A high yield review of

Pancreatic

Pathology

Tiffany M. Graham, M.D.

(4th year Pathology Resident)

 

(Click on a topic below to learn more)

 

The Basics

 

 

Neoplastic Conditions

 

Essentials for [future] Pathologists

 

 

COMING SOON...

Benign pancreatic lesions

High Yield Pancreatic tumors

How to grade & stage pancreatic cancer

How to sign-out the case

 

Index of High Yield Posts.

These posts contain high yield information collected from various educational resources including textbooks, journal articles, educational websites and more. They are intended for educational use only. I strongly believe the spreading of knowledge and depth of learned information should be encouraged in today's society rather than coveted. However, membership is required to view these posts  and should be used solely for educational purposes only. It is FREE to sign up

 
 

The Basics.

 

My Board Study Notes...

Click to view the notes I compiled on Pancreas Pathology while studying for the AP/CP Pathology Board Exams. This contains all the high yield information you need to know for the board exams and resident rotations. Filled with tables, charts, diagrams, highlights and more.

 

References include the Osler Institute online AP/CP Pathology Review, ExpertPath, Pathology Outlines, LibrePathology and various textbooks. Most histology pictures were taken personally from PathPresenter.net virtual slide website. 

*MEMBERSHIP REQUIRED TO VIEW*

NOTE: This is an evolving document. As such, it may have changed significantly since the last time you accessed it on this website. 

 

Cystic Pancreatic Lesions

 

Solid Pancreatic Lesions

 

Pancreatic Neuroendocrine Neoplasms (NET & NEC)

 
 

The Whipple.

How to gross a Pancreaticoduodenectomy (Whipple) Tumor Resection Specimen.

A Quick Overview of the Grossing Process

  1. Examine and orient the specimen (see image) 

  2. Measure the specimen (overall and each organs' dimensions).

  3. Identify and ink all of the resection margins 

    • Pancreatic neck/pancreatic duct

    • Common bile duct

    • Uncinate process

    • Proximal duodenum (or gastric)

    • Distal duodenum

  4. Also, ink the following surfaces (important for tumor staging/therapy options)

    • Vascular groove

    • Anterior/Superior/Posterior/Inferior surfaces of pancreas (different colors)

  5. Open the duodenum carefully along the anti-mesenteric border, away from the Ampulla of Vater. Open stomach or gallbladder if present. Describe and measure any visible lesions and measure their closest approach to resection margin.

  6. Probe through the Ampulla into the main pancreatic duct & bile duct. Document their overall dimensions and whether they are patent/stenosed/obstructed etc.

  7. Properly fix specimen in formalin (overnight) prior to further sectioning. Tumor staging heavily relies on proper examination of the ampulla/tumor origin! 

  8. Shave and entirely submit the resection margins 

    • Common bile duct (shaved)

    • Pancreatic neck/pancreatic duct (5 mm slice then perpendicularly sectioned to ink)

    • Uncinate process (5 mm slice then perpendicularly sectioned to ink)

    • Proximal duodenum (or gastric; shaved)

    • Distal duodenum (shaved)

  9. Use the "orange peel" approach to perpendicularly section and submit the soft tissue around the pancreatic head (this also helps increase lymph node detection- see paper below for details)

  10. Bisect the pancreatic head by probing both the CBD and the pancreatic duct from distal to the ampulla and cut the pancreatic head to the ampulla at a plane that goes through both ducts (see image).

  11. Examine the tumor- Determine the primary site and extent of tumor. Measure overall dimensions and distance to important landmarks/margins.

    • NOTE: Important cutoffs for tumor staging are 2 cm and 4 cm! Try to obtain as accurate of a tumor measurement as possible! 

  12. Submit representative sections (see paper below)

    • Make sure to take a perpendicular section of the tumor to the duodenal serosa at the "groove" area (ampullary carcinomas often extend to this region) 

    • Include sections of tumor in relation to the:

      • Ampulla

      • Common bile duct

      • Pancreatic duct

      • Invasion into soft tissues or adjacent structures (if present)

  13. CELEBRATE! You just finished grossing a Whipple :) 

This image illustrates the bivalving of the pancreatic head after both ducts are probed. There is also a stent (blue) in the CBD. With every cut made, the prosector re-checks whether both ducts are still in the same plane. In this case, the knife would have to be re-angled to re-include the CBD.

Whipple Made Simple for Surgical Pathologists

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DISCLAIMER: THIS WEBSITE DOES NOT PROVIDE MEDICAL ADVICE

These posts contain high yield information collected from various educational resources including textbooks, journal articles, educational websites and more. They are intended for educational use only and should NOT be taken as medical advice. I strongly believe the spreading of knowledge and depth of learned information should be encouraged in today's society rather than coveted. Membership is required to view these posts  and should be used solely for educational purposes only.