Adenomas

Abstract

Benign tumors of the pancreas are rare, particularly adenomas of the islands of Larhans I have been able to find only fifteen cases recorded in the literature. Yet in this paper I am able to report four cases, two from the Boston City Hospital. In addition, one already reported1 was encountered in studying the material at the Boston City HospitaL Ordinarily but little attention is paid to the pancreas at necropsy, and a s adenoma may easily escape notice. In fact, their discovery is usually due to a chance indusion in the section taken for microscopic exmina ion. Thus the rarity of the lesion is probably only apparent. It is difficult to lay down criteria for the diagnosis of this condition. Cecil2 believes that the masses represent hypertrophied islands rather than true tumors. Certain of the cases reported as adenomas very lily should be interpreted as hypertrophic islinds. Thus the large island i.5 mm. in diameter reported by Ssobelew3 in a diabetic is probably not a tumor. Simiarly, Reitmann's case 4and that of Herxheimer,5 both associated with diabetes, hardly have the characteristics of a tumor. The case reported byLg presents a good deal of difficulty in ification, but can best be considered both hyperplasia and adenoma formation. In determining the diagnosis of the four cases reported here, the following rules have been followed. The morphology and arrangement of the cells must resemble those of the islands. There must be a definite capsule, with compression of the adjacent pancreatic tissue. The mass must measure at least one millimeter in diameter. That size alone does not count can be seen from the Ilustrations of Casem (Fig. 2) and of a largeind from a non-diabetic pancreas (Fig. 3). The definite capsule and compression of the surrounding pancreatic tissue can be readily seen in the case of the adenoma, but the large island (Fig. 3) differs from a normal isld in size alone.