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Published in: World Journal of Surgical Oncology 1/2018

Open Access 01-12-2018 | Case report

Concurrent presentation of an intraductal tubulopapillary neoplasm and intraductal papillary mucinous neoplasm in the branch duct of the pancreas, with a superior mesenteric artery aneurysm: a case report

Authors: Kenta Inomata, Minoru Kitago, Hideaki Obara, Yoko Fujii-Nishimura, Masahiro Shinoda, Hiroshi Yagi, Yuta Abe, Taizo Hibi, Kentaro Matsubara, Go Oshima, Yasuhito Sekimoto, Masazumi Inoue, Osamu Itano, Michiie Sakamoto, Yuko Kitagawa

Published in: World Journal of Surgical Oncology | Issue 1/2018

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Abstract

Background

Since the concept of intraductal tubulopapillary neoplasm (ITPN) was introduced in the current World Health Organization classification of tumors, the number of reports of ITPN occurrence has increased gradually. However, ITPN is usually located in the main pancreatic duct, with few reports of a branch duct ITPN. As a result, imaging protocols for the diagnosis of a branch duct ITPN have not been established.

Case presentation

We report a case of a concurrent presentation of a branch duct ITPN and intraductal papillary mucinous neoplasm (IPMN) in the head of the pancreas, with a superior mesenteric artery (SMA) aneurysm. Initially, the cystic masses in the pancreatic head were diagnosed as branch duct IPMNs, with treatment consisting of a pylorus-preserving pancreaticoduodenectomy, in combination with an aneurysmectomy performed for treatment of the SMA aneurysm. Pathological examination confirmed these cysts were a combination of branch-type ITPN and IPMN. The patient recovered from the treatment without complication, with no evidence of recurrence over a period of 34 months post-surgery.

