BEYOND THE BELLY: PANCREATIC LESIONS AND THEIR FORENSIC IMPLICATIONS

Abstract

The pancreas, owing to its deep retroperitoneal location and dual exocrine–endocrine function, can harbour a wide range of pathological lesions—ranging from inflammatory changes to aggressive malignancies. In both clinical and forensic practice, pancreatic pathology often remains an under-explored contributor to morbidity and mortality. Pancreatic lesions discovered incidentally at autopsy may explain sudden natural deaths, while in living patients, histopathology plays a pivotal role in guiding clinical and therapeutic decisions.

Objective:
To evaluate the histomorphological spectrum of pancreatic lesions encountered in a tertiary care centre and to elucidate their potential forensic significance in determining the cause and manner of death.

Materials & Methods:

  A retrospective observational study of 67 pancreatic specimens (surgical and autopsy) examined histopathologically between July 2016 and July 2017 at the Department of Pathology, Stanley Medical College, Chennai. Routine H&E staining and relevant special stains or immunohistochemistry were employed. Clinical and forensic details were correlated where available.

Results:
Non-neoplastic lesions, predominantly chronic pancreatitis and pseudocysts, occurred mostly in the 20–40 year age group, often associated with alcohol use or prior trauma. Neoplastic lesions predominated in the 50–60 year age group and included serous cystadenoma, solid pseudopapillary neoplasm, intraductal tubulopapillary neoplasm with invasive carcinoma, acinar cell carcinoma, and ductal adenocarcinoma. Pancreatic ductal adenocarcinoma (PDAC) was the most common malignancy. Several lesions, particularly pancreatitis and PDAC, were identified incidentally at autopsy, underlining their medicolegal relevance.

Conclusion:
Pancreatic lesions, though often clinically silent, can carry significant forensic implications by contributing to sudden or unexplained natural deaths. Integrating histopathological assessment with clinical and autopsy findings is vital for accurate cause-of-death determination and medico-legal interpretation. Greater awareness of pancreatic pathology within forensic investigations can prevent diagnostic errors and enrich multidisciplinary understanding of these “hidden” diseases.