This is one of the better differentiated areas, showing a flat sheet with prominent honeycombing. The disorganization, nuclear overlapping, and lack of uniform nuclear spacing provides a clue that is this adenocarcinoma (as opposed to non-neoplastic duct epithelium). However, if all I had was a paucicellular specimen consisting of a few such sheets, I would likely back off and call it nothing higher than "suspicious" for adenocarcinoma. Fortunately from a diagnostic standpoint, all of the other clinical, radiographic, and cytological findings pointed overwhelmingly at a diagnosis of malignancy, which made this case more straighforward than it could have been with a meager specimen and inadequate clinical and radiographic information.
Pancreatic adenocarcinomas can be very well differentiated, a fact that raises the risk of both false-positive and false-negative diagnoses. It is important to secure a good specimen (which requires immediate assessment by a pathologist or cytotechnologist during the procedure), as well as accurate and complete clinical info. In most freestanding imaging centers, with no on-site pathology coverage, these aspects are often ignored. I strongly recommend that patients have radiographically-directed biopsies performed only in facilities with pathology coverage on site.