What are the other Names for this Condition? (Also known as/Synonyms)

• Intraductal Tubular Adenoma, Pyloric Gland Type
• Pancreatic Intraductal Tubular Adenoma
• Pyloric Gland Adenoma of Pancreas

What is Intraductal Tubular Adenoma of Pancreas? (Definition/Background Information)

• Intraductal Tubular Adenoma of Pancreas is an uncommon benign tumor of the pancreas that arises within the main pancreatic duct. It typically occurs in elderly adults
• Most tumors do not cause any signs and symptoms, but in some individuals, there may be abdominal pain, indigestion, and loss of appetite due to the tumor
• Complications that arise from Intraductal Tubular Adenoma of Pancreas are rare, but may include gastrointestinal and biliary tract obstruction (causing jaundice) and injury to local region
• In many cases, these tumors are detected on radiological exams undertaken for some other health condition. Generally, the tumors are solitary and occur in the body or tail of the pancreas
• Even though there are no definitive treatment recommended for Intraductal Tubular Adenoma of Pancreas, surgery is an option for tumors that present severe symptoms or complications
• The prognosis of Pancreatic Intraductal Tubular Adenoma is excellent with appropriate treatment, although it is advisable to maintain regular health checkups after treatment

The pancreas is an important organ of the digestive system.

• Based on function of the pancreas, it can be functionally divided into 2 parts, namely:
  • Exocrine pancreas, which produces digestive enzymes, and
  • Endocrine pancreas that produces hormones such as insulin, glucagon, and somatostatin. Insulin and glucagon helps with controlling sugar levels in blood
• 95% of the pancreas is exocrine portion and 5% is endocrine portion. Pancreatic tumors (both benign and malignant) can arise from both the exocrine and the endocrine part
• Based upon anatomy of the pancreas, it can be divided into 3 main parts, namely the:
  • Head,
  • Body, and
  • Tail
• Pancreatic tumors can affect the head, body, and tail region of the pancreas. Some tumors can affect one area of the pancreas more than the other areas.

Hence, localizing the tumor site can guide the healthcare provider to arrive at a probable diagnosis.

Who gets Intraductal Tubular Adenoma of Pancreas? (Age and Sex Distribution)

• Intraductal Tubular Adenoma of Pancreas is an infrequent tumor that occur in adults in the age group of 50-80 years, with average age of presentation being 64 years
• It can affect both males and females with the same frequency
• The condition can occur worldwide; individuals of all racial and ethnic background may be affected

What are the Risk Factors for Intraductal Tubular Adenoma of Pancreas? (Predisposing Factors)

• Currently, the presence of intraductal papillary mucinous neoplasm of pancreas (a malignant tumor) is an identified risk factor for Intraductal Tubular Adenoma of Pancreas

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Intraductal Tubular Adenoma of Pancreas? (Etiology)

• The exact cause of Intraductal Tubular Adenoma of Pancreas development is unknown
• However, some tumors have been observed with KRAS mutations

What are the Signs and Symptoms of Intraductal Tubular Adenoma of Pancreas?

The signs and symptoms of Intraductal Tubular Adenoma of Pancreas depend upon the size and location of the tumor. During the initial stages, small tumors may not cause any signs and symptoms that are readily recognized. Hence, these tumors are only detected incidentally, when being worked-up for other conditions (i.e., diagnostic tests and exams undertaken for other health conditions).

The signs and symptoms may include the following:

• Abdominal pain, back pain
• Loss of appetite
• Weight loss
• Indigestion
• Yellowing of skin (jaundice)
• Nausea and vomiting
• Dark-colored urine
• Fatigue (getting tired easily)

General features of Intraductal Tubular Adenoma of Pancreas include:

• This benign tumor usually arises within the main pancreatic duct (exocrine portion). It is more common in the head than in other portions of the pancreas
• The tumors are single and well-defined
• The tumor size may range from a few millimeters to a few centimeters

How is Intraductal Tubular Adenoma of Pancreas Diagnosed?

Frequently, pancreatic tumors are difficult to detect/diagnose in the early stages. The signs and symptoms can be very similar to other conditions. Since the pancreas is located in the peritoneum, behind many organs, there is a lot of space for the tumor to grow (often unnoticed).

