Intraductal Tubular Neoplasm of the Pancreas Diagnosed by Linear Echoendoscope: Case Report and Review

57 years old female with epigastralgia who was found to have dilated pancreatic main duct by transabdominal ultrasound at another hospital. She was referred to our university for further evaluation. There was no abnormal findings seen in physical examination. The results of hematology, general biochemistry, and urinalysis tests were all within normal ranges except for total cholesterol of 282mg/dl. (normal:<220mg/dL) The levels of serum carbohydrate-associated antigen 19–9, s-pancreas-1, and carcinoembryonic antigen were also within normal range. Abdominal enhanced CT and MRI revealed dilated main pancreatic duct without any evidence of obvious tumor. However, EUS revealed isoechoic mass in the main pancreatic duct measuring 5.5mm in diameter at pancreatic body with following dilated duct. No invasive into pancreas parenchyma was seen. Endoscopic retrograde pancreatography demonstrated that the main pancreatic duct at pancreatic body was partially narrowed with following dilated main pancreatic duct. IDUS showed stenotic change of pancreatic duct. Several cytology and brushing cytology tests showed negative for malignancy.

Based on those findings, the diagnose of intraductal papillary mucinous neoplasm was made and distal pancreatotectomy was performed without any complication. Resected specimen revealed a white nodular mass occupying main pancreatic duct. Histopathologically, the tumor was diagnosed as intraductal tubular adenoma.

Most of ITN are adenoma, and in many cases the prognosis are good. This disease is relatively rare. Therefore we report this case.