Histopathological Spectrum in Whipple’s Resection Specimens – a Six Years Retrospective Study in a Tertiary Care Centre

Aims and Objectives: To study the demographic distribution and histomorphological variations of Whipple’s pancreaticoduodenectomy specimens in regard to tumour site, size, type, grade, marginal status, lymph node metastasis, perineural invasion (PNI) and lymphovascular invasion (LVI). This study will also highlight the incidental pathological lesions occurring in Whipple’s specimens. Hence it will further facilitate to analyse the prognostic significance of all these parameters in order to co-relate the overall spectrum of these cases.

Study Design and Place of Study: An observational retrospective time bound descriptive study conducted at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna after approval of ethical committee.

Materials and Methods: A total of 150 Whipple’s resection specimens received in the Department of Pathology, IGIMS, Patna from January 2015 to December 2020 were selected as per inclusion and exclusion criterias. Details were collected from histopathology request forms and hospital record sheets. Gross and microscopic features were analysed and recorded. Slides were reviewed and the parameters were calculated.

Results: Statistical analysis showed that out of 150 Whipple’s pancreaticoduodenectomy specimens, 141 (94%) cases were malignant tumours, 6(4%) cases had low malignant potential and 3 (2%) cases were of benign nature. Periampullary carcinomas were the predominant malignant tumours (78.66%), followed by ampullary carcinomas (14%) and pancreatic endocrine tumours (1.33%). Tumours with low malignant potential were constituted by SPN (solid pseudopapillary neoplasm of the pancreas) (2.67%), GIST (gastrointestinal stromal tumours) (0.67%) and mucinous cystic neoplasm of the pancreas (0.67%). Mean age incidence was 49.57 years with a male to female sex ratio of 1.4:1. Most of the malignant tumours (more than 75%) were moderately differentiated and were in stage 2 category. Out of the total 141 malignant tumours, 71 (50.35%) cases showed LVI, 50 (35.46%) cases had PNI and 84 (81.67%) had tumour deposits in the lymph nodes.

Conclusions: Our study emphasizes the importance of tumour grade, tumour stage, presence of LVI, PNI, positive margins and lymph node metastasis as strong prognostic factors for patient survival. This is well corroborated by the significant P value in our study. Most of our cases were diagnosed at a locally advanced stage. Hence a more precise assessment and clinical evaluation can lead to early detection of cancer, improving the survival rates.