Paraduodenal Pancreatitis: A Deceptive Abdominal Mass with Unique Histologic Findings

Figure 2

Gross and microscopic examination of the pancreaticoduodenectomy specimen. (a) Thickening of duodenal mucosa with a polypoid appearance in the region of the accessory ampulla (on the left, arrows) and sparing of distal segments (on the right, metallic probes in the ampulla of Vater); bar: 1 cm. (b) Cut section of polypoid areas showing submucosal fibrosis and loss of demarcation of muscularis propria. On the right, a hemorrhagic area corresponding to prior FNA procedure. (c) Microabscess with deposition of keloid-type collagen fibers (asterisk) (H&E, 100x). (d) Dense fibrosis and chronic inflammation, H&E, 200X. (e) Brunner gland hyperplasia (H&E, 100x). (f) Diffuse periductal fibrosis of the accessory duct (arrows) and sparing of adjacent pancreatic parenchyma (asterisk) (H&E, 50x). Additionally identified, prominent lymphoid follicles and peripheral nerve hypertrophy (not shown).

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