title: Unusual histological findings after partial pancreaticoduodenectomy including benign multicystic mesothelioma, adenomyoma of the ampulla of Vater, and undifferentiated carcinoma, sarcomatoid variant: a case series.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General, Visceral and Pediatric Surgery; Heinrich-Heine-University Duesseldorf, Moorenstr, 5, 40225 Duesseldorf, Germany. cupisti@uni-duesseldorf.de.
authors.forename: Nadja
authors.initials: N
authors.lastname: Lehwald
authors.forename: Kenko
authors.initials: K
authors.lastname: Cupisti
authors.forename: Stephan E
authors.initials: SE
authors.lastname: Baldus
authors.forename: Patric
authors.initials: P
authors.lastname: Kröpil
authors.forename: Jan
authors.initials: J
authors.lastname: Schulte Am Esch
authors.forename: Claus F
authors.initials: CF
authors.lastname: Eisenberger
authors.forename: Wolfram T
authors.initials: WT
authors.lastname: Knoefel