Unusual histological findings after partial pancreaticoduodenectomy including benign multicystic mesothelioma, adenomyoma of the ampulla of Vater, and undifferentiated carcinoma, sarcomatoid variant: a case series

Our plain-English summary of Unusual histological findings after partial pancreaticoduodenectomy including benign multicystic mesothelioma, adenomyoma of the ampulla of Vater, and undifferentiated carcinoma, sarcomatoid variant: a case series, by N. Lehwald, K. Cupisti, S.E. Baldus, et al (Journal of Medical Case Reports, 2010).

The study

• Authors: N. Lehwald, K. Cupisti, S.E. Baldus, P. Kröpil, J. Schulte Am Esch, C.F. Eisenberger, W.T. Knoefel
• Journal: Journal of Medical Case Reports
• Published: 2010;4:402
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: The standard operation for carcinoma of the pancreatic head is a partial pancreaticoduodenectomy. Unusual histological findings may occasionally occur in the surgical specimen. We present three unusual histologic diagnoses after pancreaticoduodenectomy.

Case Presentations: In the first case, an 86-year-old Caucasian woman was admitted with abdominal pain and nausea. Preoperative evaluation showed a 3 cm cystic lesion in the head of the pancreas. Pathology revealed a benign multicystic mesothelioma. In the second case, a 45-year-old Caucasian man complained of nausea, vomiting and general malaise for several months. Endoscopic retrograde cholangiopancreatographic examination and a computed tomography scan showed a stenosis of the distal bile duct secondary to a mass in the head of the pancreas and duodenum. Histology showed an adenomyoma of the ampulla. In the third case, a 59-year-old Caucasian man presented with chronic alcoholic pancreatitis. A computed tomography scan revealed a 3.5 cm lesion in the head of the pancreas with cystic and solid components. Pathology showed an undifferentiated carcinoma, sarcomatoid variant.

Conclusion: Partial pancreaticoduodenectomy is usually performed for ductal adenocarcinomas, neuroendocrine tumors or chronic pancreatitis. Compared to the majority of the above diagnoses, the three cases in our study are very rare. Benign multicystic mesothelioma is a very rare tumor that originates from the peritoneum. Although it demonstrates a benign clinical behaviour, it frequently recurs after resection. Adenomyoma of the bile duct or ampullary region is a very unusual, benign, localized lesion characterized by adenomyomatous hyperplasia. Undifferentiated carcinoma, sarcomatoid variant, is an aggressive tumor and is characterized by spindle cells. As the lesions were suspicious for carcinoma, partial pancreaticoduodenectomy was justified in all three patients. The histologic diagnosis after partial pancreaticoduodenectomy may differ from the preoperative and intraoperative findings. These cases demonstrate that a definitive diagnosis may only be obtained by a pathologic examination of the surgical specimen.

In plain English

This article was a case series describing three patients whose pancreatic head surgery specimens showed unusual diagnoses. The article did not mention asbestos. In the first case, an 86-year-old woman had a cystic lesion in the head of the pancreas. The final diagnosis was benign multicystic mesothelioma, with no invasive growth or malignancy, and ten months later she had no signs of recurrence. The authors stated that, to their knowledge, this was the first description in the literature of benign multicystic mesothelioma of the pancreas. In the second case, a 45-year-old man had a 5.5 cm lesion in the ampulla of Vater, described as an adenomyoma of the ampulla, with no invasive component. In the third case, a 59-year-old man with chronic alcoholic pancreatitis had a 3.7 cm tumor diagnosed as undifferentiated carcinoma, sarcomatoid variant. All lymph nodes were tumor free, but two new liver metastases were found eight months after surgery and were removed. The authors noted that adenocarcinoma of the pancreas had been suspected before surgery in each case. A report of three patients does not show how often these conditions occur.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case series (three case reports)
• Who was studied: Three patients who underwent pancreatic surgery: an 86-year-old Caucasian woman, a 45-year-old Caucasian man and a 59-year-old Caucasian man. The authors are from Heinrich-Heine-University Duesseldorf, Germany. Treatment dates are not given.
• Exposure: The article does not mention asbestos. The third patient was described as having chronic alcoholic pancreatitis. The amount of alcohol is not given, and the article provides no detailed exposure history for any patient.
• Main results:
  • Case 1 (86-year-old woman): the final diagnosis was benign multicystic mesothelioma.
  • Case 1: no invasive growth or malignancy was found.
  • Case 1: ten months after surgery the patient had no signs of recurrence.
  • The authors stated that, to their knowledge, this was the first description in the literature of benign multicystic mesothelioma of the pancreas.
  • Case 2 (45-year-old man): a 5.5 cm lesion was found in the ampulla of Vater.
  • Case 2: the lesion was described as an adenomyoma of the ampulla, with no invasive component.
  • Case 3 (59-year-old man): a 3.7 cm cystic malignant tumor of the head of the pancreas was found.
  • Case 3: the tumor contained undifferentiated spindle cells and was diagnosed as undifferentiated carcinoma, sarcomatoid variant.
  • Case 3: all lymph nodes and resection margins were tumor free.
  • Case 3: two new liver metastases were found on a CT scan eight months after surgery.
  • Case 3: the two liver metastases were removed in a second operation.
• The authors' conclusion: The authors noted that adenocarcinoma of the pancreas had been suspected before surgery in each case, but the final pathology showed unexpected and unusual diagnoses.

Topics

Medical terms in this study, explained in our Lexicon: Multicystic Mesothelioma (MCM), Carcinoma, Sarcomatoid, Pathology, Histology, Adenocarcinoma, Peritoneum, Spindle Cell.

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