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Intraductal tubular adenoma

Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 2 December 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.


● Rare; intraductal tubular adenoma (ITA), pyloric gland type, first described in 1999 (Am J Surg Pathol 1999;23:227)
● Also called pyloric gland adenoma
● Cytologically bland nodular pancreatic intraductal epithelial proliferation with a predominantly tubular architecture (Stanford University)
● Benign tumor similar to pyloric gland type adenoma of gallbladder (Histopathology 2009;55:270)
● Either without (type A) or with (type B) associated gastric-type IPMN (Am J Surg Pathol 2005;29:607)

Gross description

● Polypoid mass

Gross images

Solid tumor (carcinoma) occupying main pancreatic duct with retention cyst

Micro description

● Well-demarcated nodule composed of closely packed tubular glands lined by columnar, mucin-secreting cells with abundant clear cytoplasm and basally oriented nuclei
● Focal mild atypia present
● Pyloric metaplasia and focal papillary hyperplasia present in adjacent ductal epithelium
● Adjacent pancreas may show intraductal papillary-mucinous adenoma

Micro images

Intraductal tubular neoplasm has closely packed glands resembling pyloric glands of stomach, lined by cuboidal to columnar cells with round nuclei and small nucleoli

Densely packed tubular glands without mucin pooling

Tumor cells proliferating in tubular fashion with irregular glandular arrangement.

Gallbladder lesions

Gallbladder: tubular glands lined by columnar cells with abundant mucin-containing cytoplasm and basal nuclei; cystically dilated gland is also seen

Gallbladder: cells with abundant eosinophilic cytoplasm similar to Warthin's tumor of salivary glands

Gallbladder: A-squamoid morule; B-cells with clear biotin-containing nuclei similar toendometrium of pregnancy

Gallbladder: with high-grade/dysplasia carcinoma in situ; closely packed glands lined by cells with large vesicular nuclei and prominent nucleoli; mitotic figures were present

Gallbladder: left-MUC6+, right-CDX2+

Positive stains

● PAS with and without diastase; CK7 (Am J Surg Pathol 2004;28:233)

Negative stains

● Alcian blue, chromogranin, synaptophysin

Molecular description

● May have codon 12 Kras mutation of usual type pancreatic ductal adenocarcinoma and dysplasia (Am J Surg Pathol 1999;23:227)

End of Pancreas > Tumors > Intraductal tubular adenoma

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