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Exocrine tumors

Frozen section / exploration of possible pancreatic adenocarcinoma

Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 6 December 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

Intraoperative strategies

● Surgeon should check for metastatic disease in peripancreatic nodes, liver, peritoneum
● Dilation of common bile duct and jaundice without biliary tract stones is highly suggestive of tumor
● Intraoperative FNA minimizes hemorrhage, pancreatitis, tumor seeding
● For patients with colloid carcinoma (larger tumors, typically in head, mucin lakes microscopically), avoid incisions into the tumor to prevent thromboemboli or tumor dissemination

Frozen section

● Results may change extent of resection (World J Gastrointest Surg 2010;2:352)
● Look for disorganized duct distribution, variation in nuclear size of at least 4:1, incomplete duct lumen (Arch Pathol Lab Med 2002;126:1169, Am J Surg Pathol 1981;5:179)
● Minor criteria are infiltrating single cells, perineurial invasion, mitotic figures, necrotic glandular debris

Micro images

Frozen section diagnosis of chronic pancreatitis versus ductal adenocarcinoma

Frozen section (left to right): normal, IPMN with low grade dysplasia, IMPN with borderline/moderate dysplasia

Frozen section: figures 2, 4-6 are pancreatic adenocarcinoma, figures 1 and 3 are chronic pancreatitis

Differential diagnosis

Chronic pancreatitis: characteristic lobular arrangement at low power; limited nuclear size variation, only slight nuclear irregularity, nucleoli are inconspicuous

End of Pancreas > Exocrine tumors > Frozen section / exploration of possible pancreatic adenocarcinoma

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