Tumor Tip of the Week 03-13-2026 EOD Pancreas-Which takes priority scan abutment or path

03-13-2026 EOD Pancreas-Which takes priority scan abutment or path

Scenario:

• 2025 Diagnosis Pancreas head primary site, Intraductal papillary-mucinous neoplasm w/ an associated inv ca
• CT: Complex cystic lesion versus conglomerate of cystic lesions in the pancreatic head measuring 6.2 cm and main pancreatic ductal dilation which extends to the ampulla measuring up to 18 mm in caliber. Given endoscopic findings are concerning for a malignant side branch and main duct IPMN. Abutment of the superior mesenteric and portal veins with the proximal 180 degrees involvement. Abutment of the common hepatic artery and encasement of the gastroduodenal artery.

• Classic, yet extended Whipple.
  • Path: Pancreaticoduodenectomy (Whipple resection), partial pancreatectomy
    • TUMOR
      • Tumor Site Pancreatic head
      • Histologic Type Intraductal papillary-mucinous neoplasm with an associated invasive carcinoma
      • Histologic Grade G1, well differentiated
      • Tumor Size Greatest Dimension (Centimeters): 6.9 cm
      • Site(s) Involved by Direct Tumor Extension Duodenal wall
      • Peripancreatic soft tissues
      • Treatment Effect No known presurgical therapy
      • Lymphovascular Invasion Not identified
      • Perineural Invasion Not identified
    • MARGINS
      • Margin Status for Invasive Carcinoma Invasive carcinoma present at margin
      • Margin(s) Involved by Invasive Carcinoma Pancreatic neck / parenchymal
      • Margin Status for Dysplasia and Intraepithelial Neoplasia All margins negative for dysplasia and intraepithelial neoplasia
    • REGIONAL LYMPH NODES
      • Regional Lymph Node Status All regional lymph nodes negative for tumor
      • Number of Lymph Nodes Examined 23

Question: For this case, when coding EOD primary tumor should I use the information from the Scans and Whipple to code 600 or just use info from the Whipple and code 500?

• Code 600-CT shows Abutment Superior Mesenteric veins & abutment of common hepatic artery
• Code 500-The Whipple – Carcinoma involves peripancreatic soft tissue and invades duodenal wall but no mention of the veins.

Answer & Rationale: Code 500

Per the general instructions for EOD, pathology takes priority over clinical. You would only code the “abutment” if all you had was clinical information, OR the pathology report confirmed the veins were involved.

Per the pathology report, extension was to the duodenal wall. Code 500.