title: Intraductal tubular adenoma of the pancreas, pyloric gland type: a clinicopathologic and immunohistochemical study of 6 cases.
abstract: The intraductal tubular adenoma (ITA), pyloric gland type, of the pancreas is an uncommon benign tumor, akin to the pyloric gland type adenoma of the gallbladder. We report 6 cases of ITA of the pancreas: 3 male and 3 female aged 50 to 79 years (mean, 63.5 years; median, 65 years); all were examined clinicopathologically. Four patients showed no symptoms, but appetite loss and/or general fatigue presented in two. Grossly, all tumors formed a localized polypoid mass protruding into the lumen of the dilated pancreatic duct. Five of the six tumors were found within the main duct, and the other arose within the branch duct of the pancreas. Microscopically, the tumors were composed of closely packed tubular glands resembling pyloric type glands. They were lined by columnar or cuboidal epithelial cells with foci of mild to moderate dysplastic change. In 2 cases, the adjacent pancreas showed foci of intraductal papillary-mucinous adenoma. Histochemically, the tumors largely showed neutral mucin with a lesser amount of acidic mucin made up mainly of sialomucin. Endocrine cells were found in five tumors. Immunohistochemically, all tumors were labeled with M-GGMC-1 and MUC6, whereas MUC1 and MUC2 stains were negative. Pepsinogen II was positive in 5 tumors; thus, the results displayed a pattern of differentiation similar to those of ordinary gastric pyloric or metaplastic pyloric glands. DPC4 expression was maintained in all tumors and p53-positive nuclei were hardly encountered. All patients are alive with no evidence of disease 3 to 10.5 years after surgical resection.
authors.affiliation: Department of Pathology, School of Medicine, Fukuoka University, Fukuoka, Japan. nakayama@fukuoka-u.ac.jp
authors.forename: Yoshifuku
authors.initials: Y
authors.lastname: Nakayama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Inoue
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Hamada
authors.forename: Morishige
authors.initials: M
authors.lastname: Takeshita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Iwasaki
authors.forename: Kensei
authors.initials: K
authors.lastname: Maeshiro
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Iwanaga
authors.forename: Hiroki
authors.initials: H
authors.lastname: Tani
authors.forename: Shinichirou
authors.initials: S
authors.lastname: Ryu
authors.forename: Yohichi
authors.initials: Y
authors.lastname: Yasunami
authors.forename: Seiyo
authors.initials: S
authors.lastname: Ikeda
mesh_terms: D000236:Adenoma / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D004268:DNA-Binding Proteins / Q000032:analysis; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D005753:Gastric Mucosa / Q000737:chemistry / Q000473:pathology*; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D008875:Middle Aged; D009077:Mucins / Q000032:analysis / Q000145:classification; D010183:Pancreatic Ducts / Q000737:chemistry / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D020116:Pepsinogen A / Q000032:analysis; D051901:Smad4 Protein; D015534:Trans-Activators / Q000032:analysis; D016896:Treatment Outcome; D016159:Tumor Suppressor Protein p53 / Q000032:analysis
chemical_list: D014408:Biomarkers, Tumor; D004268:DNA-Binding Proteins; D009077:Mucins; C497796:SMAD4 protein, human; D051901:Smad4 Protein; D015534:Trans-Activators; D016159:Tumor Suppressor Protein p53; D020116:Pepsinogen A