Pathology of the Pancreas: A Practical Approach

310 Pages·2013·54.313 MB·English

by  Fiona Campbell, Caroline S. Verbeke (auth.)

Fiona Campbell
Caroline S. Verbeke
Pathology
of the Pancreas
A Practical Approach
123
Pathology of the Pancreas

Fiona Campbell (cid:129) C aroline S. Verbeke
Pathology of the Pancreas
A Practical Approach
Fiona Campbell Caroline S. Verbeke
Department of Pathology Karolinska Institute, Division of Pathology
Royal Liverpool University Hospital Karolinska University Hospital
Liverpool Stockholm
United Kingdom Sweden
ISBN 978-1-4471-2448-1 ISBN 978-1-4471-2449-8 (eBook)
DOI 10.1007/978-1-4471-2449-8
Springer London Heidelberg New York Dordrecht
Library of Congress Control Number: 2013938871
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Preface
Advances in imaging technology over the last 10–20 years have led to greater detection of
asymptomatic pancreatic lesions and to improved assessment of pancreatic disease. These
imaging advances have been accompanied by increased surgical expertise, new surgical resec-
tion procedures, and a wider range of indications for surgical intervention. Consequently,
pathologists are now exposed to more pancreatic specimens and to more diverse pathology.
New pancreatic entities continue to emerge, and the development of international guidelines
on diagnostic criteria and clinical management also continues apace, with the aim of increased
standardization.
This book is dedicated solely to the pancreas, covering the spectrum of pancreatic pathol-
ogy from congenital abnormalities to in fl ammatory disease and neoplasia. It is intended for
trainees in histopathology and consultants, who deal with pancreatic specimens, and aims to
provide both practical information for all aspects of the diagnostic process and in-depth, up-to-
date knowledge that is required for the pathologist’s participation in the multidisciplinary team
meetings and discussions.
In keeping with the intention that this should be a practical benchbook to have beside the
microscope, there is limited discussion on disease pathogenesis, and the bibliography has also
been kept brief. However, where appropriate, reference is made to up-to-date reviews, interna-
tional consensus criteria and guidelines, staging or grading systems, and diagnostic algorithms
to assist the reader. The book provides only limited information on the small superspecialized
area of pediatric pancreatic pathology and does not include pancreas transplant pathology.
However, it does provide guidance on rare entities, such as hereditary disease, and newly
emerging pathology, such as the reporting of pancreatic cancer following neoadjuvant
therapy.
The book is richly illustrated with numerous macroscopic and microscopic images covering
the wide range of appearances that the same tumor or disease entity can exhibit. These illustra-
tions are also used to provide a detailed, practical, step-by-step guide to macroscopic examina-
tion and specimen handling, as well as to explain the embryology and anatomy of the pancreas.
There are numerous quick-reference tables, and the potential mimics and diagnostic pitfalls are
included in differential diagnoses. There is extensive cross-referencing to allow the reader easy
access to relevant information. Reporting checklists are provided for the main diagnostic enti-
ties with a summary of key data items to include in the pathology report.
We do hope the reader will fi nd that the information contained in this book is well balanced
between practical guidance and background knowledge and that it will serve as a comprehen-
sive resource in daily diagnostic practice and multidisciplinary team discussion.
Liverpool, UK Fiona Campbell
Stockholm, Sweden Caroline S. Verbeke
v

Acknowledgements
We are extremely grateful to Steve Bradburn (Royal Liverpool and Broadgreen University
Hospitals NHS Trust), Steve Toms, and Mikael Todd (The Leeds Teaching Hospitals NHS
Trust) for their professional help with the photography. We would also like to thank all of our
pathology and clinical colleagues in Leeds, Liverpool, and Stockholm who, over the years,
knowingly and unknowingly have contributed to our knowledge and understanding of pancre-
atic pathology.

vii

Contents
Part I General Principles
1 Embryology, Anatomy, and Histology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.2 Embryology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.3 Anatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.4 Histology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Further Reading. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2 Pancreatic Specimen Types. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.1 Pancreatoduodenectomy Specimens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.2 Distal Pancreatectomy Specimens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.3 Total Pancreatectomy Specimens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
2.4 Duodenum-Preserving Pancreatic Resection Specimens. . . . . . . . . . . . . . . . 23
2.5 Complex Multivisceral En Bloc Resection Specimens . . . . . . . . . . . . . . . . . 23
2.6 Central Pancreatectomy Specimens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
2.7 Enucleation Specimens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
2.8 Specimens Following Frey, Beger, or Puestow Procedures . . . . . . . . . . . . . . 24
2.9 Laparoscopic and Robot-Assisted Resection Specimens. . . . . . . . . . . . . . . . 25
Further Reading. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
3 Specimen Dissection and Sampling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
3.1 Handling of Fresh Specimens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
3.2 Specimen Fixation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
3.3 Macroscopic Examination of Pancreatoduodenectomy Specimens. . . . . . . . 28
3.4 Dissection of Distal Pancreatectomy Specimens . . . . . . . . . . . . . . . . . . . . . . 42
3.5 Dissection of Other Pancreatic Specimen Types . . . . . . . . . . . . . . . . . . . . . . 42
3.6 Handling of Pancreatic Biopsies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
3.7 Reporting Checklist of Macroscopic Findings. . . . . . . . . . . . . . . . . . . . . . . . 43
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
4 The Pancreatic Multidisciplinary Team. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
4.1 Discussion of Postoperative Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
4.2 Discussion of Pretreatment Cases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
4.3 Other Roles and Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Part II Exocrine Pancreas: Non-cystic
5 Common Minor Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
5.1 Acinar Cell Nodules. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
5.2 Acinar Dilatation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
ix