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2. The Normal Pancreas
3. Normal Pancreas, low power
a. The normal pancreas is seen here at low power with a large duct at the left, acinar
tissue, and scattered islets of Langerhans. The acini secrete bicarbonate, lipase, amylase,
and other digestive substances via the duct system into the duodenum at the ampulla of
Vater.
4. Normal Pancreas, medium power
a. Here is normal pancreas at medium power, with a branch of the pancreatic duct at the
left, surrounded by acinar tissue. An islet of Langerhans is seen at the right
5. Normal Islet of Langerhans, high power
a. This is a normal islet of Langerhans seen at high power, surrounded by acinar pancreas.
The endocrine cells of the islet have a similar appearance with H&E staining.
Immunohistochemical staining can reveal which are alpha cells (secreting glucagon),
beta cells (insulin), and delta cells (somatostatin).
6. Normal acinar parenchyma, high power
a. At high magnification, the acini of the pancreatic parenchyma can be seen. A small
intralobular duct is present as well.

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16: Well-differentiated pancreatic neuroendocrine tumors (WD-NET): These tumors have had many
synonyms (i.e., islet cell tumors), but they are just the carcinoid-like neuroen- docrine tumors of the
pancreas. These tumors are usually well circumscribed and cellular, and the neoplastic cells tend to
form nests or trabeculae. The cells are like those of a WD-NET in any other site (Figure 10.12), with
smooth round to oval nuclei, finely speck- led chromatin, and pink-to-purple cytoplasm. Some are
functional in that they produce clinical symptoms directly related to expression of hormones such as
insulin, glucagon, and somatostatin. However, most pancreatic neuroendocrine tumors are
nonfunctional. Lack of atypia is not an indication of good behavior, and a bland tumor may look just as
bland when you later find it in the liver. Instead, the prognosis depends on the tumor’s proliferative
activity (e.g., mitotic rate), which separates these neoplasms into low grade and intermediate grade