Exosomal glypican-1 is elevated in pancreatic cancer precursors and can signal genetic predisposition in the absence of endoscopic ultrasound abnormalities

Figure 2 Pancreatic abnormalities in endoscopy ultrasound examination and pathological exams of endoscopic ultrasound-guided fine needle aspiration/biopsy specimens from intraductal papillary mucinous neoplasms. A: Main-duct intraductal papillary mucinous neoplasm (MD-IPMN) with a large mural nodule, visualized in B-mode (right panel) and characterized with qualitative elastography (left panel) that revealed areas of hard consistency (blue color); B: Endoscopic ultrasound-guided fine needle biopsy with a 22 G needle targeting the harder lesions in the described mural nodule (pathological exam showed malignant degeneration); C: Complex septate cyst with areas of wall focal thickenings and a mural nodule (green arrow); D: Simple bilobulated cyst without worrisome features or high-risk stigmata; E: Chronic pancreatitis-like parenchymal changes (lobulation, hyperechoic foci, and strands); F: Homogenous hyperechogenic appearance of pancreatic parenchyma suggestive of lipomatous transformation; G: Branch-duct IPMN with low-grade dysplasia [hematoxylin and eosin (H&E)-stained cellblock]. These images show the wall of a cystic lesion, partly lined by a cylindrical mucosecretory epithelium with low-grade atypia (left: 100 ×; right: 200 ×); H: Well-differentiated adenocarcinoma originated in a MD-IPMN (H&E-stained cellblock: 400 ×). These images show an epithelial neoplasm with marked architectural disorganization and severe cytological atypia. The cells have a high nucleus-cytoplasmic ratio, with anisokaryosis, irregular nuclei with coarse chromatin and some with an exuberant nucleolus.