Intraductal tubulopapillary neoplasms with rupture of the distal main pancreatic duct: a case report

Abstract

Background: Intraductal tubulopapillary neoplasm (ITPN) is a rare and newly described entity defined as an intraductal, grossly visible, tubule-forming epithelial neoplasm with high-grade dysplasia and ductal differentiation without overt production of mucin. Because of its rarity, the clinical and molecular aspects of ITPN have not been fully investigated. Case presentation: A 73-year-old woman presented to a local hospital with epigastric discomfort and pain. Abdominal multidetector-row computed tomography (MDCT) revealed a 2.5-cm hypovascular tumor in the pancreatic body with distal pancreatic duct dilatation and a slightly low-density area spreading over the ventral side of the pancreatic body. Endoscopic ultrasonography and fine-needle biopsy of the tumor revealed adenocarcinoma of the pancreas. She was referred to our hospital 2 months later. MDCT performed at our hospital showed no significant change in the tumor size or pancreatic duct dilatation. However, the low-density area at the ventral side of the pancreas had shrunk; therefore, this finding was considered to have been an inflammatory change. Under a preoperative diagnosis of resectable pancreatic ductal adenocarcinoma, distal pancreatectomy was performed. The final diagnosis was ITPN with associated invasive carcinoma. Macroscopically and microscopically, the main pancreatic duct (MPD) had ruptured at the distal side of the tumor, and the fistula connected the MPD and extrapancreatic scar tissue. Conclusions: ITPN with rupture of the pancreatic duct is extremely rare. In the present case, a sudden increase in the pancreatic duct internal pressure or acute inflammation likely caused the rupture of the MPD.

Intraductal tubulopapillary neoplasm (ITPN) of the pancreas: a distinct entity among pancreatic tumors

“…After applying our inclusion criteria, 68 articles were included in the systematic review (Figure S1). 11–78 …”

Intraductal Tubulopapillary Neoplasm Diagnosed Before Surgery: A Case Report

“…Based on the literature review, four articles [ 3 , 5 , 12 , 13 ] mentioned 24 cases with a “two-tone-duct sign” (Table 1 ). Twenty-five percent (6/24 cases) showed a “two-tone-duct sign” and 87.5% (21/24) had an invasive component, out of which, 23.8% (5/21) showed the sign.…”

“…However, few cases have been diagnosed preoperatively. In some cases, surgery was performed with a suspicion of either pancreatic ductal adenocarcinoma (PDAC) or intraductal papillary mucinous neoplasm (IPMN) [3][4][5]. Some articles previously reported that the prognosis of ITPN is better than the conventional PDAC [6][7][8].…”