[Pancreatic intraductal adenoma, adenomatosis and adenocarcinoma]

Three cases of adenomatous lesions of the pancreatic ducts are reported. There was 1 case each of adenoma of the main pancreatic duct, adenomas of the uncinate process and diffuse adenomatosis of the cephalic pancreatic ducts with ampullary involvement. On ultrasound and computerized tomography, the main pancreatic duct was enlarged in all cases, associated in 2 cases with a mass in the head of the pancreas, and in 1 case, with pseudocystic dilation of the uncinate process ducts. At duodenoscopy, the papilla was tumoral in 1 case, enlarged with mucous flow in 1 case and normal in the third case in which cytologic examination of secretions disclosed glandular cells. Endoluminal lesions were diagnosed by endoscopic retrograde pancreatography in 2 cases and on gross pathologic examination in 1 case. Treatment was surgical: cephalic pancreatoduodenectomy in 2 cases and local resection in 1 case, which relapsed 3 years later. At pathology, lesions were benign in all 3 cases including 1 case of severe dysplasia. On the basis of these 3 cases and a review of the literature, distinctive features of pancreatic endoluminal adenomas and adenocarcinomas are specified. Pancreatic resection is mandatory because of the risk of pancreatic obstruction and malignant degeneration.