If there several islets greater than 300 micrometers in diameter, a diagnosis of islet cell hyperplasia should be made. Also, if the overall area occupied by the islets in a section of pancreas is greater than that of the controls, a diagnosis of islet cell hyperplasia may be appropriate. Affected islets may be contiguous, giving a lobular appearance (Figure 3) or distinctly separated (Figure 4). The distinction between hyperplasia and adenoma is largely influenced by evidence of compression in adenomas and lack of compression in hyperplasia (Figure 5 and Figure 6). In islet cell adenomas, there may be some cellular atypia or pleomorphism, which is not typically seen in hyperplastic lesions. Occasional acinar cells may become trapped within coalescing hyperplastic islets (Figure 7, Figure 8, and Figure 9) and should not be confused with invasion of an islet cell carcinoma.
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