How to gross a Whipple's specimen

Just mentioning presence of a Whipple's specimen in the lab would bring throngs of histopathology trainees to observe the grossing of the specimen. It is associated with intimidating combination of organs, many margins to remember, and last but definitely not least, the lament of a trainee saying: "Where is the tumour??"

When I was a second year Pathology Masters student (first year Histopathology trainee), a senior trainee taught us a simplified way to gross a Whipple's specimen. It is the same as any other textbook, but the lack of wordiness (as compared to the textbook) make it less intimidating.

(Picture from www.pancreapedia.org)

1. Margins

Stomach (proximal margin)
Duodenum (distal margin)
Uncinate (Soft tissue margin)
Anterior pancreas
Common bile duct (shaved)

Then the sample can be fixed for another day by slicing the pancreas

2. Take sample of tumour (or non-tumour) with common bile duct in continuity with the pancreas.

This sample will answer crucial questions like, "Is the tumour from the pancreas or from the bile duct?"

3. Try to find some lymph nodes.

Comments

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