Histopathological study of early lesions of pancreatoduodenal cancer

The early lesions of pancreatoduodenal cancer, which was defined as those in which the site of origin is confined in a single certain anatomical part and the mode of early extension can be pursued, were found in 28 of 52 surgical specimens examined; 12 in the pancreatic portion of the common bile duct (PCBD), 12 in the common channel, 1 each in the terminal portion of the common bile duct and the terminal portion of the pancreatic duct, and 2 in the peripapillary zone of the duodenum. There were roughly two types of tumor growth; one annular flat-raised, histologically scirrhous tubular adenocarcinoma, principally found in PCBD and the other polypoid, histologically papillary or papillotubular adenocarcinoma, found everywhere. The staining properties of mucin was of no value in differential diagnosis for the site of origin. One typical carcinoid was observed in PCBD. The surface spread of carcinoma beyond the originating part was seen in 10 cases (36%), lymphatic invasion in 23 cases (82%), node metastasis in 9 cases (32%), and venous invasion in 6 cases (21%). Only 2 cases were mucosal carcinomas. From these figures it can be concluded that the carcinoma of this region is of high grade malignancy.