Solid lesions of pancreas a diagnostic dilemma: Utility of histopathology

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Original Article

Author Details : Kalaranjini K V, Limi Mohandas*, Sheela Vasudevan

Volume : 7, Issue : 1, Year : 2020

Article Page : 181-185

https://doi.org/10.18231/j.ijpo.2020.034

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Abstract

Introduction: Pancreatic pseudotumor: solid non neoplastic lesions of pancreas can often mimic
pancreatic cancer clinically and radiologically. Despite major evolution and development in radiology
accurate diagnosis of pancreatic lesion are often difficult. The purpose of the study was to assess the
diagnostic accuracy of USG in pancreatic lesion and study various solid lesions of pancreas in our tertiary
care center.
Materials and Methods: A descriptive study done on all resections (PPPD and Frey excision) of pancreas
for a period 18 months. A total of 30 cases were included with adequate clinical and radiological
features. Formalin fixed paraffin embedded sections were studied and analysed for USG findings, signs
and symptoms, associated co morbidities and histological factors.
Results: Females were more affected than males (1.7:1). Solid lesions presented in individuals as young as
21years to older individuals of 71yrs. The solid lesions included inflammatory lesions (such as acute and
chronic pancreatitis) and neoplastic lesions. Most common clinical presentation was jaundice and vague
abdominal pain accounting for 67.8 percent of study population. The histomorphological spectrum of solid
lesions included 14 cases of inflammatory lesions and 16 cases of neoplastic lesion (Table 1). Among the 16
cases neoplastic lesion 5 cases had coexisting tropical pancreatitis. USG examination showed a sensitivity
of 53.85%, specificity of 38.46%, positive predictive value of 46.67% and negative predictive value of
45.45% and accuracy of 46.15% for USG examination. Histomorphological features of pancreatitis were
studied and most common finding was calcification (100%) present as both microscopic concretions or
macroscopic calculi, followed by fatty changes (77%) and fibrosis (72%).
Conclusion: Solid lesions of pancreas still pose diagnostic difficulty for clinician. USG has poor predictive
value for non-neoplastic lesions. Histopathological examination remains the gold standard for diagnosis.
However, emphasis for minimally invasive techniques such as FNAC must be given.

Keywords: Solid lesion, Pseudotumors, Chronic pancreatitis, Tropical pancreatitis, USG.

How to cite : Kalaranjini K V, Mohandas L, Vasudevan S , Solid lesions of pancreas a diagnostic dilemma: Utility of histopathology. Indian J Pathol Oncol 2020;7(1):181-185

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