Abstract :
Background: Whipple’s pancreaticoduodenectomy (PD) is performed for various benign and malignant conditions of pancreas, duodenum and its periampullary region. 5% of the gastrointestinal malignancy is constituted by the ampullary and periampullary carcinoma. Histopathological studies helps in diagnosis, grading, staging, nodal status, marginal status, prognosis of the tumor.Aim: To study the clinicopathological spectrum of Whipple’s pancreatico-duodenectomy specimens.Materials and Methods: This is a retrospective cross-sectional study of 7 years, wherein 20 cases of Whipple’s PD were analyzed. Clinical details and gross examination findings were examined in detail and reported as per AJCC 8th edition of CAP protocol.Results: Of the 20 cases, male to female ratio was 1.5:1, obstructive jaundice was the most common presenting complaint followed by abdominal pain. 8 of the 20 cases underwent pylorus preserving surgery and rest were classical Whipple’s surgery. The mean age of the study group was 55.2 years. 19 cases were malignant and one case was benign with periampullary region as the most common site of malignancy (31.5%). 68.8% were diagnosed to have intestinal type of adenocarcinoma and it was the most common histological type. One case was diagnosed as chronic pancreatitis. Lymphovascular invasion was seen in 3 of the 4 cases of pancreatic adenocarcinoma and in one case of periampullary carcinoma. Majority of the tumors were moderately differentiated (56.2%).Conclusion: Intestinal adenocarcinoma is the most common histological subtype in our study. It is important to differentiate it from pancreatico-biliary subtype as it has worser prognosis. Detailed gross examination is important with more emphasis to the margins, perineural and lymphovascular invasion is important, so as to effectively and appropriately determine the stage and treatment of the patient.
Keyword :
Whipple’s pancreaticoduodenectomy, Pancreatic tumors, Intestinal adenocarcinoma, Pancreatico-biliary adenocarcinoma.