Misra Sunayana, Mahajan Vrushali, Kansal Surbhi, Khaitan Divya, Rao Seema, Badwal Sonia, Nundy Samiran, Rawat Kishan, Dhawan Shashi
Department of Pathology, Histopathology division, Sir Ganga Ram Hospital, New Delhi, India.
Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Int J Surg Pathol. 2025 Sep;33(6):1411-1424. doi: 10.1177/10668969251323932. Epub 2025 Mar 19.
IntroductionPancreaticoduodenectomy is the standard treatment for resectable pancreatic head malignancies and other ampullary/peri-ampullary lesions. It is also the standard of care for symptomatic relief in chronic pancreatitis. However, despite advancements in diagnostic modalities, some lesions that are clinically suspicious for malignancy may reveal a surprising benign pathology. Thus, various neoplastic and non-neoplastic lesions are encountered in the pancreaticoduodenectomy specimens.MethodsPancreaticoduodenectomy specimens received at our institute over a period of 11 years were retrieved. Only those patients with a final diagnosis of benign neoplastic or non-neoplastic disease were included in the study. The clinical data, age, sex, presenting complaint, relevant imaging, cyst fluid cytology, and preoperative tissue diagnosis wherever available, were recorded. Patients with a preoperative malignant diagnosis for which pancreaticoduodenectomy was performed and subsequently turned out to be benign/non-neoplastic were analyzed for possible preoperative diagnostic pitfalls.ResultsBenign tumors and non-neoplastic lesions together comprised 8% of the total patients. Serous cystic neoplasm was the most common benign tumor while the most common non-neoplastic entity was chronic pancreatitis. Concordance of preoperative fine-needle aspiration cytology diagnosis with the final histopathological diagnosis was noted in 44% patients. Other rare lesions such as choledochocele, arteriovenous malformation, and adenomyomatous hyperplasia of the common bile duct were also encountered.ConclusionIn this study, we highlight the spectrum of benign neoplastic and non-neoplastic lesions encountered in pancreaticoduodenectomy specimens at a tertiary care center, emphasizing on those lesions that were clinically suspicious for malignancy and revealed a surprising benign diagnosis on the final surgical pathology excision specimen.
引言
胰十二指肠切除术是可切除的胰头恶性肿瘤及其他壶腹/壶腹周围病变的标准治疗方法。它也是缓解慢性胰腺炎症状的标准治疗手段。然而，尽管诊断方式有所进步，但一些临床上怀疑为恶性的病变最终病理结果可能是令人惊讶的良性病变。因此，在胰十二指肠切除标本中会遇到各种肿瘤性和非肿瘤性病变。
方法
回顾我院11年间接收的胰十二指肠切除标本。本研究仅纳入最终诊断为良性肿瘤性或非肿瘤性疾病的患者。记录临床资料、年龄、性别、主诉、相关影像学检查、囊液细胞学检查以及术前组织诊断（若有）。对术前诊断为恶性并接受胰十二指肠切除术但术后病理结果为良性/非肿瘤性的患者分析可能存在的术前诊断陷阱。
结果
良性肿瘤和非肿瘤性病变共占总患者数的8%。浆液性囊性肿瘤是最常见的良性肿瘤，而最常见非肿瘤性病变是慢性胰腺炎。44%的患者术前细针穿刺细胞学诊断与最终组织病理学诊断一致。还遇到了其他罕见病变，如胆总管囊肿、动静脉畸形和胆总管腺肌瘤样增生。
结论
在本研究中，我们强调了在三级医疗中心的胰十二指肠切除标本中遇到的良性肿瘤性和非肿瘤性病变谱，重点关注那些临床上怀疑为恶性但最终手术病理切除标本显示为令人惊讶的良性诊断的病变。
