Abstract
IntroductionThe standard operation for carcinoma of the pancreatic head is a partial pancreaticoduodenectomy. Unusual histological findings may occasionally occur in the surgical specimen. We present three unusual histologic diagnoses after pancreaticoduodenectomy.Case presentationsIn the first case, an 86-year-old Caucasian woman was admitted with abdominal pain and nausea. Preoperative evaluation showed a 3 cm cystic lesion in the head of the pancreas. Pathology revealed a benign multicystic mesothelioma. In the second case, a 45-year-old Caucasian man complained of nausea, vomiting and general malaise for several months. Endoscopic retrograde cholangiopancreatographic examination and a computed tomography scan showed a stenosis of the distal bile duct secondary to a mass in the head of the pancreas and duodenum. Histology showed an adenomyoma of the ampulla. In the third case, a 59-year-old Caucasian man presented with chronic alcoholic pancreatitis. A computed tomography scan revealed a 3.5 cm lesion in the head of the pancreas with cystic and solid components. Pathology showed an undifferentiated carcinoma, sarcomatoid variant.ConclusionPartial pancreaticoduodenectomy is usually performed for ductal adenocarcinomas, neuroendocrine tumors or chronic pancreatitis. Compared to the majority of the above diagnoses, the three cases in our study are very rare. Benign multicystic mesothelioma is a very rare tumor that originates from the peritoneum. Although it demonstrates a benign clinical behaviour, it frequently recurs after resection. Adenomyoma of the bile duct or ampullary region is a very unusual, benign, localized lesion characterized by adenomyomatous hyperplasia. Undifferentiated carcinoma, sarcomatoid variant, is an aggressive tumor and is characterized by spindle cells. As the lesions were suspicious for carcinoma, partial pancreaticoduodenectomy was justified in all three patients. The histologic diagnosis after partial pancreaticoduodenectomy may differ from the preoperative and intraoperative findings. These cases demonstrate that a definitive diagnosis may only be obtained by a pathologic examination of the surgical specimen.
Highlights
The standard operation for carcinoma of the pancreatic head is a partial pancreaticoduodenectomy
Partial pancreaticoduodenectomy is usually performed for ductal adenocarcinomas, neuroendocrine tumors or chronic pancreatitis
Benign multicystic mesothelioma is a very rare tumor that originates from the peritoneum
Summary
In light of these factors, complete resection offers the only potentially curative treatment option in malignant tumors of the head of the pancreas. The Whipple procedure is still considered to be a major surgical intervention with high morbidity and low long-term survival, partial pancreaticoduodenectomy is indicated for all suspicious tumor-like lesions of the head of the pancreas. These unexpected pathologic diagnoses underscore the fact that confirmatory evidence of suspicious diagnoses by surgery is still the gold standard. Author details 1Department of General, Visceral and Pediatric Surgery; Heinrich-HeineUniversity Duesseldorf, Moorenstr. SEB performed the histopathological work-up and contributed to the pathology part of the manuscript.
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