Endocrine Tumors of the Pancreas

  • Kevin Turner
  • Qihui “Jim” ZhaiEmail author
  • Jeff M. Sutton
  • Syed Ahmad
Part of the Frozen Section Library book series (FROZEN, volume 12)


In the pancreas, frozen section consultations are commonly used to provide real-time input to surgeons. There are several benign and neoplastic entities commonly encountered within these intraoperative specimens. Frequently encountered entities include chronic pancreatitis, pancreatic ductal adenocarcinoma, pancreatic endocrine tumors, mixed exocrine-endocrine carcinomas, solid pseudopapillary tumors, acinar cell carcinomas, lymphoproliferative disorders, and metastatic diseases. These entities can be found in varying degrees within the head, body, or tail of the pancreas. Frozen section diagnoses can help to answer questions which are imperative for the correct course of treatment. Is the mass an inflammatory or a neoplastic process? If neoplastic, is it benign or malignant? What type of neoplasm might it be? Does it extend to the resection margin? Is it a metastasis? To answer these questions, a variety of specimen types may be submitted including needle core biopsies, wedge resections, resection margin biopsies, lymph nodes, or entire pancreaticoduodenectomy (the Whipple procedure) resection specimens.


Positron Emission Tomography Chronic Pancreatitis Acinar Cell Distal Pancreatectomy Pancreatic Ductal Adenocarcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Recommended Reading

