Pancreas - Intraductal tubulopapillary neoplasm (ITPN)

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Pancreas

Exocrine tumors

Intraductal tubulopapillary neoplasm (ITPN)

Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 9 December 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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● Intraductal, grossly visible, tubule forming epithelial neoplasm with high-grade dysplasia and ductal differentiation without overt production of mucin; focal tubulopapillary growth may be seen (WHO)
● First described in 2009 (Am J Surg Pathol 2009;33:1164)
● ~3% of intraductal neoplasms of pancreas

Case reports
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● With focal invasion and stromal osseous and cartilaginous metaplasia (Pathol Int 2012;62:339)

Gross description
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● Solid and nodular tumor obstructing dilated pancreatic ducts; no visible mucin.

Gross images
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Various images

Micro description
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● Tubulopapillae with scant cytoplasmic mucin and high grade atypia
● Frequent necrotic foci
● Variable invasive disease

Micro images
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Tubulopapillary growth of neoplastic cells with eosinophilic cytoplasm, but no intracytoplasmic mucin

Staining of bile duct tumor

Cytology description
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● Moderately cellular with few fragments of markedly atypical epithelium
● Atypical cells have moderate cytoplasm, no intracytoplasmic mucin, enlarged eccentric nuclei, anisonucleosis and prominent nucleoli, irregular nuclear membranes, high nucleus to cytoplasmic ratio (Diagn Cytopathol 2012 Jul 16 [Epub ahead of print])

Positive stains
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● CK7, CK19, MUC1, MUC6

WHO table comparing staining of various IPMN related entities

Negative stains
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● MUC2, MUC5AC, CDX2 trypsin, chymotrypsin, p53, fascin

Molecular description
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● Mutations in PIK3CA were found in 3 of 11, and most cases expressed phosphorylated AKT (Am J Surg Pathol 2011;35:1812)
● Usually no abnormal expression of p53, SMAD4, beta-catenin
● Usually no KRAS or BRAF mutations

Differential diagnosis
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● Acinar cell cystadenoma: trysin+ (Pathol Res Pract 2012;208:691)

End of Pancreas > Exocrine tumors > Intraductal tubulopapillary neoplasm (ITPN)

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