Answer: Chronic pancreatitis

Histology: The pancreas was very firm. Histologically, prominent nerves are easily appreciated. In some instances acinar cells abut these nerves, raising the possibility of an acinar cell carcinoma.

Discussion: Neural hyperplasia is common in long-standing chronic pancreatitis. Islets of Langerhans and non-neoplastic acinar cells can abut and even involve these nerves, and in so doing mimic a neoplasm. In the case presented, the acinar cells near nerves lack atypia, retain an overall lobular growth pattern, and the lobules contain small ducts, establishing the non-neoplastic nature of the process.