma) and malignant tumours (carcinoma). How- ever, in recent
years we have learned that this division is not a sharp but rather
a gradual transition. We therefore added a third group which we
call "tumours of uncertain malignant potential" representing a
borderline category analogous to that recognized for some ovarian
tumours. This group includes mucinous cystic tumour, intraductal
papillary-mucinous tumour and solid- pseudopapillary tumour. These
neoplasms are defined by the grade of dysplasia and/or potential to
become malignant. Mucinous cystic tumours of uncertain malignant
potential, for instance, exhibit moderate epithelial dysplasia, but
do not show severe dysplasia/carcinoma in situ changes, nor
carcinomatous invasion of the cyst wall or the adjacent pancreatic
tissue. Solid- pseudopapillary tumour has a benign looking
histological ap- pearance, but metastases may occur. Biologically,
all these neoplasms are primarily slow-growing lesions and have an
excel- lent prognosis when adequately treated by complete
resection.
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