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Intraductal tubulopapillary neoplasm (ITPN) of the pancreas has been recently reported. It is very rare, therefore clinical behavior and prognosis has not yet been characterized. We experienced a case of ITPN of the pancreas which presented with acute pancreatitis and treated with Whipple's operation. Histopathologic finding showed papillary hyperplasia with carcinomatous change. The tumor recurred after 47 month of operation, and she underwent total pancreatectomy. Pathologic finding revealed tubulopapillary growth with high grade dysplasia. Immunohistochemial staining was not performed, however gross and microscopic findings were compatible with ITPN of the pancreas. We report a case of ITPN of the pancreas.
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Abdomen computed tomography (CT) findings. (A) Diffuse parenchymal swellling of pancreas, peripancreatic fatty infiltration and fluid collection are seen. (B, C) A small nodule and scanty dilatation of pancreatic duct in the pancreas head are seen on the CT scan (arrows). (D) Endoscopic retrograde cholangiopancreatography findings. A nodular filling defect and duct dilatation of pancreatic head portion and common bile duct dilatation are seen on the cholangiopancreatogram (arrows).
Fig. 2
Histopathologic findings. (A) Brush cytology picture shows hyperchromatic nucleus and nuclear molding, therefore those are suspected to be malignant cells. (B) Gross finding after resection shows a 1.6×1.1 cm sized polypoid mass (red circle) is seen on the proximal portion of dilated pancreatic duct. (C) Tubulopapillary proliferations are seen (H&E, ×40). (D) Cells with nuclear polymorphism, hyperchromatism, and mitosis are seen, therefore high grade dysplasia or carcinomatous change is suspected (H&E, ×250).
Fig. 3
(A, B) Computed tomography (CT) findings after 47 months of resection. Axial and coronal CT scan shows diffuse pancreatic duct dilatation with enhancing mass (arrow) inside of the duct. (C, D) Magnetic resonance imaging findings after 47 month of resection. T2 weighted images also shows mass like lesion (arrow) inside of dilated pancreatic duct after 47 months of resection.
Fig. 4
(A) Gross sample of 2nd operation (total pancreatectomy and splenectomy). A brownish mass like lesion mixed with brownish sludge material (red circle) is seen inside of dilated pancreatic duct. (B) Tubulopapillary proliferation is seen (H&E, ×40). (C) Nuclear polymorphism and hyperchomatic nucleus suggests high grade dysplasia (H&E, ×250).
Acute Pancreatitis Associated with Intraductal Tubulopapillary Neoplasm of the Pancreas
Fig. 1
Abdomen computed tomography (CT) findings. (A) Diffuse parenchymal swellling of pancreas, peripancreatic fatty infiltration and fluid collection are seen. (B, C) A small nodule and scanty dilatation of pancreatic duct in the pancreas head are seen on the CT scan (arrows). (D) Endoscopic retrograde cholangiopancreatography findings. A nodular filling defect and duct dilatation of pancreatic head portion and common bile duct dilatation are seen on the cholangiopancreatogram (arrows).
Fig. 2
Histopathologic findings. (A) Brush cytology picture shows hyperchromatic nucleus and nuclear molding, therefore those are suspected to be malignant cells. (B) Gross finding after resection shows a 1.6×1.1 cm sized polypoid mass (red circle) is seen on the proximal portion of dilated pancreatic duct. (C) Tubulopapillary proliferations are seen (H&E, ×40). (D) Cells with nuclear polymorphism, hyperchromatism, and mitosis are seen, therefore high grade dysplasia or carcinomatous change is suspected (H&E, ×250).
Fig. 3
(A, B) Computed tomography (CT) findings after 47 months of resection. Axial and coronal CT scan shows diffuse pancreatic duct dilatation with enhancing mass (arrow) inside of the duct. (C, D) Magnetic resonance imaging findings after 47 month of resection. T2 weighted images also shows mass like lesion (arrow) inside of dilated pancreatic duct after 47 months of resection.
Fig. 4
(A) Gross sample of 2nd operation (total pancreatectomy and splenectomy). A brownish mass like lesion mixed with brownish sludge material (red circle) is seen inside of dilated pancreatic duct. (B) Tubulopapillary proliferation is seen (H&E, ×40). (C) Nuclear polymorphism and hyperchomatic nucleus suggests high grade dysplasia (H&E, ×250).
Fig. 1
Fig. 2
Fig. 3
Fig. 4
Acute Pancreatitis Associated with Intraductal Tubulopapillary Neoplasm of the Pancreas
