Rare benign pathologies mimicking malignancy: A cautionary tale for Whipple's resections

Area of Science:

• Gastroenterology and Hepatology
• Surgical Oncology
• Pathology

Background:

• Pancreatoduodenectomy (Whipple's procedure) is typically performed for malignant pancreatic and peri-ampullary lesions.
• Benign pathologies necessitating this extensive surgery are rare.
• Accurate pre-operative diagnosis can be challenging.

Purpose of the Study:

• To report two uncommon cases of benign pathologies diagnosed after Whipple's resection for suspected malignancy.
• To highlight the diagnostic challenges posed by rare benign lesions mimicking cancer.
• To emphasize the importance of considering rare benign conditions in differential diagnoses.

Main Methods:

• Review of two patient cases undergoing Whipple's resection.
• Analysis of pre-operative imaging and clinical presentation.
• Histopathological examination of resected specimens.

Main Results:

• Case 1: Cholesterol polyp in the distal common bile duct.
• Case 2: Ampullary intramural ectopic gland hyperplasia.
• Both rare benign lesions were initially suspected as malignant.

Conclusions:

• Rare benign pathologies can mimic pancreaticobiliary cancers, leading to unnecessary Whipple's resections.
• Despite advancements in imaging, definitive pre-operative differentiation remains difficult for certain rare conditions.
• Pathological confirmation is crucial for accurate diagnosis and management.