The following are the diagnostic methods that may be used to detect Intraductal Tubular Adenoma of Pancreas:

• A thorough physical examination and a complete medical history is very important
• Blood test to check for serum amylase levels
• Complete blood count with differential
• Blood tests that may involve tumors markers, such as:
  • Carcinoembryonic antigen (CEA)
  • CA 19.9
  • CA 15.3
  • Alpha fetoprotein
• Radiological studies that may include:
  • Abdominal ultrasound: A procedure where high-frequency sound waves are used to produce real-time images
  • Endoscopic ultrasound: It is a minimally-invasive procedure that uses high-frequency sound waves to obtain detailed images of the pancreas
  • CT scan of abdomen: It may be helpful in detecting recurrences, or if metastasis to other organs has occurred
  • MRI scan of abdomen: It helps produce high-quality pictures of certain body parts including the tissues, muscles, nerves, and bones
• Additionally, the following magnetic resonance imaging procedures may be used particularly in individuals suspected of having pancreatic tumor/cancer:
  • MR cholangio-pancreatography (MRCP)
  • MR angiography (MRA)
• Positron emission tomography (PET) scan: It is particularly helpful in visualizing the spread of the cancer to other body parts (metastasis) and/or recurrence
• Percutaneous transhepatic cholangiography (PTC): A contrast material is injected into the bile ducts to visualize the structure
• Endoscopic retrograde cholangio-pancreatography (ERCP): This technique is used when symptoms of pancreatic cancer are present in the individual. A special equipment and dye injections are used to obtain a series of images. If required, a biopsy sample may also be collected during the procedure
• Endoscopic pancreatocholangiography (pancreatocholangiogram)
• Invasive diagnostic procedures such as:
  • Laparoscopy: A special device is inserted through a small hole into the abdomen, to visually examine it. If necessary, a tissue sample is obtained for further analysis. Exploration of the abdomen using a laparoscope is called ‘exploratory laparoscopy’
  • Laparotomy: The abdomen is opened through an incision for examination, and if required, a biopsy sample obtained. Exploration of the abdomen using laparotomy procedure is called ‘exploratory laparotomy’
• Tissue biopsy: A tissue biopsy is performed and sent to a laboratory for a pathological examination to the pathologist, who examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

The tissue for diagnosis can be procured in multiple different ways, and they include:

• Fine needle aspiration (FNA) biopsy of the pancreatic tumor:
  • A FNA biopsy may not be helpful, because one may not be able to visualize the different morphological areas of the tumor. Hence, a FNA biopsy as a diagnostic tool has certain limitations, and an open surgical biopsy is preferred
• Core biopsy of the pancreatic tumor
• Open biopsy of the pancreatic tumor

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Intraductal Tubular Adenoma of Pancreas?

The complications due to Intraductal Tubular Adenoma of Pancreas are rare, but may include the following:

• Gastrointestinal obstruction
• Biliary tract obstruction causing jaundice
• Compress adjoining organs if the tumor size is large, which may cause the organs to dysfunction or function abnormally
• Injury to local region
• If the tumor destroys enough islet cells of the pancreas, it can result in diabetes 

How is Intraductal Tubular Adenoma of Pancreas Treated?

Currently, there are no definitive treatment measures available for Intraductal Tubular Adenoma of Pancreas.

• If there are no signs and symptoms, then a “wait and watch” approach may be recommended, since it is a benign condition. Although, a close follow-up and monitoring of the tumor is important
• If there are noticeable signs and symptoms, then removal of the tumor may be necessary and surgery is a treatment option. Under such circumstances, a complete surgical excision can be curative
• Follow-up care with regular screening and checkups are important

How can Intraductal Tubular Adenoma of Pancreas be Prevented?

Currently, there are no specific methods or guidelines to prevent Intraductal Tubular Adenoma of Pancreas.

What is the Prognosis of Intraductal Tubular Adenoma of Pancreas? (Outcomes/Resolutions)

• The prognosis of Intraductal Tubular Adenoma of Pancreas is excellent with appropriate treatment. Most of the signs and symptoms recede and disappear on removal of the tumor
• Current evidence shows that the presence of Pancreatic Intraductal Tubular Adenoma does not increase the risk of developing invasive carcinoma
• However, regular follow up visits with the healthcare provider are important

Additional and Relevant Useful Information for Intraductal Tubular Adenoma of Pancreas:

• If Intraductal Tubular Adenoma of Pancreas is present with intraductal papillary mucinous neoplasm of pancreas, it is referred to as Type A, else it is known as Type B
• It is estimated that the average lifetime risk of developing pancreatic cancer is about 1.5%