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 Appearance
This intraductal tubulopapillary neoplasm (ITPN) is forming solid nodules image that obstruct the dilated pancreatic duct. There is no grossly visible mucin.


image
Low-Power View
This 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 Pattern
ITPN typically exhibits a cellular, tubulopapillary growth pattern with high-grade cytologic atypia and easily identifiable necrosis image .

image
Back-to-Back Tubules
ITPNs 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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