Macroscopy

Ductal adenocarcinomas are firm and poorly defined masses. The cut surfaces are yellow to white. Haemorrhage and necrosis are uncommon, but microcystic areas may occur. In surgical series, the size of most carcinomas of the head of the pancreas ranges from 1.5 to 5 cm, with a mean diameter between 2.5 and 3.5 cm. Carcinomas of the body/tail are

Fig. 10.02 Ductal adenocarcinoma. An ill-defined pale carcinoma in the head of the pancreas.

usually somewhat larger at diagnosis. Tumours with a diameter less than 2 cm are infrequent {697} and may be difficult to recognise by gross inspection. Carcinomas of the head of the pancreas usually invade the common bile duct and/or the main pancreatic duct and produce stenosis that results in proximal dilatation of both duct systems. Complete obstruction of the main pancreatic duct leads to extreme prestenotic duct dilatation with duct haustration and fibrous atrophy of the parenchyma (i.e. obstructive chronic pancreatitis). More advanced pancreatic head carcinomas involve the ampulla of Vater and/or the duodenal wall, causing ulcerations. Carcinomas in the pancreatic body or tail obstruct the main pancreatic duct, but typically do not involve the common bile duct.

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