Cystic and Intraductal Neoplasms of the Pancreatobiliary Tract

The Pancreatobiliary Pathology Society (PBPS) would like to thank Alain C. Borczuk, MD, and the Archives of Pathology & Laboratory Medicine for again highlighting our society by publishing 4 review articles based on the presentations at the PBPS companion society symposium at the 2020 United States and Canadian Academy of Pathology (USCAP) meeting. Our mission is to educate surgical pathologists and cytopathologists on the importance of the advances in this complex area and hopefully transform the way we practice pancreatobiliary pathology. The PBPS fosters excellence and international collaboration in education, research, and the global practice of pancreatobiliary pathology. PBPS became an official society in 2016 and a USCAP companion society in 2018, but the sharing of knowledge, enthusiasm, and ideas in pancreatobiliary pathology started more than 20 years ago as an annual “Pancreas Club” luncheon held during the USCAP meeting, which grew over the years and became the PBPS. The first advisory council members of the Pancreas Club were Volkan Adsay, MD; Ralph Hruban, MD; David Klimstra, MD; Günter Klöppel, MD; and Giuseppe Zamboni, MD. Thanks to their dedication to pancreatobiliary pathology and contagious enthusiasm, many other pathologists interested in pancreatobiliary pathology were attracted to join and motivated the transformation into the official 501c3 society that it is today (PBPath.org).The 2020 PBPS Companion Society Symposium was entitled “Cystic and Intraductal Neoplasms of the Pancreatobiliary Tract” and consisted of 5 outstanding presentations entitled (1) “Preoperative Molecular Assessment of Pancreatic Cysts and Intraductal Lesions,” (2) “Cytologic Assessment of Cystic/Intraductal Lesions of the Pancreatobiliary Tract,” (3) “Mucinous Cystic and Intraductal Neoplasms of the Pancreatobiliary Tract,” (4) “Nonmucinous Cystic Lesions of the Pancreas,” and (5) “Management Algorithms for Pancreatic Cysts and Intraductal Neoplasms: The Surgeon's Perspective.” These topics represented a 360-degree expert evaluation of cystic and intraductal pancreatobiliary lesions and were given in the same stepwise manner in which they are often encountered, from the cytomorphologic and molecular characteristics to their histomorphology, and finally to management from a surgeon's perspective.Four of the presentations from the 2020 companion meeting have been converted into review articles in this issue of Archives of Pathology & Laboratory Medicine. In the first article, Michelle Reid, MD, MS, reviews the cytologic features of cystic and intraductal pancreatobiliary tract lesions. Dr Reid emphasizes the use of an integrated, multidisciplinary approach for the evaluation of cystic/intraductal pancreatobiliary tract lesions, incorporating clinical, radiologic, and cytologic findings with chemical and molecular cyst fluid analysis as well as ancillary studies for definitive diagnosis and classification (and, where applicable, grading) of mucinous and nonmucinous cystic lesions. She also describes the cytologic features of tumoral intraepithelial neoplasms, intraductal oncocytic papillary neoplasms (IOPNs), intraductal tubulopapillary neoplasms (ITPNs), and intraductal papillary neoplasm of bile duct (IPNB), which may be sampled by bile duct brushing or fine-needle aspiration biopsy. The second article examines recent advances in mucinous cystic and intraductal neoplasms of the pancreatobiliary tract and is written by David Klimstra, MD, along with his colleague Kerem Ozcan, MD. In this article Drs Klimstra and Ozcan explore the clinicopathologic, genetic, and prognostic features of cystic and intraductal mucinous neoplasms of the pancreas, including mucinous cystic neoplasms and pancreatic intraductal neoplasms, intraductal papillary mucinous neoplasm (IPMN), IOPN, and ITPN. Additionally, the histologic features of preinvasive mass-forming neoplasms of the bile duct IPNB, IOPN, and ITPN are described, along with similarities and differences compared with their pancreatic counterparts. Recently described aspects of morphology, grading, classification, and genomic alterations in these neoplasms are emphasized. The third article is on nonmucinous cystic lesions of the pancreas and is by Irene Esposito, MD, and her colleague Lena Haeberle, MD. In this article Drs Esposito and Haeberle examine the spectrum of nonmucinous cystic lesions of the pancreas and their different biological behaviors. They review serous cystic neoplasms, solid-pseudopapillary neoplasms, cystic neuroendocrine tumors, and pancreatitis-associated pseudocysts, and discuss their epidemiology and clinical and gross features as well as their histomorphology, immunohistochemistry, molecular profile, and prognostic associations. The fourth and final article is entitled “Management Algorithms for Pancreatic Cystic Neoplasms: The Surgeon's Perspective” and is written by Jin-Young Jang, MD, PhD, along with his colleague Hyeong Seok Kim, MD. Drs Jang and Kim review the current status of pancreatic cystic neoplasms including IPMNs, their epidemiology, malignancy risk, and treatment-related factors. They also discuss optimal management algorithms for IPMNs, which require thoughtful assessment to determine the indication for resection. The use of nomograms, surveillance, and other management strategies in customizing IPMN management is explored, along with more tailored approaches to surgical intervention versus surveillance.We are extremely proud of our society and the continued contributions of its members to the field of pancreatobiliary pathology. We hope that you will enjoy these review articles exploring a unique, 360-degree (cytopathologist's, surgical pathologist's, and surgeon's) perspective on cystic and intraductal neoplasms of the pancreatobiliary tract.

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