PROGRESSION OF PANCREATIC INTRADUCTAL NEOPLASIAS TO INFILTRATING ADENOCARCINOMA OF THE PANCREAS

Pancreata with cancer also frequently have intraductal proliferative l esions, suggesting an association between pancreatic cancer and these lesions. We present three cases in which atypical papillary hyperplasi a of the pancreas was documented 17 months to 10 years before the deve lopment of an infiltrating adenocarcinoma of the pancreas. The first p atient was a 70-year-old woman who underwent pancreaticoduodenectomy f or adenocarcinoma of the pancreas. Atypical papillary duct hyperplasia extended to the pancreatic neck margin of resection, but the margin w as negative for infiltrating carcinoma. Nine years later, an infiltrat ing adenocarcinoma developed in the remaining pancreas. The second pat ient was a 58-year-old man who underwent distal pancreatectomy for chr onic pancreatitis with pseudocyst. Histologic examination showed chron ic pancreatitis and multiple foci of atypical papillary duct hyperplas ia, Ten years later, the patient underwent a Whipple procedure for inf iltrating adenocarcinoma of the pancreas. The third patient was a 46-y ear-old woman with recurrent pancreatitis who underwent a Whipple proc edure. Histologic examination showed atypical papillary duct hyperplas ia and chronic pancreatitis but no infiltrating carcinoma. At the time of surgery, the tail of the pancreas was grossly and radiographically normal. Seventeen months later, a malignant pleural effusion develope d, and postmortem examination showed infiltrating adenocarcinoma in th e tail of the pancreas. In the cases presented, atypical papillary hyp erplasia was documented 17 months, 9 years, and 10 years before the de velopment of infiltrating adenocarcinoma of the pancreas, supporting t he concept that there is a progression from intraductal hyperplasia to infiltrating carcinoma of the pancreas, just as there is a progressio n from adenoma to infiltrating carcinoma in the colorectum. Based on e vidence that these intraductal lesions are precursor lesions to infilt rating adenocarcinoma of the pancreas, we suggest that the term ''hype rplasia'' be replaced by the more specific term ''pancreatic intraepit helial neoplasia.''