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Yamamoto K, Takada Y, Kobayashi T, Ito R, Ikeda Y, Ota S, Adachi K, Shimada Y, Hayashi M, Itani T, Asai S, Nakamura K. Rapid transformation of branched pancreatic duct-derived intraductal tubulopapillary neoplasm into an invasive carcinoma: A case report. World J Clin Oncol 2023; 14:620-627. [PMID: 38179403 PMCID: PMC10762528 DOI: 10.5306/wjco.v14.i12.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/22/2023] [Accepted: 12/13/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Intraductal tubulopapillary neoplasm (ITPN) is a rare disease accounting for approximately 3% of all intraductal pancreatic tumors, with intraductal papillary mucinous neoplasm (IPMN) being one of the most common differential diagnoses. Both ITPN and IPMN display slow growth. A branched pancreatic duct type is commonly observed in IPMN, whereas ITPN derived from the branched pancreatic duct has been reported in a limited number of cases; hence, its pathogenesis remains unclear. CASE SUMMARY Here, we present the case of a patient with ITPN localized in a branched pancreatic duct, with poorly controlled irritable bowel syndrome. A contrast-enhanced computed tomography scan of the abdomen incidentally revealed a 5-mm oligemic nodule-like change in the body of the pancreas. Endoscopic ultrasound (EUS) indicated a 10-mm hypoechoic mass without any cystic structures that had grown within 2 mo. EUS-guided fine needle aspiration was performed for definitive diagnosis, and the findings suggested ductal papillary carcinoma. Distal pancreatectomy was performed, and the tumor was pathologically diagnosed as ITPN with an invasive cancerous component, pT3N1aM0, pStage IIB (International Cancer Control, 8th edition). The patient underwent treatment with postoperative adjuvant chemotherapy (S-1 monotherapy); however, relapse was observed 1 year and 10 mo after surgical resection, and subsequent treatment involving a combination of chemotherapy and radiotherapy was administered. Maintenance therapy has since facilitated a stable disease state. CONCLUSION Regardless of the microscopic size of the neoplasm, early diagnosis of ITPN with EUS-guided fine needle aspiration and surgical resection are crucial.
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Affiliation(s)
- Kenta Yamamoto
- Department of Gastroenterology and Hepatology, Kobe City Nishi-Kobe Medical Center, Kobe 651-2273, Hyogo, Japan
| | - Yutaka Takada
- Department of Gastroenterology and Hepatology, Kobe City Nishi-Kobe Medical Center, Kobe 651-2273, Hyogo, Japan
| | - Takuya Kobayashi
- Department of Gastroenterology and Hepatology, Kobe City Nishi-Kobe Medical Center, Kobe 651-2273, Hyogo, Japan
| | - Ryo Ito
- Department of Gastroenterology and Hepatology, Kobe City Nishi-Kobe Medical Center, Kobe 651-2273, Hyogo, Japan
| | - Yuka Ikeda
- Department of Gastroenterology and Hepatology, Kobe City Nishi-Kobe Medical Center, Kobe 651-2273, Hyogo, Japan
| | - Shogo Ota
- Department of Gastroenterology and Hepatology, Kobe City Nishi-Kobe Medical Center, Kobe 651-2273, Hyogo, Japan
| | - Kanna Adachi
- Department of Gastroenterology and Hepatology, Kobe City Nishi-Kobe Medical Center, Kobe 651-2273, Hyogo, Japan
| | - Yukari Shimada
- Department of Gastroenterology and Hepatology, Kobe City Nishi-Kobe Medical Center, Kobe 651-2273, Hyogo, Japan
| | - Motohito Hayashi
- Department of Gastroenterology and Hepatology, Kobe City Nishi-Kobe Medical Center, Kobe 651-2273, Hyogo, Japan
| | - Toshinao Itani
- Department of Gastroenterology and Hepatology, Kobe City Nishi-Kobe Medical Center, Kobe 651-2273, Hyogo, Japan
| | - Satsuki Asai
- Department of Pathology, Kobe City Nishi-Kobe Medical Center, Kobe 651-2273, Hyogo, Japan
| | - Kojiro Nakamura
- Department of Surgery and Gastroenterological Surgery, Kobe City Nishi-Kobe Medical Center, Kobe 651-2273, Hyogo, Japan
