A thorough understanding of the pathology of the pancreas is critical to the proper surgical management of patients with pancreatic disease. Some neoplasms of the pancreas are entirely benign and can be managed conservatively, while others are highly lethal malignancies that are best treated by aggressive surgical resection. This chapter provides a broad overview of the pathology of pancreatic neoplasia with emphasis on features important for the surgical management of patients with pancreatic disease. Recent developments in our understanding of pancreatic neoplasia will also be discussed, particularly the growing recognition that a variety of noninvasive precursor lesions can give rise to invasive pancreatic cancer. These noninvasive precursor lesions create an opportunity to cure pancreatic neoplasia before an invasive cancer develops. At the same time they present a significant clinical management problem because there is precious little evidence-based medicine on which to judge when the benefit of removing a precursor lesion outweighs the risks of surgery. In this chapter we will broadly divide our discussion of neoplasms of the pancreas into a description of those with predominantly exocrine differentiation and those with predominantly endocrine differentiation. The discussion of exocrine neoplasms will be further subdivided into those that are cystic and those that are solid.
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