Conclusion

This case report of a synchronous presentation of an ITPN and IPMN indicates the difficulty in differentiating these two types of neoplasms in the branch duct of the pancreatic head.
Literature
1.
go back to reference Yamaguchi H, Shimizu M, Ban S, Koyama I, Hatori T, Fujita I, et al. Intraductal tubulopapillary neoplasms of the pancreas distinct from pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms. Am J Surg Pathol. 2009;33:1164–72.CrossRefPubMed Yamaguchi H, Shimizu M, Ban S, Koyama I, Hatori T, Fujita I, et al. Intraductal tubulopapillary neoplasms of the pancreas distinct from pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms. Am J Surg Pathol. 2009;33:1164–72.CrossRefPubMed
2.
go back to reference Kasugai H, Tajiri T, Takehara Y, Mukai S, Tanaka J, Kudo SE. Intraductal tubulopapillary neoplasms of the pancreas: case report and review of the literature. J Nippon Med Sch. 2013;80:224–9.CrossRefPubMed Kasugai H, Tajiri T, Takehara Y, Mukai S, Tanaka J, Kudo SE. Intraductal tubulopapillary neoplasms of the pancreas: case report and review of the literature. J Nippon Med Sch. 2013;80:224–9.CrossRefPubMed
3.
go back to reference Jokoji R, Tsuji H, Tsujimoto M, Shinno N, Tori M. Intraductal tubulopapillary neoplasm of pancreas with stromal osseous and cartilaginous metaplasia: a case report. Pathol Int. 2012;62:339–43.CrossRefPubMed Jokoji R, Tsuji H, Tsujimoto M, Shinno N, Tori M. Intraductal tubulopapillary neoplasm of pancreas with stromal osseous and cartilaginous metaplasia: a case report. Pathol Int. 2012;62:339–43.CrossRefPubMed
4.
go back to reference Furuhata A, Minamiguchi S, Mikami Y, Kodama Y, Sumiyoshi S, Adachi S, et al. Intraductal tubulopapillary neoplasm with expansile invasive carcinoma of the pancreas diagnosed by endoscopic ultrasonography-guided fine needle aspiration: a case report. Diagn Cytopathol. 2014;42:314–20.CrossRefPubMed Furuhata A, Minamiguchi S, Mikami Y, Kodama Y, Sumiyoshi S, Adachi S, et al. Intraductal tubulopapillary neoplasm with expansile invasive carcinoma of the pancreas diagnosed by endoscopic ultrasonography-guided fine needle aspiration: a case report. Diagn Cytopathol. 2014;42:314–20.CrossRefPubMed
5.
go back to reference Stone WM, Abbas M, Cherry KJ, Fowl RJ, Gloviczki P. Superior mesenteric artery aneurysms: is presence an indication for intervention? J Vasc Surg. 2002;36:234–7. discussion 237CrossRefPubMed Stone WM, Abbas M, Cherry KJ, Fowl RJ, Gloviczki P. Superior mesenteric artery aneurysms: is presence an indication for intervention? J Vasc Surg. 2002;36:234–7. discussion 237CrossRefPubMed
6.
go back to reference Jiang J, Ding X, Su Q, Zhang G, Wang Q, Jian W, et al. Therapeutic management of superior mesenteric artery aneurysms. J Vasc Surg. 2011;53:1619–24.CrossRefPubMed Jiang J, Ding X, Su Q, Zhang G, Wang Q, Jian W, et al. Therapeutic management of superior mesenteric artery aneurysms. J Vasc Surg. 2011;53:1619–24.CrossRefPubMed
7.
go back to reference Suzuki K, Mori Y, Komada T, Matsushima M, Ota T, Naganawa S. Stent-graft treatment for bleeding superior mesenteric artery pseudoaneurysm after pancreaticoduodenectomy. Cardiovasc Intervent Radiol. 2009;32:762–6.CrossRefPubMed Suzuki K, Mori Y, Komada T, Matsushima M, Ota T, Naganawa S. Stent-graft treatment for bleeding superior mesenteric artery pseudoaneurysm after pancreaticoduodenectomy. Cardiovasc Intervent Radiol. 2009;32:762–6.CrossRefPubMed
8.
go back to reference Ito K, Fujita N, Noda Y, Kobayashi G, Kimura K, Horaguchi J, et al. Intraductal tubular adenocarcinoma of the pancreas diagnosed before surgery by transpapillary biopsy: case report and review. Gastrointest Endosc. 2005;61:325–9.CrossRefPubMed Ito K, Fujita N, Noda Y, Kobayashi G, Kimura K, Horaguchi J, et al. Intraductal tubular adenocarcinoma of the pancreas diagnosed before surgery by transpapillary biopsy: case report and review. Gastrointest Endosc. 2005;61:325–9.CrossRefPubMed
9.
go back to reference Itatsu K, Sano T, Hiraoka N, Ojima H, Takahashi Y, Sakamoto Y, et al. Intraductal tubular carcinoma in an adenoma of the main pancreatic duct of the pancreas head. J Gastroenterol. 2006;41:702–5.CrossRefPubMed Itatsu K, Sano T, Hiraoka N, Ojima H, Takahashi Y, Sakamoto Y, et al. Intraductal tubular carcinoma in an adenoma of the main pancreatic duct of the pancreas head. J Gastroenterol. 2006;41:702–5.CrossRefPubMed
