Pancreas
Exocrine tumors / carcinomas
Intraductal tubulopapillary neoplasm (ITPN)

Author: Deepali Jain, M.D. (see Authors page)

Revised: 15 December 2017, last major update August 2012

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Intraductal tubulopapillary neoplasm OR ITPN pancreas

Cite this page: Jain, D. Intraductal tubulopapillary neoplasm (ITPN). PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/pancreasitpn.html. Accessed June 21st, 2018.
Definition / general
  • 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
  • First described in 2009 (Am J Surg Pathol 2009;33:1164)
  • ~3% of intraductal neoplasms of pancreas
Case reports
Gross description
  • Solid and nodular tumor obstructing dilated pancreatic ducts; no visible mucin
Microscopic (histologic) description
  • Tubulopapillae with scant cytoplasmic mucin and high grade atypia
  • Frequent necrotic foci
  • Variable invasive disease
Microscopic (histologic) images

Images hosted on other servers:

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

Staining of bile duct tumor

Cytology description
  • 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 2014;42:156)
Positive stains
Negative stains
Molecular / cytogenetics description
  • 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