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  • Surgical Pathology Criteria
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    Intraductal Tubular Adenoma of the Pancreas

    Definition

    • Cytologically bland nodular pancreatic intraductal epithelial proliferation with a predominantly tubular architecture

    Alternate/Historical Names

    • Intraductal tubular adenoma, pyloric gland type
    • Intraductal tubular neoplasm with low grade dysplasia
    • Pyloric gland adenoma of the pancreas

    Diagnostic Criteria

    • Nodular intraductal growth
      • Duct dilated locally
        • May fill and obliterate duct lining
        • Grossly present mucin but no distension of ducts
      • Upstream pancreas may be atrophic
    • Tubular growth pattern predominates
      • Tightly packed tubules
      • Variable sized tubules
      • May be focally villous
    • Cuboidal to columnar cells resembling normal pyloric gland cells
      • Moderate to abundant apical cytoplasm
        • Eosinophilic to clear cytoplasm
        • Abundant cytoplasmic mucin in most cases
      • Basal nuclei
      • Scattered goblet cells and endocrine cells may be present
    • Cytologically bland to low grade dysplasia
      • Mitotic rate 1-5/50 hpf
    • Some of the reported cases presented with a synchronous IPMN
    • No reported association with invasive carcinoma

    Robert V Rouse MD
    Department of Pathology
    Stanford University School of Medicine
    Stanford CA 94305-5342

    Original posting : August 25, 2009

    Supplemental studies

    Immunohistology

    CK7 Pos
    CK20 Neg
    MUC1 Neg
    MUC2 Neg except for goblet cells
    MUC5AC Pos
    MUC6 Pos

    KRAS mutations have been described

    Differential Diagnosis

    Intraductal Tubular Adenoma Intraductal Tubular Carcinoma
    Composed of mucin positive pyloric type cells Generally mucin poor or negative
    Frequent goblet cells No goblet cells
    Low grade atypia High grade atypia
    Mitotic rate 1-5/50 hpf Mitotic rate frequently >5/50 hpf
    No necrosis Frequent necrosis
    Not associated with invasive carcinoma May have associated invasive carcinoma
    Intraductal tubular adenoma and carcinoma do not appear to be related

    Intraductal Tubular Adenoma Intraductal Papillary Mucinous Neoplasm
    Discrete lesion Usually diffuse lesion
    Cystic dilation of ducts at tumor site with scant mucin Distended ducts filled with mucin
    Tubular pattern Papillary pattern
    Low grade atypia Atypia may vary from low to high
    MUC2 negative MUC2 positive

    Intraductal Tubular Adenoma PanIN
    Usually clinically detectable Usually not clinically detectable
    Grossly visible Not grossly visible
    Well formed tubules No well formed tubules
    Low grade atypia Atypia may vary from low to high

    Intraductal Tubular Adenoma Mucinous Cystic Neoplasm of the Pancreas
    Nodular intraductal growth Mucin filled cyst or cysts
    Low grade atypia Atypia may vary from low to high
    Males and females affected Nearly all female
    Involves segments of ducts Does not communicate with ducts
    Extensive tubule formation No tubules
    No ovarian type stroma Ovarian type stroma

    Lists

    Cystic Pancreatic Lesions

    Mucinous Pancreatic Lesions

    Bibliography

    • Katabi N, Klimstra DS. Intraductal papillary mucinous neoplasms of the pancreas: clinical and pathological features and diagnostic approach. J Clin Pathol. 2008 Dec;61(12):1303-13.

    • Albores-Saavedra J, Sheahan K, O'Riain C, Shukla D. Intraductal tubular adenoma, pyloric type, of the pancreas: additional observations on a new type of  pancreatic neoplasm. Am J Surg Pathol. 2004 Feb;28(2):233-8.

    • Nakayama Y, Inoue H, Hamada Y, Takeshita M, Iwasaki H, Maeshiro K, Iwanaga S, Tani H, Ryu S, Yasunami Y, Ikeda S. Intraductal tubular adenoma of the pancreas, pyloric gland type: a clinicopathologic and immunohistochemical study of 6 cases. Am J Surg Pathol. 2005 May;29(5):607-16.

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    © 2005  Stanford University School of Medicine