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Tumor-like lesions in the pancreas include any non-neoplastic pancreatic lesion that has the gross appearance of a mass. If diagnosed at frozen section, many of these lesions do not require a major procedure. However, some cases may still require a resection to exclude an adjacent malignancy. The final diagnosis is usually not made until the pancreas is widely sampled on the resection specimen. Examples...
Liver lesions, enlarged lymph nodes, and suspicious peritoneal nodules may be biopsied in an attempt to diagnose metastatic pancreatic adenocarcinoma and help determine resectability. Small, radiologically inapparent liver metastases are often subcapsular and must be distinguished from benign liver lesions such as bile duct adenoma, bile duct hamartoma (von Meyenburg complex), focal scarring, or reactive...
Although most pancreatic tumors seen at frozen section are adenocarcinomas, occasionally other types of pancreatic neoplasms are present. Table 6.1 compares some of the typically solid pancreatic tumors.
Secondary tumors involving the pancreas (metastatic or by direct extension) may not be treated by surgical resection. They are usually suspected with the proper clinical history and imaging techniques. Tissue confirmation may be obtained through fine needle aspiration or biopsy. In some cases, the diagnosis of a primary pancreatic neoplasm is suspected pre-operatively, and the surgeon may be surprised...
The pre- and intra-operative diagnosis of cystic pancreatic lesions is important since the management and prognosis varies between different lesions. The majority of pancreatic cystic lesions are pseudocysts that do not require major surgical resections. Fig. 5.1 shows the typical intra-operative management for cystic lesions in response to frozen section diagnosis. Generally the surgeon submits a...
Ductal adenocarcinoma is the most common primary malignant neoplasm of the pancreas, representing more than 90% of the exocrine pancreatic tumors. Variants of ductal adenocarcinoma can mimic involvement by the pancreas from other tumors (pancreatic and metastatic).
Frozen sections of the pancreas are performed for tumor confirmation and to assess resectability and margin status. Accurate frozen section diagnoses are important to help guide the surgical procedure. Diagnostic difficulties in pancreatic frozen sections are related to technical and morphological factors, with the main problematic differential diagnosis being between chronic pancreatitis and duct...
Frozen Sections are performed while a patient is undergoing surgery as a basis for making an immediate diagnosis that will impact treatment decisions. Frozen section diagnosis is often a highly demanding situation for the pathologist who must render a diagnosis quickly for the patient and surgeon. The Frozen Section Library series will provide concise, user-friendly, site specific handbooks that...
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