Solid lesions of pancreas a diagnostic dilemma: Utility of histopathology

Pancreatic pseudotumor: solid non neoplastic lesions of pancreas can often mimicpancreatic cancer clinically and radiologically. Despite major evolution and development in radiologyaccurate diagnosis of pancreatic lesion are often difficult. The purpose of the study was to assess thediagnostic accuracy of USG in pancreatic lesion and study various solid lesions of pancreas in our tertiarycare center.Materials and Methods: A descriptive study done on all resections (PPPD and Frey excision) of pancreasfor a period 18 months. A total of 30 cases were included with adequate clinical and radiologicalfeatures. Formalin fixed paraffin embedded sections were studied and analysed for USG findings, signsand symptoms, associated co morbidities and histological factors.Results: Females were more affected than males (1.7:1). Solid lesions presented in individuals as young as21years to older individuals of 71yrs. The solid lesions included inflammatory lesions (such as acute andchronic pancreatitis) and neoplastic lesions. Most common clinical presentation was jaundice and vagueabdominal pain accounting for 67.8 percent of study population. The histomorphological spectrum of solidlesions included 14 cases of inflammatory lesions and 16 cases of neoplastic lesion (Table 1). Among the 16cases neoplastic lesion 5 cases had coexisting tropical pancreatitis. USG examination showed a sensitivityof 53.85%, specificity of 38.46%, positive predictive value of 46.67% and negative predictive value of45.45% and accuracy of 46.15% for USG examination. Histomorphological features of pancreatitis werestudied and most common finding was calcification (100%) present as both microscopic concretions ormacroscopic calculi, followed by fatty changes (77%) and fibrosis (72%).Conclusion: Solid lesions of pancreas still pose diagnostic difficulty for clinician. USG has poor predictivevalue for non-neoplastic lesions. Histopathological examination remains the gold standa