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Presented by Ralph Hruban, M.D. and prepared by Rui Zheng, M.D., Ph.D.
Case 5: This elderly patient presented with a long history of vague abdominal pain.
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1. Question
Week 449: Case 5
This elderly patient presented with a long history of vague abdominal pain. Computerized tomography revealed a cystic mass with a solid component. The lesion was resected. Mucin was not appreciated grossly.images/1alex/08302010case5image1.jpg
images/1alex/08302010case5image2.jpg
images/1alex/08302010case5image3.jpgCorrect
Answer: Intraductal tubulopapillary neoplasm with high-grade dysplasia
Histology: This intraductal neoplasm lacks mucin (both grossly and microscopically) and is composed of back to back glands, almost forming a cribriform pattern. Focal papillae can be found, but they are not prominent.
Discussion: Intraductal tubulopapillary neoplasms (ITPNs, formerly intraductal tubular neoplasms) are rare tumors that arise within the duct system of the pancreas. Several features set these neoplasms apart from the more common intraductal papillary mucinous neoplasm (IPMN). First, by definition, ITPNs both grossly and microscopically do not have the mucin production that is so characteristic of IPMNs. Second, the architecture is that of back-to-back tubular glands rather than long papillae.
Reference(s):
– Yamaguchi H, Shimizu M, Ban S, Koyama I, Hatori T, Fujita I, Yamamoto M, Kawamura S, Kobayashi M, Ishida K, Morikawa T, Motoi F, Unno M, Kanno A, Satoh K, Shimosegawa T, Orikasa H, Watanabe T, Nishimura K, Ebihara Y, Koike N, Furukawa T. Am J Surg Pathol. 2009 Aug;33(8):1164-27.Incorrect
Answer: Intraductal tubulopapillary neoplasm with high-grade dysplasia
Histology: This intraductal neoplasm lacks mucin (both grossly and microscopically) and is composed of back to back glands, almost forming a cribriform pattern. Focal papillae can be found, but they are not prominent.
Discussion: Intraductal tubulopapillary neoplasms (ITPNs, formerly intraductal tubular neoplasms) are rare tumors that arise within the duct system of the pancreas. Several features set these neoplasms apart from the more common intraductal papillary mucinous neoplasm (IPMN). First, by definition, ITPNs both grossly and microscopically do not have the mucin production that is so characteristic of IPMNs. Second, the architecture is that of back-to-back tubular glands rather than long papillae.
Reference(s):
– Yamaguchi H, Shimizu M, Ban S, Koyama I, Hatori T, Fujita I, Yamamoto M, Kawamura S, Kobayashi M, Ishida K, Morikawa T, Motoi F, Unno M, Kanno A, Satoh K, Shimosegawa T, Orikasa H, Watanabe T, Nishimura K, Ebihara Y, Koike N, Furukawa T. Am J Surg Pathol. 2009 Aug;33(8):1164-27.
