Pancreatic Intraductal Adenoma Pyloric Gland-Type with Intraductal Papillary Mucinous Neoplasm and Foci of Pancreatic Ductal Adenocarcinoma
Rizzo N1, Arrigoni G1, Albarello L1, Zerbi A2, Di Carlo V2, Doglioni C1
1Department of Anatomy and Pathology, 2Pancreas Unit, Department of Surgery, Scientific Institute H. San Raffaele, HSR. Milan, Italy
ABSTRACT
Context Pancreatic intraductal tubular adenoma (ITA) of pyloric gland type is a rare benign tumor occurring mostly in the 5th-7th decade of life, affecting equally male and female patients. Only 12 cases have been described so far; 10 arose within the main pancreatic duct, a single case was located at the junction of Santorini and Wirsung duct and another case in a branch of the dorsal pancreatic duct. This neoplasm is composed of packed tubular pyloric glands and morphologically resembles the pyloric gland type adenoma of the gallbladder. All the reported cases were benign. Case report We report a case of an unusual ITA pyloric gland-type of the pancreas in a 72-year-old man; it was bifocal and it was located within a dorsal and ventral pancreatic branch ducts. The neoplasm was composed of two polypoid mass measuring 2.7 cm and 1 cm in diameter, located in the head and in the uncinate process respectively, protruding into the lumen of dilated pancreatic ducts. Microscopically the lesion in the uncinate duct was composed of packed tubular pyloric type glands only; the largest lesion in the dorsal duct was composed by an ITA merging with an intraductal papillary mucinous tumor (IPMT) with varying degrees of dysplasia and with an associated invasive component showing tubular features, perineural and peripancreatic adipose tissue infiltration but no lymphnode metastasis. Conclusion This case indicates that: ITA may arise in the branch ducts; ITA can be associated with IPMT and invasive adenocarcinoma; extensive sampling of the surgical specimen is mandatory in every case of ITA in order to exclude a malignant component.
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