The incidence of pancreatic ductal adenocarcinoma (PDAC) continues to rise, and the disease remains a leading cause of cancer-related deaths.1, 2, 3 The current overall 5-year relative survival rate is approximately 13 %, up from 5 % two decades ago.1,4 This improvement in survival is likely attributable to the changing prevalence of disease risk factors (e.g., smoking, diabetes, pancreatitis, etc.), advancements in surgical and chemotherapeutic treatments, and earlier detection of disease, among others.5 Current clinical management of PDAC hinges on radiologic classification of disease as either localized (resectable, borderline resectable, or locally advanced) or metastatic. Over half of patients present with metastatic disease, and therapeutic options beyond palliative care are limited.6,7 PDAC research continues to grow as investigators seek better understanding of disease biology, screening possibilities, and therapeutic options.

Pathology remains crucial in diagnosing PDAC on tissue biopsy, detailing disease extent and margin status on resection, and performing molecular-based assays to guide therapy. The following review summarizes gross processing, histologic evaluation, immunohistochemistry (IHC), and molecular aspects of PDAC. Salient pathologic features to include in clinical reports are in Table 1.