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Vlăduţ C, Bilous D, Ciocîrlan M. Real-Life Management of Pancreatic Cysts: Simplified Review of Current Guidelines. J Clin Med 2023; 12:4020. [PMID: 37373713 DOI: 10.3390/jcm12124020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Pancreatic cysts are becoming a popular diagnostic tool due to the increased availability of high-quality cross-sectional imaging. Pancreatic cystic lesions constitute closed, liquid-containing cavities, which are either neoplastic or non-neoplastic. While serous lesions often follow a benign course, mucinous lesions can hide carcinoma and, therefore, require different management. Moreover, all cysts should be considered mucinous until proven otherwise, thus limiting the errors in managing these entities. Due to the need for high contrast soft tissue imaging, magnetic resonance imaging represents an elective, non-invasive diagnostic tool. Endoscopic ultrasound (EUS) has started gaining more prominence with regard to the proper diagnosis and management of pancreatic cysts, offering quality information with minimal risks. Enabling both the acquisition of endoscopic images of the papilla and the endosonographic high-quality evaluation of septae, mural nodules along with the vascular patterns of the lesion contribute to a definitive diagnosis. Moreover, the possibility of obtaining cytological or histological samples could become mandatory in the foreseeable future, allowing for more precise molecular testing. Future research should focus on detecting methods to quickly diagnose high-grade dysplasia or early cancer for patients with pancreatic cysts, thus allowing time for appropriate treatment and avoiding surgical overtreatment or over surveillance in selected cases.
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Affiliation(s)
- Cătălina Vlăduţ
- Department 5, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Gastroenterology Department, "Prof Dr Agrippa Ionescu" Emergency Hospital, 011356 Bucharest, Romania
| | - Dana Bilous
- Gastroenterology Department, "Prof Dr Agrippa Ionescu" Emergency Hospital, 011356 Bucharest, Romania
| | - Mihai Ciocîrlan
- Department 5, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Gastroenterology Department, "Prof Dr Agrippa Ionescu" Emergency Hospital, 011356 Bucharest, Romania
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3
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Khristenko E, Hank T, Gaida MM, Kauczor HU, Hackert T, Klauß M, Mayer P. Imaging features of intraductal tubulopapillary neoplasm of the pancreas and its differentiation from conventional pancreatic ductal adenocarcinoma. Sci Rep 2022; 12:15557. [PMID: 36114217 PMCID: PMC9481632 DOI: 10.1038/s41598-022-19517-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 08/30/2022] [Indexed: 11/19/2022] Open
Abstract
Intraductal tubulopapillary neoplasms (ITPN) are rare pancreatic tumors (< 1% of exocrine neoplasms) and are considered to have better prognosis than classical pancreatic ductal adenocarcinoma (PDAC). The present study aimed to evaluate imaging features of ITPN in computed tomography (CT) and magnetic resonance (MR) imaging. We performed monocentric retrospective analysis of 14 patients with histopathologically verified ITPN, operated in 2003–2018. Images were available for 12 patients and were analysed independently by two radiologists, blinded to reports. Imaging features were compared to a matched control group consisting of 43 patients with PDAC, matched for sex and age. Histopathologic analysis showed invasive carcinoma component in all ITPN patients. CT-attenuation values of ITPN were higher in arterial and venous phases (62.3 ± 14.6 HU and 68 ± 15.6 HU) than in unenhanced phase (39.2 ± 7.9 HU), compatible with solid lesion enhancement. Compared to PDAC, ITPN lesions had significantly higher HU-values in both arterial and venous phases (arterial and venous phases, p < 0.001). ITPN were significantly larger than PDAC (4.1 ± 2.0 cm versus 2.6 ± 0.84 cm, p = 0.021). ITPN lesions were more often well-circumscribed (p < 0.002). Employing a multiple logistic regression analysis with forward stepwise method, higher HU density in the arterial phase (p = 0.012) and well-circumscribed lesion margins (p = 0.047) were found to be significant predictors of ITPN versus PDAC. Our study identified key imaging features for differentiation of ITPN and PDAC. Isodensity or moderate hypodensity and well-circumscribed margins favor the diagnosis of ITPN over PDAC. Being familiar with CT-features of these rare pancreatic tumors is essential for radiologists to accelerate the diagnosis and narrow the differentials.
