A Case of Intraductal Tubulopapillary Neoplasm of the Pancreas (ITPN) which with Difficult to Diagnose Preoperatively

A 47-year-old diabetic woman was followed in the Department of Internal Medicine. Abdominal echographic studies revealed a mass lesion in the head of the pancreas by chance. The maximum standardized uptake values (SUV max) on PET imaging was 3.8. Magnetic resonance cholangiopancreatography (MRCP) re...

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Published inThe Japanese Journal of Gastroenterological Surgery Vol. 46; no. 3; pp. 196 - 202
Main Authors Shibata, Kunitaka, Fukuzaki, Takayuki, Matsushita, Katsunori, Motoki, Yoshiyuki, Takeuchi, Makoto, Okano, Miho, Hirao, Takafumi, Morimoto, Osakuni, Adachi, Shinichi
Format Journal Article
LanguageJapanese
Published The Japanese Society of Gastroenterological Surgery 2013
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ISSN0386-9768
1348-9372
DOI10.5833/jjgs.2011.0312

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Abstract A 47-year-old diabetic woman was followed in the Department of Internal Medicine. Abdominal echographic studies revealed a mass lesion in the head of the pancreas by chance. The maximum standardized uptake values (SUV max) on PET imaging was 3.8. Magnetic resonance cholangiopancreatography (MRCP) revealed an obstruction of the main pancreatic duct in the pancreatic head. She underwent pancreaticoduodenectomy under a diagnosis of pancreatic cancer. The postoperative pathological diagnosis was ITPN. The patient showed no recurrence at 18 months after the operation. ITPN is very rare and is classified as a tumor of the pancreatic duct. It is important to distinguish ITPN from the pancreatic cancer and other tumors in the pancreatic duct.
AbstractList A 47-year-old diabetic woman was followed in the Department of Internal Medicine. Abdominal echographic studies revealed a mass lesion in the head of the pancreas by chance. The maximum standardized uptake values (SUV max) on PET imaging was 3.8. Magnetic resonance cholangiopancreatography (MRCP) revealed an obstruction of the main pancreatic duct in the pancreatic head. She underwent pancreaticoduodenectomy under a diagnosis of pancreatic cancer. The postoperative pathological diagnosis was ITPN. The patient showed no recurrence at 18 months after the operation. ITPN is very rare and is classified as a tumor of the pancreatic duct. It is important to distinguish ITPN from the pancreatic cancer and other tumors in the pancreatic duct.
Author Adachi, Shinichi
Morimoto, Osakuni
Fukuzaki, Takayuki
Motoki, Yoshiyuki
Shibata, Kunitaka
Matsushita, Katsunori
Okano, Miho
Hirao, Takafumi
Takeuchi, Makoto
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  fullname: Matsushita, Katsunori
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  fullname: Motoki, Yoshiyuki
  organization: Department of Surgery, Ikeda Public Hospital
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  fullname: Takeuchi, Makoto
  organization: Department of Pathology, Ikeda Public Hospital
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  fullname: Okano, Miho
  organization: Department of Surgery, Ikeda Public Hospital
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  fullname: Hirao, Takafumi
  organization: Department of Surgery, Ikeda Public Hospital
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  fullname: Morimoto, Osakuni
  organization: Department of Surgery, Ikeda Public Hospital
– sequence: 1
  fullname: Adachi, Shinichi
  organization: Department of Surgery, Ikeda Public Hospital
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References 15) Suda K, Hirai S, Matsumoto Y, Mogaki M, Oyama T, Mitsui T, et al. Variant of intraductal carcinoma (with scant mucin production) is of main pancreatic duct origin: a clinicopathological study of four patients. Am J Gastroenterol. 1996;91:798–800.
9) 花田 敬士,飯星 知博,天野 始,日野 文明,黒田 義則,米原 修治.出血性嚢胞を併発した浸潤性膵管内管状腺癌(ITC)の1例.膵臓.2007;22:143–148.
12) 木村 理,森谷 敏幸.膵管内乳頭粘液性腫瘍(IPMN)と膵粘液嚢胞性腫瘍(MCN).竹井謙之,川崎誠治編.別冊「医学のあゆみ」消化器疾患―state of arts II 肝・胆・膵 Ver. 3.東京:医歯薬出版;2006. p. 709–712.
8) Itatsu K, Sano T, Hiraoka N, Ojima H, Takahashi Y, Sakamoto Y, et al. Intraductal tubular carcinoma in an adenoma of the main pancreatic duct of the pancreas head. J Gastoroenterol. 2006;41:702–705.
6) Tajiri T, Tate G, Kunimura T, Inoue K, Mitsuya T, Yoshiba M, et al. Histological and immunohistochemical comparison of intraductal tubular carcinoma, intraductal papillary-mucinous carcinoma, and ductal adenocarcinoma of the pancreas. Pancreas. 2004;29:116–122.
