Pancreatic Pathology Online
An approach to Reporting of Pancreatic Specimen
Dr Sampurna Roy MD July 2016
Specimens from the pancreas are rarely received outside specialist centers.
Biopsy specimens may be taken to establish whether there is a neoplasm of the pancreas, either as open biopsy at laparotomy, through an endoscope, especially if the tumour is ampullary, or percutaneously under radiological guidance.
Large specimens comprise tissues from pancreatodenectomy (Whipple's operation), distal pancreatectomy and total pancreatectomy.
Partial pancreatectomy is usually the treatment for islet cell tumours as most occur in the body and tail of the pancreas, but Whipple's operation is occasionally necessary to remove a tumour in the head of the pancreas.
Frozen section diagnosis may be required to confirm suspicions raised by preoperative biopsies and ancillary investigations.
Intra-operative frozen sections may be performed to confirm the nature of the tumour or to assess the pancreatic surgical margin for evidence of tumour involvement.
Frozen sections may also be taken of possible metastatic deposits found at laparotomy.
Needle biopsies of the pancreas are most commonly are performed under image guidance during the investigation of a radiologically detected pancreatic lesion, or more rarely if a pancreatic lesion of unknown nature is identified at laparotomy.
The following clinical information should be provided to the histopathologist :
- Age and sex of the patient;
- Symptoms and their duration: Jaundice, malabsorption, abdominal pain, dizziness, fainting, mental confusion;
- History of alcohol intake ;
- History of previous pancreatitis ;
- Findings on CT, MRI, angiography, ERCP ;
- Results of biochemical investigation: liver function tests, blood glucose, hormone measurements, serum amylase;
- Family history of endocrine disorders, especially of the pituitary, parathyroids and pancreas.
The following Special stains and Immunostains are useful in the diagnosis of pancreatic lesions:
Congo red for amyloid ;
- Cytokeratins to demonstrate inapparent infiltrating carcinoma cells in small biopsies and to distinguish undifferentiated carcinoma from lymphoma or sarcoma ;
- Neuroendocrine markers : Chromogranin, NSE ;
- Lymphoid markers :
- Hormones : Insulin, glucagons, gastrin, pancreatic polypeptide, VIP, ACTH.
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