10.
go back to reference Ishigami K, Yoshimitsu K, Irie H, Shinozaki K, Nagata S, Yamaguchi K, et al. Imaging of intraductal tubular tumors of the pancreas. Am J Roentgenol. 2008;191:1836–40.CrossRef Ishigami K, Yoshimitsu K, Irie H, Shinozaki K, Nagata S, Yamaguchi K, et al. Imaging of intraductal tubular tumors of the pancreas. Am J Roentgenol. 2008;191:1836–40.CrossRef
11.
go back to reference Oh DK, Kim SH, Choi SH, Jang KT. Intraductal tubular carcinoma of the pancreas: a case report with the imaging findings. Korean J Radiol. 2008;9:473–6.CrossRefPubMedPubMedCentral Oh DK, Kim SH, Choi SH, Jang KT. Intraductal tubular carcinoma of the pancreas: a case report with the imaging findings. Korean J Radiol. 2008;9:473–6.CrossRefPubMedPubMedCentral
12.
go back to reference Motosugi U, Yamaguchi H, Furukawa T, Ichikawa T, Hatori T, Fujita I, et al. Imaging studies of intraductal tubulopapillary neoplasms of the pancreas: 2-tone duct sign and cork-of-wine-bottle sign as indicators of intraductal tumor growth. J Comput Assist Tomogr. 2012;36:710–7.CrossRefPubMed Motosugi U, Yamaguchi H, Furukawa T, Ichikawa T, Hatori T, Fujita I, et al. Imaging studies of intraductal tubulopapillary neoplasms of the pancreas: 2-tone duct sign and cork-of-wine-bottle sign as indicators of intraductal tumor growth. J Comput Assist Tomogr. 2012;36:710–7.CrossRefPubMed
13.
go back to reference Yoshida Y, Matsubayashi H, Sasaki K, Kanemoto H, Uesaka K, Ono H. Intraductal tubulopapillary neoplasm of the pancreatic branch duct showing atypical images. J Dig Dis. 2015;16:357–61.CrossRefPubMed Yoshida Y, Matsubayashi H, Sasaki K, Kanemoto H, Uesaka K, Ono H. Intraductal tubulopapillary neoplasm of the pancreatic branch duct showing atypical images. J Dig Dis. 2015;16:357–61.CrossRefPubMed
14.
go back to reference Tanaka M, Fernandez-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12:183–97.CrossRefPubMed Tanaka M, Fernandez-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12:183–97.CrossRefPubMed
15.
go back to reference Ban S, Naitoh Y, Mino-Kenudson M, Sakurai T, Kuroda M, Koyama I, et al. Intraductal papillary mucinous neoplasm (IPMN) of the pancreas: its histopathologic difference between 2 major types. Am J Surg Pathol. 2006;30:1561–9.CrossRefPubMed Ban S, Naitoh Y, Mino-Kenudson M, Sakurai T, Kuroda M, Koyama I, et al. Intraductal papillary mucinous neoplasm (IPMN) of the pancreas: its histopathologic difference between 2 major types. Am J Surg Pathol. 2006;30:1561–9.CrossRefPubMed
16.
go back to reference Tajiri T, Tate G, Inagaki T, Kunimura T, Inoue K, Mitsuya T, Yoshiba M, et al. Intraductal tubular neoplasms of the pancreas: histogenesis and differentiation. Pancreas. 2005;30:115–21.CrossRefPubMed Tajiri T, Tate G, Inagaki T, Kunimura T, Inoue K, Mitsuya T, Yoshiba M, et al. Intraductal tubular neoplasms of the pancreas: histogenesis and differentiation. Pancreas. 2005;30:115–21.CrossRefPubMed
18.
go back to reference Yamaguchi H, Kuboki Y, Hatori T, Yamamoto M, Shiratori K, Kawamura S, et al. Somatic mutations in PIK3CA and activation of AKT in intraductal tubulopapillary neoplasms of the pancreas. Am J Surg Pathol. 2011;35:1812–7.CrossRefPubMed Yamaguchi H, Kuboki Y, Hatori T, Yamamoto M, Shiratori K, Kawamura S, et al. Somatic mutations in PIK3CA and activation of AKT in intraductal tubulopapillary neoplasms of the pancreas. Am J Surg Pathol. 2011;35:1812–7.CrossRefPubMed
19.
go back to reference Tajiri T, Tate G, Matsumoto K, Hoshino H, Iwamura T, Kodaira Y, et al. Diagnostic challenge: intraductal neoplasms of the pancreatobiliary system. Pathol Res Pract. 2012;208:691–6.CrossRefPubMed Tajiri T, Tate G, Matsumoto K, Hoshino H, Iwamura T, Kodaira Y, et al. Diagnostic challenge: intraductal neoplasms of the pancreatobiliary system. Pathol Res Pract. 2012;208:691–6.CrossRefPubMed
20.
go back to reference Urata T, Naito Y, Nagamine M, Izumi Y, Tonaki G, Iwasaki H, et al. Intraductal tubulopapillary neoplasm of the pancreas with somatic BRAF mutation. Clin J Gastroenterol. 2012;5:413–20.CrossRefPubMed Urata T, Naito Y, Nagamine M, Izumi Y, Tonaki G, Iwasaki H, et al. Intraductal tubulopapillary neoplasm of the pancreas with somatic BRAF mutation. Clin J Gastroenterol. 2012;5:413–20.CrossRefPubMed
