A case of intraductal tubular neoplasm of the pancreas which we could detect by endoscopic ultrasonography at first time

Case: 57 years old, female. Chief complaint: Epigastralgia. Past History: 31 years old & 37 years old: Uterine myoma surgery. Present illness: On January 2010 she consulted the hospital about epigastralgia. She was pointed out main pancreatic duct dilatation at the pancreatic tail on abdominal US. She received enhanced CT and MRI. But there were no tumor in the pancreas. So she came our institute in order to examine pancreas in detail. Physical examination conscious level: clear, There is no abnormal findings in physical examination. (Laboratory Data) CBC and serum biochemical levels were almost normal without Total cholesterol (282mg/dl). CEA, CA 19–9 and SPan-1 were normal range. Diagnostic imaging:

MRCP and ERCP showed minor dilatation of pancreatic tail duct. Dynamic CT did not show tumor in the pancreas. There was no abnormal uptake at pancreas on PET. In ERCP We showed a stenosis of main pancreatic duct at pancreatic body. We performed brush cytological diagnosis and pancreatic juice cytological diagnosis, but there was no atypical cell. When we performed endoscopic ultrasonography, we could see the nodular lesion of 5.5mm size in pancreatic duct at the body. We thought the diagnosis was IPMN (Main duct type), pancreatic cancer, or intraductal tubular neoplasm. We consulteda surgeons, and they performed distal resection of the pancreas. The final diagnosis was intraductal tubular adenoma of the pancreas. By using EUS we could detect this lesion and surgery in early phase. Intraductal tubular neoplasm is rare, so we report this case.