Intraductal Tubulopapillary Neoplasm

 No grossly visible mucin

Clinical Issues

• Very rare entity
• Majority are discovered incidentally
• Age
image Range: 36-79 years
image Average: 59 years
• Presentation
image Similar to intraductal papillary mucinous neoplasms (IPMNs)
– Symptomatic cases present with abdominal pain
– Majority discovered incidentally

Macroscopic

• Size
image Range: 1-15 cm
image Average: 4.2 cm

Microscopic

• Tubulopapillary or tubular growth
image Some may resemble pyloric gland adenomas
image Scant or absent mucin
• Cases with high-grade dysplasia have marked architectural and cytologic atypia, mitoses, necrosis
• Invasive component may be similar to intraductal component or highly infiltrative

Top Differential Diagnoses

• IPMN
• Acinar cell carcinoma, intraductal variant
• Pancreatic ductal adenocarcinoma
image
Gross AppearanceThis intraductal tubulopapillary neoplasm (ITPN) is forming solid nodules image that obstruct the dilated pancreatic duct. There is no grossly visible mucin.

image
Low-Power ViewThis low-power view shows an ITPN with stromal invasion. Note the solid masses with focal necrosis image within a dilated duct. A focus of invasion is also seen image .
image
Tubulopapillary Growth PatternITPN typically exhibits a cellular, tubulopapillary growth pattern with high-grade cytologic atypia and easily identifiable necrosis image .
image
Back-to-Back TubulesITPNs may contain back-to-back tubules. The neoplastic cells have eosinophilic cytoplasm and enlarged, irregular nuclei with scattered mitoses image. There is no mucinous epithelium.

TERMINOLOGY

Abbreviations

• Intraductal tubulopapillary neoplasm (ITPN)
• Intraductal tubular carcinoma (ITC)

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Apr 20, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Intraductal Tubulopapillary Neoplasm

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