  1. Alzahrani MA, Schmulewitz N, Grewal S, Turner KO, Lucas FV, McKenzie JT, Sussman JJ, Ahmad SA. Metastases to the pancreas: the experience of a high volume center and a review of the literature. J Surg Oncol. 2012;105(2):156–61. doi: 10.1002/jso.22009.PubMedCrossRefGoogle Scholar
  2. Battula N. Primary pancreatic lymphoma: diagnostic and therapeutic dilemma. Pancreas. 2006;33(2):192.PubMedCrossRefGoogle Scholar
  3. Cioc AM, Ellison EC, Proca DM, Lucas JG, Frankel WL. Frozen section diagnosis of pancreatic lesions. Arch Pathol Lab Med. 2002;126(10):1169–73.PubMedGoogle Scholar
  4. Couvelard A, Sauvanet A. Gastroenteropancreatic neuroendocrine tumors: indications for and pitfalls of frozen section examination. Virchows Arch. 2008;453(5):441–8.PubMedCrossRefGoogle Scholar
  5. Dagradi A, Serio G. Pancreatectomia intermedia. In: Enciclopedia medica italiana, Pancreas, vol. XI. Firenze: USES Edizioni Scientifiche; 1984. p. 850.Google Scholar
  6. Doherty GM. Pancreatic neuroendocrine tumors. In: Fischer JE et al., editors. Mastery of surgery. 5th ed. Philadelphia: Lippincott, Williams, and Wilkins; 2006.Google Scholar
  7. Fischer WE, Andersen DK, Bell RH, Saluja AK, Brunicardi FC, et al. Pancreas. In: Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, editors. Schwartz’s principles of surgery. 9th ed. New York: McGraw-Hill; 2010.Google Scholar
  8. Gibril F, Curtis LT, Termanini B, et al. Primary cardiac gastrinoma causing Zollinger-Ellison syndrome. Gastroenterology. 1997;112(2):567–74.PubMedCrossRefGoogle Scholar
  9. Hruban RH, Pitman MB, Klimstra DS. Tumors of the pancreas. Washington, DC: American Registry of Pathology; 2007.Google Scholar
  10. Hyland C, Kheir SM, Kashlan MB. Frozen section diagnosis of pancreatic carcinoma: a prospective study of 64 biopsies. Am J Surg Pathol. 1981;5(2):179–91.PubMedCrossRefGoogle Scholar
  11. Iacono C, Bortolasi L, Facci E, Nifosi F, Pachera S, Ruzzenente A, Guglielmi A. The Dagradi-Serio-Iacono operation central pancreatectomy. J Gastrointest Surg. 2007;11:364–76.PubMedCrossRefGoogle Scholar
  12. Kennedy EP, Brody JP, Yeo CJ. Neoplasms of the endocrine pancreas. In: Mulholland MW, Lillemoe KD, Doherty GM, et al., editors. Greenfield’s surgery: scientific principles and practice. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2010.Google Scholar
  13. Khalifa MA. Intraoperative assessment of the Whipple resection specimen. J Clin Pathol. 2007;60(9):975–80.PubMedCrossRefGoogle Scholar
  14. Klimstra DS, Hruban RH, Pitman MB. Pancreas. In: Sternberg SS, editor. Histology for pathologists. Philadelphia: Lippincott-Raven; 2007. p. 723–60.Google Scholar
  15. Lack EE. Pathology of the pancreas, gallbladder, extrahepatic biliary tract, and ampullary region. New York: Oxford University Press, Inc.; 2003.Google Scholar
  16. Lechago J. Frozen section examination of liver, gallbladder, and pancreas. Arch Pathol Lab Med. 2005;129(12):1610–8.PubMedGoogle Scholar
  17. Maton PN, Mackem SM, Norton JA, Gardner JD, O’Dorisio TM, Jensen RT. Ovarian carcinoma is a cause of Zollinger-Ellison syndrome. Natural history, secretory products, and response to provocative tests. Gastroenterology. 1989;97(2):468–71.PubMedGoogle Scholar
  18. Metz DC. Diagnosis and treatment of pancreatic neuroendocrine tumors. Semin Gastrointest Dis. 1995;6:67–74.PubMedGoogle Scholar
  19. Milan SA, Yeo CJ. Neuroendocrine tumors of the pancreas. Curr Opin Oncol. 2012;24:46–55.PubMedCrossRefGoogle Scholar
  20. Pattou F, Proye C. Endocrine tumors of the pancreas. In: Holzheimer RG, Mannick JA, editors. Surgical treatment: evidence-based and problem-oriented. Munich: Zuckschwerdt; 2001.Google Scholar
  21. Rosch T, Lightdale CJ, Botet JF, et al. Localization of pancreatic neuroendocrine tumors by endoscopic ultrasonography. N Engl J Med. 1992;326:1721–6.PubMedCrossRefGoogle Scholar
  22. Spelsberg F, Wirsching R. Comparative value of enucleation and resection in the surgical treatment of organic hyperinsulinism (insulinoma). Acta Chir Iugosl. 1979;26(2):19–26.PubMedGoogle Scholar
  23. Staley CA, Cleary KR, Abbruzzese JL, Lee JE, Ames FC, Fenoglio CJ, Evans DB. The need for standardized pathologic staging of pancreaticoduodenectomy specimens. Pancreas. 1996;12(4):373–80.PubMedCrossRefGoogle Scholar
  24. Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery. 2003;133(5):521–7.PubMedCrossRefGoogle Scholar
  25. Strasberg SM, Linehan DC, Hawkins WG. Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas: ability to obtain negative tangential margins. J Am Coll Surg. 2007;204(2):244–9.PubMedCrossRefGoogle Scholar
  26. The International Agency for Research on Cancer, Bosman FT, Carneiro F, Hruban RH. WHO classification of tumours of the digestive system (IARC WHO classification of tumours). Lyon: IARC; 2010.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Kevin Turner
    • 1
  • Qihui “Jim” Zhai
    • 2
    Email author
  • Jeff M. Sutton
    • 3
    • 4
  • Syed Ahmad
    • 3
  1. 1.Department of Pathology and Laboratory MedicineUniversity of Cincinnati, College of MedicineCincinnatiUSA
  2. 2.Laboratory Medicine and PathologyMayo Clinic FloridaJacksonvilleUSA
  3. 3.Department of SurgeryUniversity of Cincinnati, College of MedicineCincinnatiUSA
  4. 4.Otolaryngology-Head and Neck SurgeryUniversity of Cincinnati Medical CenterCincinnatiUSA

Personalised recommendations