Ruben Bellotti, Hartmut Steinle, Stefan Stättner, Georg Oberhuber
Context Gastric-type intraductal papillary neoplasm pyloric gland type of the pancreas is an uncommon neoplasm with indolent behavior in many cases, morphologically resembling pyloric gland adenomas of the gallbladder, with only few reported cases of concurrent malignancy. Case Report We report the case of an asymptomatic seventy-two-years-old woman accidentally diagnosed with main ductintraductal papillary neoplasm. The lesion has been surgically removed due to the endosonographic features, similar to those of an intraductal papillary neoplasm with high-risk stigmata. Histologically the neoplasia was composed of tubular glands lined by epithelial cells with low-grade dysplasia, resembling gastric foveolar type epithelium and pyloric gland like epithelium. The lesion developed in an area of main duct-intraductal papillary neoplasm gastric-type. The expression of MUC5AC and MUC6 supported gastric type differentiation. Conclusion In the majority of cases intraductal papillary neoplasm pyloric gland type are considered to follow a benign course. However, malignant intraductal papillary neoplasm pyloric gland type has been reported. In order to avoid surgical overtreatment, the development of reliable criteria determining the course of the disease is an important task. Potentially, technical advances in molecular analysis of cystic fluids may aid in the assessment of cystic lesions to avoid overtreatment.
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