A CASE OF INTRADUCTAL PAPILLARY ADENOMA OF THE PANCREAS

Abstract

A 67-year-old male was admitted to our hospital complaining of general malaise and body weight-loss. No abnormal findings were noticed in physical examinations of the patient. However, chemical laboratory tests suggested the presence of biliopancreatic disorders because of the elevation of LAP, GOT and FBS levels in the serum. Abdominal ultrasonography demonstrated a tortuous dilatation of the main pancreatic duct with irregular echo level of the pancreas and with no abnormality of the liver and bile duct system. Endoscopic ultrasonography scanned through the duodenal wall also showed a hypoechoic mass within the dilated main pancreatic duct at the head. ERP revealed a round radiolucent shadow within the duct (15×13 mm in size), suggesting the presence of a tumor of the pancreas at the head. The lesion was directly inspected as a grayish villous tumor within the duct by using peroral pancreatoscopy under duodenoscopic guidance. Direct biopsy from the tumor through the papilla under duodenoscopy showed no malignant development (Group II). Laparotomy with pancreatoduodenectomy was then performed because the lesion could not be completely ruled out from malignancy. Resected specimens revealed a tumor, 20×16×16 mm in size, within the duct at the head of the pancreas, and it was histologically confirmed as a papillary adenoma of the duct with partial atypism.