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

Authors
  • Shimizu, Yuji1
  • Ashida, Ryo1
  • Sugiura, Teiichi1
  • Okamura, Yukiyasu1
  • Ito, Takaaki1
  • Yamamoto, Yusuke1
  • Ohgi, Katsuhisa1
  • Sasaki, Keiko1
  • Uesaka, Katsuhiko1
  • 1 Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan , Shizuoka (Japan)
Type
Published Article
Journal
Surgical Case Reports
Publisher
Springer Berlin Heidelberg
Publication Date
Aug 14, 2020
Volume
6
Issue
1
Identifiers
DOI: 10.1186/s40792-020-00972-0
Source
Springer Nature
Keywords
License
Green

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.

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