14) 中村 奈海,山口 武人,原 太郎,喜多 絵美里,須藤 研太郎,中村 和貴,ほか.画像診断(ERCP,MDCT,MRI,FDG-PET).肝胆膵.2009;9:407–415.
5) 本杉 宇太郎,山口 浩,古川 徹,羽鳥 隆,藤田 泉,山本 雅一,ほか.膵intraductal tubulopapillary neoplasm(ITPN)の画像所見.膵臓.2009;24(3):434.
1) Yamaguchi H, Shimizu M, Ban S, Koyama I, Hatori T, Fujita I, et al. Intraductal tubulopapillary neoplasms of the pancreas distinct from pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasm. Am J Surg Pathol. 2009;33:1164–1172.
11) Kimura W, Kuroda A, Makuuchi M. Problems in the diagnosis and treatment of a so-called mucin-producing tumor of the pancreas. Pancreas. 1998;16:363–369.
3) Yamaguchi H, Kuboki Y, Hatori T, Yamamoto M, Shiratori K, Kawamura S, et al. Somatic mutations in PIK3CA and activation of AKT in intraductal tubulopapillary neoplasms of the pancreas. Am J Surg Pathol. 2011 Dec;35(12):1812–1817.
7) Tajiri T, Tate G, Inagaki T, Kunimura T, Inoue K, Mitsuya T, et al. Intraductal tubular neoplasms of the pancreas: histogenesis and differentiation. Pancreas. 2005;30:115–121.
4) 古川 徹,山口 浩,清水 道生.膵管内管状乳頭腫瘍(ITPN)の病理.肝胆膵.2011;62(1):77–81.
13) 小山内 学,真口 宏介,高橋 邦幸,潟沼 朗生,矢根 圭,金子 真紀,ほか.内科例からみて.肝胆膵.2010;9:427–435.
2) Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. WHO Classification of Tumours of the Digestive System. 4th Edition. Lyon: International Agency for Research on Cancer;2010. 280 p.
10) 小林 剛,藤田 直孝,野田 裕,伊藤 啓,尾花 貴志,洞口 淳,ほか.IPMN由来浸潤癌と併存膵癌.肝胆膵.2010;9:445–‍457.
References_xml – reference: 11) Kimura W, Kuroda A, Makuuchi M. Problems in the diagnosis and treatment of a so-called mucin-producing tumor of the pancreas. Pancreas. 1998;16:363–369.
– reference: 2) Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. WHO Classification of Tumours of the Digestive System. 4th Edition. Lyon: International Agency for Research on Cancer;2010. 280 p.
– reference: 14) 中村 奈海,山口 武人,原 太郎,喜多 絵美里,須藤 研太郎,中村 和貴,ほか.画像診断(ERCP,MDCT,MRI,FDG-PET).肝胆膵.2009;9:407–415.
– reference: 10) 小林 剛,藤田 直孝,野田 裕,伊藤 啓,尾花 貴志,洞口 淳,ほか.IPMN由来浸潤癌と併存膵癌.肝胆膵.2010;9:445–‍457.
– reference: 4) 古川 徹,山口 浩,清水 道生.膵管内管状乳頭腫瘍(ITPN)の病理.肝胆膵.2011;62(1):77–81.
– reference: 3) Yamaguchi H, Kuboki Y, Hatori T, Yamamoto M, Shiratori K, Kawamura S, et al. Somatic mutations in PIK3CA and activation of AKT in intraductal tubulopapillary neoplasms of the pancreas. Am J Surg Pathol. 2011 Dec;35(12):1812–1817.
– reference: 5) 本杉 宇太郎,山口 浩,古川 徹,羽鳥 隆,藤田 泉,山本 雅一,ほか.膵intraductal tubulopapillary neoplasm(ITPN)の画像所見.膵臓.2009;24(3):434.
– reference: 13) 小山内 学,真口 宏介,高橋 邦幸,潟沼 朗生,矢根 圭,金子 真紀,ほか.内科例からみて.肝胆膵.2010;9:427–435.
– reference: 7) Tajiri T, Tate G, Inagaki T, Kunimura T, Inoue K, Mitsuya T, et al. Intraductal tubular neoplasms of the pancreas: histogenesis and differentiation. Pancreas. 2005;30:115–121.
– reference: 9) 花田 敬士,飯星 知博,天野 始,日野 文明,黒田 義則,米原 修治.出血性嚢胞を併発した浸潤性膵管内管状腺癌(ITC)の1例.膵臓.2007;22:143–148.
– reference: 1) Yamaguchi H, Shimizu M, Ban S, Koyama I, Hatori T, Fujita I, et al. Intraductal tubulopapillary neoplasms of the pancreas distinct from pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasm. Am J Surg Pathol. 2009;33:1164–1172.
– reference: 6) Tajiri T, Tate G, Kunimura T, Inoue K, Mitsuya T, Yoshiba M, et al. Histological and immunohistochemical comparison of intraductal tubular carcinoma, intraductal papillary-mucinous carcinoma, and ductal adenocarcinoma of the pancreas. Pancreas. 2004;29:116–122.
– reference: 12) 木村 理,森谷 敏幸.膵管内乳頭粘液性腫瘍(IPMN)と膵粘液嚢胞性腫瘍(MCN).竹井謙之,川崎誠治編.別冊「医学のあゆみ」消化器疾患―state of arts II 肝・胆・膵 Ver. 3.東京:医歯薬出版;2006. p. 709–712.
– reference: 15) Suda K, Hirai S, Matsumoto Y, Mogaki M, Oyama T, Mitsui T, et al. Variant of intraductal carcinoma (with scant mucin production) is of main pancreatic duct origin: a clinicopathological study of four patients. Am J Gastroenterol. 1996;91:798–800.
– reference: 8) Itatsu K, Sano T, Hiraoka N, Ojima H, Takahashi Y, Sakamoto Y, et al. Intraductal tubular carcinoma in an adenoma of the main pancreatic duct of the pancreas head. J Gastoroenterol. 2006;41:702–705.
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Snippet A 47-year-old diabetic woman was followed in the Department of Internal Medicine. Abdominal echographic studies revealed a mass lesion in the head of the...
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SubjectTerms pancreatic tumor
pancreaticoduodenectomy
Title A Case of Intraductal Tubulopapillary Neoplasm of the Pancreas (ITPN) which with Difficult to Diagnose Preoperatively
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