Pyloric gland adenoma of the main pancreatic duct

Bradley W. Bakotic, Morton J. Robinson, Patrick D.J. Sturm, Ralph H. Hruban, G. Johan A. Offerhaus, Jorge Albores-Saavedra

Research output: Contribution to journalArticlepeer-review

41 Scopus citations

Abstract

A case of a pyloric gland type adenoma of the main pancreatic duct in a 69-year-old woman is reported. The tumor led to occlusion and cystic dilatation of the main duct in the pancreatic tail. The surgical resection specimen disclosed a polypoid, bilobed mass attached to the wall of the main pancreatic duct by a thin fibrous stalk. Light-microscopic examination revealed a well-demarcated nodule composed of closely packed tubular glands lined by columnar, mucin-secreting cells with abundant clear cytoplasm and basally oriented nuclei. Focal, mild cytologic atypia was seen. Pyloric metaplasia and focal papillary hyperplasia was present in the adjacent ductal epithelium. Periodic acid-Schiff reactions, with and without diastase predigestion, showed reactivity in the tubular glands, whereas alcian blue (pH 2.5) was negative. Immunohistochemical stains for chromogranin, serotonin, somatostatin, and gastrin failed to detect the respective antigens. Genetic analysis using polymerase chain reaction with mutant enrichment and allele specific oligonucleotide hybridization detected a single mutation at codon 12 of K-ras, which changed the wild-type glycine to arginine. This mutation is commonly found in invasive pancreatic ductal carcinomas. Although tumors with microscopic and immunohistochemical features consistent with pyloric gland adenoma have been described in the gallbladder, to our knowledge, this is the first reported case within the pancreatic ductal system. The finding of a K-ras, codon 12 mutation and the presence of focal dysplasia may denote neoplastic potential in association with this lesion.

Original languageEnglish (US)
Pages (from-to)227-231
Number of pages5
JournalAmerican Journal of Surgical Pathology
Volume23
Issue number2
DOIs
StatePublished - Feb 1999

Keywords

  • Genetic analysis
  • K-ras mutations
  • Pancreatic duct
  • Pyloric gland adenoma

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine

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