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Intraductal serrated adenoma of the pancreas. A case report
C A Rubio1, L Grimelius, K Von Sivers
1Department of Pathology, Karolinska University Hospital, Stockholm, Sweden. Carlos.Rubio@onkpat.ki.se
Insights
A slow-growing pancreatic tumor, initially an intraductal serrated adenoma, was monitored for 2.7 years. It later showed early invasive carcinoma, highlighting the progression of serrated neoplasia.
Area of Science:
- Gastroenterology and Oncology
- Surgical Pathology
Background:
- Pancreatic incidentalomas require careful monitoring for neoplastic progression.
- Intraductal serrated adenomas are a precursor to pancreatic cancer.
Observation:
- A 48-year-old male presented with transient ischemic attack symptoms.
- Initial CT revealed a pancreatic head mass, stable for 14 months.
- Subsequent CT showed significant tumor growth over 2.7 years.
Findings:
- Surgical resection revealed a 4 cm intraductal serrated adenoma with sawtooth-like epithelial fronds.
- Histopathology confirmed an area of early invasive carcinoma.
- The tumor demonstrated slow but steady progression.
Implications:
- This case underscores the malignant potential of intraductal serrated adenomas.
- Long-term surveillance is crucial for managing pancreatic cystic neoplasms.
- Early detection and intervention are key for improved patient outcomes in pancreatic cancer.
Case Report:
A 48-year-old male with known hypothyreosis consulted his physician for symptoms compatible with TIA (transient ischemic attacks). Computer tomography (CT) in December 2001 revealed an irregular, lobulated mass in the processus uncinatus of the pancreas head. A CT examination 14 months later revealed status quo. In July 2004, a new CT showed an increase in size of the expansive pancreatic mass. The patient was operated on in August 2004 with a preliminary diagnosis of incidentaloma of the pancreas. The pathological examination showed a 4 x 3.5 x 2.5 cm large tumour. Histology revealed an intraductal serrated adenoma. The epithelial fronds had sawtooth-like configurations. An area with early invasive carcinoma was found. The tumour had progressed slowly during the 2.7 years of surveillance. Serrated neoplasia in the duodenum may result in similar cases in the future.
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