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Paolino G, Esposito I, Hong SM, Basturk O, Mattiolo P, Kaneko T, Veronese N, Scarpa A, Adsay V, Luchini C. Intraductal tubulopapillary neoplasm (ITPN) of the pancreas: A distinct entity among pancreatic tumors. Histopathology 2022; 81:297-309. [PMID: 35583805 PMCID: PMC9544156 DOI: 10.1111/his.14698] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/03/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
Abstract
Aims Intraductal tubulopapillary neoplasm (ITPN) of the pancreas is a recently recognized pancreatic tumor entity. Here we aimed to determine the most important features with a systematic review coupled with an integrated statistical approach. Methods and results PubMed, SCOPUS, and Embase were searched for studies reporting data on pancreatic ITPN. The clinicopathological, immunohistochemical, and molecular data were summarized. Then a comprehensive survival analysis and a comparative analysis of the molecular alterations of ITPN with those of pancreatic ductal adenocarcinoma (PDAC) and intraductal papillary mucinous neoplasm (IPMN) from reference cohorts (including the International Cancer Genome Consortium‐ ICGC dataset and The Cancer Genome Atlas, TCGA program) were conducted. The core findings of 128 patients were as follows: (i) Clinicopathological parameters: pancreatic head is the most common site; presence of an associated adenocarcinoma was reported in 60% of cases, but with rare nodal metastasis. (ii) Immunohistochemistry: MUC1 (>90%) and MUC6 (70%) were the most frequently expressed mucins. ITPN lacked the intestinal marker MUC2; unlike IPMN, it did not express MUC5AC. (iii) Molecular landscape: Compared with PDAC/IPMN, the classic pancreatic drivers KRAS, TP53, CDKN2A, SMAD4, GNAS, and RNF43 were less altered in ITPN (P < 0.001), whereas MCL amplifications, FGFR2 fusions, and PI3KCA mutations were commonly altered (P < 0.001). (iv) Survival analysis: ITPN with a “pure” branch duct involvement showed the lowest risk of recurrence. Conclusion ITPN is a distinct pancreatic neoplasm with specific clinicopathological and molecular characteristics. Its recognition is fundamental for its clinical/prognostic implications and for the enrichment of potential targets for precision oncology.
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Affiliation(s)
- Gaetano Paolino
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - Irene Esposito
- Institute of Pathology, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Olca Basturk
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Paola Mattiolo
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - Takuma Kaneko
- Department of Hepato-Biliary-Pancreatic Medicine, NTT Medical Center, Tokyo, Japan
| | - Nicola Veronese
- Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy.,ARC-Net Research Center, University and Hospital Trust of Verona, Verona, Italy
| | - Volkan Adsay
- Department of Pathology, Koç University Hospital and Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy.,ARC-Net Research Center, University and Hospital Trust of Verona, Verona, Italy
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Seki T, Watanabe A, Harimoto N, Shirabe K. Systematic review of resectable intraductal tubulopapillary neoplasm with special reference to recurrence patterns. Surg Today 2022; 52:532-541. [PMID: 34196805 DOI: 10.1007/s00595-021-02324-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Intraductal tubulopapillary neoplasm is a rare pancreatic tumor. The purpose of this study was to clarify the recurrence type and prognosis in recurrent cases after intraductal tubulopapillary neoplasm resection. METHODS PubMed was searched for previous reports on surgical resection of intraductal tubulopapillary neoplasm of the pancreas that were published from 2009 to July 2020. The clinical features obtained from these reports were summarized and analyzed. RESULTS The clinicopathological data of 35 intraductal tubulopapillary neoplasm cases were obtained. Of these, 21 were males, and 14 were females, with an average age of 57.9 years old. Invasive findings were observed in 21 of 35 patients (60%). Recurrence was observed in 11 of the 35 cases (31.4%), including remnant pancreatic recurrence in 6 cases (17.1%) and liver metastasis in 5 cases (14.3%). The tumor size was significantly larger in the liver metastasis group than in the remnant pancreas recurrence group (P = 0.04), and patients with liver metastases tended to have a poorer prognosis than those with remnant pancreas recurrence. CONCLUSIONS The recurrence type of intraductal tubulopapillary neoplasm resection was mainly remnant pancreatic recurrence and liver metastasis recurrence. Total pancreatectomy for remnant pancreatic recurrence may be suitable because of its good prognosis.
