Carcinoma of the pancreas and periampullary structures. Pattern of metastasis at autopsy.

We studied the pattern of metastasis at autopsy in 158 patients with carcinoma of the pancreas and in 29 patients with carcinoma of the periampullary structures. The three most commonly involved organs were the abdominal lymph nodes, liver, and lung. Other organs and sites were involved in less than 25% of the cases. For pancreatic carcinoma, whether the diagnosis was made antemortem or at autopsy, the incidence of metastatic involvement of various sites was similar. Comparing patients with carcinoma of the pancreatic head only with those with tumor of the body or tail, the latter group had a higher incidence of involvement of abdominal nodes, liver, stomach, small bowel, spleen, peritoneum, lung, and other intrathoracic organs. Carcinoma of the duodenum or ampulla had the highest incidence (67%) of involving only one abdominal lymph nodal region, whereas 14% to 50% of carcinomas of the pancreas had such nodal metastasis.