Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Dec 24, 2023; 14(12): 620-627
Published online Dec 24, 2023. doi: 10.5306/wjco.v14.i12.620
Rapid transformation of branched pancreatic duct-derived intraductal tubulopapillary neoplasm into an invasive carcinoma: A case report
Kenta Yamamoto, Yutaka Takada, Takuya Kobayashi, Ryo Ito, Yuka Ikeda, Shogo Ota, Kanna Adachi, Yukari Shimada, Motohito Hayashi, Toshinao Itani, Satsuki Asai, Kojiro Nakamura
Kenta Yamamoto, Yutaka Takada, Takuya Kobayashi, Ryo Ito, Yuka Ikeda, Shogo Ota, Kanna Adachi, Yukari Shimada, Motohito Hayashi, Toshinao Itani, Department of Gastroenterology and Hepatology, Kobe City Nishi-Kobe Medical Center, Kobe 651-2273, Hyogo, Japan
Satsuki Asai, Department of Pathology, Kobe City Nishi-Kobe Medical Center, Kobe 651-2273, Hyogo, Japan
Kojiro Nakamura, Department of Surgery and Gastroenterological Surgery, Kobe City Nishi-Kobe Medical Center, Kobe 651-2273, Hyogo, Japan
Author contributions: All authors made substantial contributions to the study design and data analysis and interpretation; All authors drafted the manuscript, revised it critically for important intellectual content, and read and approved the final version of the manuscript to be published.
Informed consent statement: Written informed consent has been obtained from the patient to publish this paper.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yutaka Takada, MD, PhD, Doctor, Department of Gastroenterology and Hepatology, Kobe City Nishi-Kobe Medical Center, 5-7-1 Koujidai, Kobe 651-2273, Hyogo, Japan. ichigojellylike@gmail.com
Received: September 5, 2023
Peer-review started: September 5, 2023
First decision: November 14, 2023
Revised: November 22, 2023
Accepted: December 13, 2023
Article in press: December 13, 2023
Published online: December 24, 2023
Processing time: 107 Days and 21.3 Hours
Abstract
BACKGROUND

Intraductal tubulopapillary neoplasm (ITPN) is a rare disease accounting for approximately 3% of all intraductal pancreatic tumors, with intraductal papillary mucinous neoplasm (IPMN) being one of the most common differential diagnoses. Both ITPN and IPMN display slow growth. A branched pancreatic duct type is commonly observed in IPMN, whereas ITPN derived from the branched pancreatic duct has been reported in a limited number of cases; hence, its pathogenesis remains unclear.

CASE SUMMARY

Here, we present the case of a patient with ITPN localized in a branched pancreatic duct, with poorly controlled irritable bowel syndrome. A contrast-enhanced computed tomography scan of the abdomen incidentally revealed a 5-mm oligemic nodule-like change in the body of the pancreas. Endoscopic ultrasound (EUS) indicated a 10-mm hypoechoic mass without any cystic structures that had grown within 2 mo. EUS-guided fine needle aspiration was performed for definitive diagnosis, and the findings suggested ductal papillary carcinoma. Distal pancreatectomy was performed, and the tumor was pathologically diagnosed as ITPN with an invasive cancerous component, pT3N1aM0, pStage IIB (International Cancer Control, 8th edition). The patient underwent treatment with postoperative adjuvant chemotherapy (S-1 monotherapy); however, relapse was observed 1 year and 10 mo after surgical resection, and subsequent treatment involving a combination of chemotherapy and radiotherapy was administered. Maintenance therapy has since facilitated a stable disease state.

CONCLUSION

Regardless of the microscopic size of the neoplasm, early diagnosis of ITPN with EUS-guided fine needle aspiration and surgical resection are crucial.

Keywords: Intraductal tubulopapillary neoplasm, Pancreatic tumors, Neoplasia, Carcinoma, Pancreaticoduodenectomy, Case report

Core Tip: Intraductal tubulopapillary neoplasm (ITPN), a relatively rare intraductal pancreatic cancer, is frequently derived from the main pancreatic duct rather than from the branching ducts. Although tumors with larger diameters are more likely to develop into cancer, we reported a case of small ITPN originating from a bifurcated pancreatic duct rapidly developing into invasive cancer. The tumor was diagnosed and managed with endoscopic ultrasound-guided fine needle aspiration and surgery. However, relapse occurred 1 year and 10 mo postoperatively and was managed using chemotherapy and radiotherapy. Our case suggests the importance of early diagnosis and surgical resection even of a small ITPN.