Adenocarcinoma in Intraductal Tubulopapillary Neoplasm of the Pancreas: A Case Report and Literature Review

Intraductal tubulopapillary neoplasms (ITPNs) are a subgroup of pre-malignant pancreatic epithelial lesions. The histomorphological and immunophenotypical characteristics of ITPN have been described by several authors based on case series; however, the rarity of this tumor subtype and its similarity to other entities makes the identification of ITPN challenging for radiologists and pathologists. Herein, we report a case of ITPN with associated invasive carcinoma along with a literature review that will benefit further studies and help in planning treatments for patients in the future. A pancreatic mass was incidentally discovered in a 40-year-old woman during her annual check-up. Radiological investigation revealed a mass that obstructed the main pancreatic duct and caused ductal dilatation. Endoscopic retrograde cholangiopancreatography with biopsy indicated poorly differentiated adenocarcinoma. Subsequently, total pancreatectomy with splenectomy was performed to remove the tumor. ITPN of the pancreas with associated poorly differentiated adenocarcinoma was diagnosed based on pathological and immunohistological test results. Achieving complete resection of the tumor, the patient did not require chemotherapy during follow-up care. Thus, our study demonstrated the necessity of radiological and histopathological correlation in the definitive diagnosis of pancreatic ITPN. However, the determination of an invasive component is essential because malignant transformation affects the prognosis of patients.