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2018 ; 472
(4
): 533-543
Nephropedia Template TP
gab.com Text
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English Wikipedia
Dilemmas for the pathologist in the oncologic assessment of pancreatoduodenectomy
specimens : An overview of different grossing approaches and the relevance of the
histopathological characteristics in the oncologic assessment of
pancreatoduodenectomy specimens
#MMPMID29589102
Soer E
; Brosens L
; van de Vijver M
; Dijk F
; van Velthuysen ML
; Farina-Sarasqueta A
; Morreau H
; Offerhaus J
; Koens L
; Verheij J
Virchows Arch
2018[Apr]; 472
(4
): 533-543
PMID29589102
show ga
A pancreatoduodenectomy specimen is complex, and there is much debate on how it
is best approached by the pathologist. In this review, we provide an overview of
topics relevant for current clinical practice in terms of gross dissection, and
macro- and microscopic assessment of the pancreatoduodenectomy specimen with a
suspicion of suspected pancreatic cancer. Tumor origin, tumor size, degree of
differentiation, lymph node status, and resection margin status are universally
accepted as prognostic for survival. However, different guidelines diverge on
important issues, such as the diagnostic criteria for evaluating the completeness
of resection. The macroscopic assessment of the site of origin in periampullary
tumors and cystic lesions is influenced by the grossing method. Bi-sectioning of
the head of the pancreas may offer an advantage in this respect, as this method
allows for optimal visualization of the periampullary area. However, a
head-to-head comparison of the assessment of clinically relevant parameters,
using axial slicing versus bi-sectioning, is not available yet and the gold
standard to compare both techniques prospectively might be subject of debate.
Further studies are required to validate the various dissection protocols used
for pancreatoduodenectomy specimens and their specific value in the assessment of
pathological parameters relevant for prognosis.
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