Pyloric gland adenoma of the main pancreatic duct
Por:
Bakotic B.W., Robinson M.J., Sturm P.D.J., Hruban R.H., Offerhaus G.J.A., Albores-Saavedra J.
Publicada:
1 ene 1999
Resumen:
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.
Filiaciones:
Bakotic B.W.:
Dept. of Pathol. and Lab. Medicine, Mount Sinai Medical Center, Miami Beach, FL, United States
Univ. of Miami School of Medicine, Miami, FL, United States
Dept. of Pathol. and Lab. Medicine, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL 33140-2800, United States
Robinson M.J.:
Dept. of Pathol. and Lab. Medicine, Mount Sinai Medical Center, Miami Beach, FL, United States
Univ. of Miami School of Medicine, Miami, FL, United States
Sturm P.D.J.:
Dept. of Pathol. and Lab. Medicine, Mount Sinai Medical Center, Miami Beach, FL, United States
Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, United States
Hruban R.H.:
Dept. of Pathol. and Lab. Medicine, Mount Sinai Medical Center, Miami Beach, FL, United States
Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, United States
Offerhaus G.J.A.:
Dept. of Pathol. and Lab. Medicine, Mount Sinai Medical Center, Miami Beach, FL, United States
Department of Pathology, Academic Medical Center, Amsterdam, Netherlands
Albores-Saavedra J.:
Dept. of Pathol. and Lab. Medicine, Mount Sinai Medical Center, Miami Beach, FL, United States
Division of Anatomic Pathology, Department of Pathology, Univ. Texas Southwestern Med. Ctr., Dallas, TX, United States
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