21.
go back to reference Ahls MG, Niedergethmann M, Dinter D, Sauer C, Luttges J, Post S, et al. Case report: intraductal tubulopapillary neoplasm of the pancreas with unique clear cell phenotype. Diagn Pathol. 2014;9:11.CrossRefPubMedPubMedCentral Ahls MG, Niedergethmann M, Dinter D, Sauer C, Luttges J, Post S, et al. Case report: intraductal tubulopapillary neoplasm of the pancreas with unique clear cell phenotype. Diagn Pathol. 2014;9:11.CrossRefPubMedPubMedCentral
22.
go back to reference Del Chiaro M, Mucelli RP, Blomberg J, Segersvard R, Verbeke CI. Intraductal tubulopapillary neoplasia a new entity in the spectrum of familial pancreatic cancer syndrome? Familial Cancer. 2014;13:227–9.PubMed Del Chiaro M, Mucelli RP, Blomberg J, Segersvard R, Verbeke CI. Intraductal tubulopapillary neoplasia a new entity in the spectrum of familial pancreatic cancer syndrome? Familial Cancer. 2014;13:227–9.PubMed
23.
go back to reference Guan H, Gurda G, Lennon AM, Hruban RH, Erozan YS. Intraductal tubulopapillary neoplasm of the pancreas on fine needle aspiration: case report with differential diagnosis. Diagn Cytopathol. 2014;42:156–60.CrossRefPubMed Guan H, Gurda G, Lennon AM, Hruban RH, Erozan YS. Intraductal tubulopapillary neoplasm of the pancreas on fine needle aspiration: case report with differential diagnosis. Diagn Cytopathol. 2014;42:156–60.CrossRefPubMed
24.
go back to reference Someya Y, Nakamoto Y, Nakatani K, Kawaguchi M, Minamiguchi S, Togashi K. 18F-FDG uptake in intraductal tubulopapillary neoplasm of the pancreas. Clin Nucl Med. 2014;39:e277–80.CrossRefPubMed Someya Y, Nakamoto Y, Nakatani K, Kawaguchi M, Minamiguchi S, Togashi K. 18F-FDG uptake in intraductal tubulopapillary neoplasm of the pancreas. Clin Nucl Med. 2014;39:e277–80.CrossRefPubMed
25.
go back to reference Zhao L, Hart J, Xiao SY, Antic T. Cytological features of pancreatic intraductal tubulopapillary neoplasm and an unexpected immunohistochemical profile. Pathology. 2014;46:662–5.CrossRefPubMed Zhao L, Hart J, Xiao SY, Antic T. Cytological features of pancreatic intraductal tubulopapillary neoplasm and an unexpected immunohistochemical profile. Pathology. 2014;46:662–5.CrossRefPubMed
26.
go back to reference Kitaguchi K, Kato Y, Kojima M, Okubo S, Takahashi D, Okada R, et al. A resected case of intraductal tubulopapillary neoplasm of the pancreas: report of a case. Int Surg. 2015;100:281–6.CrossRefPubMedPubMedCentral Kitaguchi K, Kato Y, Kojima M, Okubo S, Takahashi D, Okada R, et al. A resected case of intraductal tubulopapillary neoplasm of the pancreas: report of a case. Int Surg. 2015;100:281–6.CrossRefPubMedPubMedCentral
27.
go back to reference Kolby D, Thilen J, Andersson R, Sasor A, Ansari D. Multifocal intraductal tubulopapillary neoplasm of the pancreas with total pancreatectomy: report of a case and review of literature. Int J Clin Exp Pathol. 2015;8:9672–80.PubMedPubMedCentral Kolby D, Thilen J, Andersson R, Sasor A, Ansari D. Multifocal intraductal tubulopapillary neoplasm of the pancreas with total pancreatectomy: report of a case and review of literature. Int J Clin Exp Pathol. 2015;8:9672–80.PubMedPubMedCentral
28.
go back to reference Matthews Y, McKenzie C, Byrne C, Kench JG. Intraductal tubulopapillary neoplasm of pancreas with associated invasive carcinoma, lymph node, rectal and hepatic metastases. Pathology. 2015;47:169–71.CrossRefPubMed Matthews Y, McKenzie C, Byrne C, Kench JG. Intraductal tubulopapillary neoplasm of pancreas with associated invasive carcinoma, lymph node, rectal and hepatic metastases. Pathology. 2015;47:169–71.CrossRefPubMed
29.
go back to reference Muraki T, Uehara T, Sano K, Oota H, Yoshizawa A, Asaka S, et al. A case of MUC5AC-positive intraductal neoplasm of the pancreas classified as an intraductal tubulopapillary neoplasm? Pathol Res Pract. 2015;211:1034–9.CrossRefPubMed Muraki T, Uehara T, Sano K, Oota H, Yoshizawa A, Asaka S, et al. A case of MUC5AC-positive intraductal neoplasm of the pancreas classified as an intraductal tubulopapillary neoplasm? Pathol Res Pract. 2015;211:1034–9.CrossRefPubMed
