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WHO Classification of Tumours
Noninvasive pancreatobiliary papillary neoplasm with high-grade dysplasia (high-grade intraepithelial neoplasia)
Region of the ampulla of Vater


Definition

Noninvasive papillary neoplasms are exophytic neoplasms with cytological features resembling a subset of the intraductal papillary neoplasms of the bile ducts and pancreas
Click to access Pubmed
Furukawa T, Klöppel G, Volkan Adsay N, Albores-Saavedra J, Fukushima N, Horii A, Hruban RH, Kato Y, Klimstra DS, Longnecker DS, Lüttges J, Offerhaus GJ, Shimizu M, Sunamura M, Suriawinata A, Takaori K, Yonezawa S (2005)
Classification of types of intraductal papillary-mucinous neoplasm of the pancreas: a consensus study.
Virchows Arch 447: 794-9




Click to access Pubmed
Katabi N, Klimstra DS (2008)
Intraductal papillary mucinous neoplasms of the pancreas: clinical and pathological features and diagnostic approach.
J Clin Pathol 61: 1303-13




Click to access Pubmed
Klimstra DS (2005)
Cystic, mucin-producing neoplasms of the pancreas: the distinguishing features of mucinous cystic neoplasms and intraductal papillary mucinous neoplasms.
Semin Diagn Pathol 22: 318-29




Click to access Pubmed
Nara S, Shimada K, Kosuge T, Kanai Y, Hiraoka N (2008)
Minimally invasive intraductal papillary-mucinous carcinoma of the pancreas: clinicopathologic study of 104 intraductal papillary-mucinous neoplasms.
Am J Surg Pathol 32: 243-55



and are designated noninvasive papillary neoplasms, pancreatobiliary type, of the ampulla
Click for details
Albores-Saavedra J, Henson DE, and Klimstra DS eds.
Tumors of the Gallbladder, Extrahepatic Bile Ducts, and Ampulla of Vater
Armed Forces Institute of Pathology: Washington, DC 2000



. They are less common than intestinal-type adenomas .

The papillae of pancreatobiliary-type noninvasive papillary neoplasms are complex and arborizing and are usually lined by moderately to markedly atypical cells. The marked architectural complexity may result in intraepithelial lumen formation and cribriforming.

The degree of dysplasia (based on the highest grade present) should be specified. Almost all pancreatobiliary-type noninvasive papillary neoplasms have at least focal high-grade dysplasia, and many cases also have an associated invasive carcinoma

Click for details
Albores-Saavedra J, Henson DE, and Klimstra DS eds.
Tumors of the Gallbladder, Extrahepatic Bile Ducts, and Ampulla of Vater
Armed Forces Institute of Pathology: Washington, DC 2000




Click to access Pubmed
Furukawa T, Klöppel G, Volkan Adsay N, Albores-Saavedra J, Fukushima N, Horii A, Hruban RH, Kato Y, Klimstra DS, Longnecker DS, Lüttges J, Offerhaus GJ, Shimizu M, Sunamura M, Suriawinata A, Takaori K, Yonezawa S (2005)
Classification of types of intraductal papillary-mucinous neoplasm of the pancreas: a consensus study.
Virchows Arch 447: 794-9




Click to access Pubmed
Katabi N, Klimstra DS (2008)
Intraductal papillary mucinous neoplasms of the pancreas: clinical and pathological features and diagnostic approach.
J Clin Pathol 61: 1303-13




Click to access Pubmed
Klimstra DS (2005)
Cystic, mucin-producing neoplasms of the pancreas: the distinguishing features of mucinous cystic neoplasms and intraductal papillary mucinous neoplasms.
Semin Diagn Pathol 22: 318-29




Click to access Pubmed
Nara S, Shimada K, Kosuge T, Kanai Y, Hiraoka N (2008)
Minimally invasive intraductal papillary-mucinous carcinoma of the pancreas: clinicopathologic study of 104 intraductal papillary-mucinous neoplasms.
Am J Surg Pathol 32: 243-55



.

The epithelial lining consists of cuboidal cells with round nuclei predominantly arranged in a single layer. Paneth cells are not found, although an endocrine cell component may be detectable by immunohistochemical labelling. The invasive carcinomas arising in association with pancreatobiliary-type noninvasive papillary neoplasms usually have a tubular pattern of growth and are usually also classified as pancreatobiliary-type adenocarcinomas, although some may also be of intestinal type

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Bosman FT, Carneiro F, Hruban RH, Theise ND (Eds.)
WHO Classification of Tumours of the Digestive System.
4th Edition
International Agency for Research on Cancer: Lyon 2010



.

Commentary: Preneoplastic lesions of the digestive system