Pancreatic intraductal tubulopapillary neoplasm progression requiring completion pancreatectomy: A case report and literature review.
ITPN can lead to malignant transformation, and completion resection is recommended if found at a pancreatic resection margin.
Where it sits
this study against the rest of the pancragen (kedw) corpusSummary and findings
A case of a 68-year-old male with an ampullary adenoma and high-grade dysplasia who underwent pancreaticoduodenectomy revealed an intraductal tubulopapillary neoplasm (ITPN) at the resection margin. The patient subsequently developed invasive adenocarcinoma associated with recurrent ITPN, necessitating a completion total pancreatectomy. The study discusses the clinical implications of ITPN and its potential for malignant transformation.
Abstract
<h4>Introduction</h4>Intraductal tubulopapillary neoplasm (ITPN) is a recently described rare tumor of the pancreas. Diagnostic approach and treatment are based on relatively few cases.<h4>Presentation of case</h4>Here we report a case of a 68-year-old male presenting with an ampullary adenoma with high grade dysplasia who underwent pancreaticoduodenectomy and was incidentally found to have an ITPN at the pancreatic resection margin with areas of microinvasion throughout the resected specimen. He went on to rapidly develop an invasive adenocarcinoma arising in association with recurrent ITPN in the remnant pancreas requiring a completion total pancreatectomy.<h4>Discussion</h4>Patients with ITPN present with non-specific symptoms and diagnosis can be challenging. Radiographic evaluation will reveal tumor ingrowth into the main pancreatic duct and distal duct dilatation without upstream dilation or mucinous engorgement. ITPNs are treated with formal resection given that determination of an invasive component can be difficult and the risk of malignant transformation. Following resection, recurrences are infrequent and 5-year survival is over 70 % even with microinvasion.<h4>Conclusions</h4>ITPNs can follow a variable clinical course but hold the potential for malignant transformation. When ITPN is incidentally found at a pancreatic resection margin, we recommend completion resection due to the risk of local recurrence.
Background
Intraductal tubulopapillary neoplasm (ITPN) is a rare pancreatic tumor with limited cases documented in the literature. Prior knowledge indicates that diagnosis and treatment of ITPN can be challenging due to non-specific symptoms and the difficulty in determining the presence of invasive components. This case report aims to highlight the clinical course of ITPN and the implications for surgical management.
Methods
This is a case report of a 68-year-old male who underwent pancreaticoduodenectomy. The patient was found to have ITPN at the pancreatic resection margin with microinvasion. The case discusses the subsequent development of invasive adenocarcinoma and the need for a completion total pancreatectomy.
Results
The patient developed invasive adenocarcinoma following the initial surgery, which required a completion total pancreatectomy. The report highlights that ITPNs can lead to malignant transformation and emphasizes the importance of resection when found incidentally.
Interpretation
This case adds to the limited literature on ITPN and underscores the potential for malignant transformation. While the 5-year survival rate of over 70% is reported, the clinical significance of this finding may vary based on individual patient circumstances and the presence of invasive features. Limitations include the singular case nature of the report, which may not generalize to broader populations.
Key findings
- 5-year survival is over 70 % even with microinvasion.
Limitations
- Not a clinical trial, single case report.
- Limited sample size, n=1.
- No long-term follow-up data reported.
- Potential for publication bias in case reporting.