30.
go back to reference Tajima S. Intraductal tubulopapillary neoplasm of the pancreas suspected by endoscopic ultrasonography-fine-needle aspiration cytology: report of a case confirmed by surgical specimen histology. Diagn Cytopathol. 2015;43:1003–6.CrossRefPubMed Tajima S. Intraductal tubulopapillary neoplasm of the pancreas suspected by endoscopic ultrasonography-fine-needle aspiration cytology: report of a case confirmed by surgical specimen histology. Diagn Cytopathol. 2015;43:1003–6.CrossRefPubMed
31.
go back to reference Takayama S, Maeda T, Nishihara M, Kanazawa A, Chong HS, Oka H, et al. A case of intraductal tubulopapillary neoplasm of pancreas with severe calcification, a potential pitfall in diagnostic imaging. Pathol Int. 2015;65:501–6.CrossRefPubMed Takayama S, Maeda T, Nishihara M, Kanazawa A, Chong HS, Oka H, et al. A case of intraductal tubulopapillary neoplasm of pancreas with severe calcification, a potential pitfall in diagnostic imaging. Pathol Int. 2015;65:501–6.CrossRefPubMed
32.
go back to reference Date K, Okabayashi T, Shima Y, Iwata J, Sumiyoshi T, Kozuki A, et al. Clinicopathological features and surgical outcomes of intraductal tubulopapillary neoplasm of the pancreas: a systematic review. Langenbeck's Arch Surg. 2016;401:439–47.CrossRef Date K, Okabayashi T, Shima Y, Iwata J, Sumiyoshi T, Kozuki A, et al. Clinicopathological features and surgical outcomes of intraductal tubulopapillary neoplasm of the pancreas: a systematic review. Langenbeck's Arch Surg. 2016;401:439–47.CrossRef
33.
go back to reference Savant D, Lee L, Das K. Intraductal tubulopapillary neoplasm of the pancreas masquerading as pancreatic neuroendocrine carcinoma: review of the literature with a case report. Acta Cytol. 2016;60:267–74.CrossRefPubMed Savant D, Lee L, Das K. Intraductal tubulopapillary neoplasm of the pancreas masquerading as pancreatic neuroendocrine carcinoma: review of the literature with a case report. Acta Cytol. 2016;60:267–74.CrossRefPubMed
34.
go back to reference Fujimoto Y, Tomimaru Y, Tamura H, Noguchi K, Nagase H, Hamabe A, et al. Pancreatic intraductal tubulopapillary neoplasm with associated invasive cancer successfully treated by total pancreatectomy: a case report. Oncol Lett. 2017;14:153–8.CrossRefPubMedPubMedCentral Fujimoto Y, Tomimaru Y, Tamura H, Noguchi K, Nagase H, Hamabe A, et al. Pancreatic intraductal tubulopapillary neoplasm with associated invasive cancer successfully treated by total pancreatectomy: a case report. Oncol Lett. 2017;14:153–8.CrossRefPubMedPubMedCentral
35.
go back to reference Kovacevic B, Latorre Ano P, Toxvaerd A, Vilmann P, Kalaizakis E. Intraductal tubulopapillary neoplasm of the pancreas diagnosed by endoscopic ultrasonography-guided fine needle aspiration. Endoscopy. 2017;49:E266–7.CrossRefPubMed Kovacevic B, Latorre Ano P, Toxvaerd A, Vilmann P, Kalaizakis E. Intraductal tubulopapillary neoplasm of the pancreas diagnosed by endoscopic ultrasonography-guided fine needle aspiration. Endoscopy. 2017;49:E266–7.CrossRefPubMed
36.
go back to reference Niu L, Xu Z, Liu H, Cao H, Yang G. Intraductal tubulopapillary neoplasm accompanied by invasive carcinoma of the pancreas: a case report and review of the literature. Mol Clin Oncol. 2017;6:676–82.CrossRefPubMedPubMedCentral Niu L, Xu Z, Liu H, Cao H, Yang G. Intraductal tubulopapillary neoplasm accompanied by invasive carcinoma of the pancreas: a case report and review of the literature. Mol Clin Oncol. 2017;6:676–82.CrossRefPubMedPubMedCentral
Metadata
Title
Concurrent presentation of an intraductal tubulopapillary neoplasm and intraductal papillary mucinous neoplasm in the branch duct of the pancreas, with a superior mesenteric artery aneurysm: a case report
Authors
Kenta Inomata
Minoru Kitago
Hideaki Obara
Yoko Fujii-Nishimura
Masahiro Shinoda
Hiroshi Yagi
Yuta Abe
Taizo Hibi
Kentaro Matsubara
Go Oshima
Yasuhito Sekimoto
Masazumi Inoue
Osamu Itano
Michiie Sakamoto
Yuko Kitagawa
Publication date
01-12-2018
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2018
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/s12957-018-1391-9

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