Abstract
BackgroundIntraductal 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 presentationA 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.ConclusionsITPN 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.
Highlights
Intraductal tubulopapillary neoplasm (ITPN) was first described in 2009 [1] and formally introduced in the 2010 World Health Organization classification [2] as a distinct entity among premalignant epithelial tumors of the pancreas
A sudden increase in the pancreatic duct internal pressure or acute inflammation likely caused the rupture of the main pancreatic duct (MPD)
multidetector-row computed tomography (MDCT) showed no significant change in the tumor size or pancreatic duct dilatation, but the low-density area (LDA) at the ventral side of the pancreas had shrunk (Fig. 1b)
Summary
Intraductal tubulopapillary neoplasm (ITPN) was first described in 2009 [1] and formally introduced in the 2010 World Health Organization classification [2] as a distinct entity among premalignant epithelial tumors of the pancreas. A sudden increase in the pancreatic duct internal pressure or acute inflammation likely caused the rupture of the MPD. ITPN-associated rupture of the MPD is extremely rare, and only one case has been reported to date [4].
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