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Presented by Ralph Hruban, M.D. and prepared by Whitney Green, M.D.
Case 3: This 70-some year old man presented with abdominal pain.
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1. Question
Week 570: Case 3
This 70-some year old man presented with abdominal pain. A cystic mass was found in the head of the patient’s pancreasimages/Case3_papillae.jpg
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images/Case3_highpower3.jpgCorrect
Answer: Intraductal tubulopapillary neoplasm with high-grade dysplasia
Histology: This intraductal neoplasm forms cribriform structures that protrude into the duct lumen. Areas of necrosis are noted, and the overall appearance is similar to that of an intraductal cribriform carcinoma of the breast.
Discussion: Intraductal tubulopapillary neoplasms of the pancreas are rare neoplasms characterized by intraductal growth, cribriform rather than papillary architecture, and minimal mucin production. Most have high-grade dysplasia. The differential diagnosis would include an intraductal papillary mucinous neoplasm (which would have more mucin), and intraductal growth of an acinar cell carcinoma (which would express chymotrypsin and bcl-10). The presence or absence of an associated invasive component will drive prognosis and these neoplasms therefore need to be thoroughly and carefully examined.
Incorrect
Answer: Intraductal tubulopapillary neoplasm with high-grade dysplasia
Histology: This intraductal neoplasm forms cribriform structures that protrude into the duct lumen. Areas of necrosis are noted, and the overall appearance is similar to that of an intraductal cribriform carcinoma of the breast.
Discussion: Intraductal tubulopapillary neoplasms of the pancreas are rare neoplasms characterized by intraductal growth, cribriform rather than papillary architecture, and minimal mucin production. Most have high-grade dysplasia. The differential diagnosis would include an intraductal papillary mucinous neoplasm (which would have more mucin), and intraductal growth of an acinar cell carcinoma (which would express chymotrypsin and bcl-10). The presence or absence of an associated invasive component will drive prognosis and these neoplasms therefore need to be thoroughly and carefully examined.