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Affiliation(s)
- Takaomi Seki
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showamachi, Maebashi, 371-8511, Japan
| | - Akira Watanabe
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showamachi, Maebashi, 371-8511, Japan
| | - Norifumi Harimoto
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showamachi, Maebashi, 371-8511, Japan.
| | - Ken Shirabe
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showamachi, Maebashi, 371-8511, Japan
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Balloon Extraction of an Intraductal Tubulopapillary Neoplasm of the Bile Duct During Endoscopic Retrograde Cholangiopancreatography. ACG Case Rep J 2020; 7:e00481. [PMID: 33269290 PMCID: PMC7685965 DOI: 10.14309/crj.0000000000000481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022] Open
Abstract
Intraductal tubulopapillary neoplasm (ITPN) of the bile duct is a rare type of intraductal neoplasm of the bile duct that has mainly been described in the literature in case reports and small case series. Only within the past decade has ITPN of the bile duct been identified as its own entity and have definitive diagnostic criteria been established. Given its rarity, there is no standard of care for treatment. Here, we describe a case report of biliary ITPN diagnosed in a unique manner.
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Kosmidis C, Varsamis N, Atmatzidis S, Koimtzis G, Mantalovas S, Anthimidis G, Georgakoudi E, Sevva CD, Zarampouka K, Chourmouzi D, Leptopoulou A, Baka S, Kosmidou M. Total Pancreatectomy with Splenectomy for Multifocal Intraductal Tubulopapillary Neoplasm (ITPN) of the Pancreas Associated with Invasive Component: Report of a Rare Case. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e924760. [PMID: 32647104 PMCID: PMC7377523 DOI: 10.12659/ajcr.924760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patient: Male, 82-year-old Final Diagnosis: Pancreatic intraductal tubulopappilary neoplasm (ITPN) Symptoms: Abdominal pain • anorexia • weakness • weight loss Medication: Amlodipine 5 mg/valsartan 160 mg • nebivolol 5 mg • metformin 850 mg • pancreatin 25 000 IU Clinical Procedure: Total pancreatectomy with splenectomy Specialty: Oncology • Pathology • Radiology • Surgery
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Affiliation(s)
| | - Nikolaos Varsamis
- Department of Surgery, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Stefanos Atmatzidis
- Third Department of Surgery, AHEPA University Hospital, Thessaloniki, Greece
| | - Georgios Koimtzis
- Third Department of Surgery, AHEPA University Hospital, Thessaloniki, Greece
| | | | - Georgios Anthimidis
- Department of Surgery, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Eleni Georgakoudi
- Department of Oncology, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Christina D Sevva
- Department of Medicine, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Katerina Zarampouka
- Department of Pathology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Danai Chourmouzi
- Department of Radiology, Interbalkan European Medical Center, Thessaloniki, Greece
| | | | - Sofia Baka
- Department of Oncology, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Maria Kosmidou
- Department of Internal Medicine, University of Ioannina, Ioannina, Greece
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Nabrinsky E, Baste CL, Gonzalez M, James E. Intraductal Tubulopapillary Neoplasm of the Pancreas Presenting as a Localized Pancreatic Tumor in a 52-Year-Old Woman: Focusing on a Rare Pancreatic Malignancy and Contrasting to Intrapapillary Mucinous Neoplasm. Cureus 2020; 12:e8548. [PMID: 32670685 PMCID: PMC7357332 DOI: 10.7759/cureus.8548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Intraductal tubulopapillary neoplasm (ITPN) is a distinctive type of pancreatic tumor first discovered more than three decades ago. ITPNs currently account for less than 1% of all pancreatic exocrine tumor cases recognized, and less than 5% of pancreatic intraductal tumors. A patient's presentation is often nonspecific in comparison to other intraductal pancreatic neoplasms. We discuss a 52-year-old female presenting with abdominal pain and weight loss with ITPN, and go on to define the typical presentation, clinical features, and pathology behind the tumor.
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Affiliation(s)
- Edward Nabrinsky
- Internal Medicine, Advocate Lutheran General Hospital, Park Ridge, USA
| | | | - Miguel Gonzalez
- Pathology, Advocate Lutheran General Hospital, Park Ridge, USA
| | - Edward James
- Medical Oncology, Advocate Lutheran General Hospital, Park Ridge, USA
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