A case of pancreatic ductal adenocarcinoma growing within the pancreatic duct mimicking an intraductal tubulopapillary neoplasm.

IF 0.8 Q4 GASTROENTEROLOGY & HEPATOLOGY
Clinical Journal of Gastroenterology Pub Date : 2025-04-01 Epub Date: 2025-02-05 DOI:10.1007/s12328-025-02098-y
Ryosuke Sato, Kazuyuki Matsumoto, Mayu Uka, Kosei Takagi, Kenji Nishida, Takehiro Tanaka, Yuki Fujii, Koichiro Tsutsumi, Shigeru Horiguchi, Motoyuki Otsuka
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引用次数: 0

Abstract

We herein report a case of pancreatic ductal adenocarcinoma (PDAC) that developed within the pancreatic duct and was initially diagnosed as an intraductal tubulopapillary neoplasm (ITPN). A 76-year-old man presented with weight loss and main pancreatic duct dilation. The imaging studies revealed a 30-mm hypovascular tumor within the main duct of the pancreatic head. An endoscopic examination with a biopsy revealed high-grade atypical epithelial cells with immunostaining patterns suggestive of ITPN. Following robot-assisted pancreaticoduodenectomy, postoperative pathology revealed conflicting features: nodular/cribriform infiltrations typical of ITPN and non-lobular replacement with scattered infiltrations characteristic of PDAC. A comprehensive genomic profiling test detected KRAS and TP53 mutations, leading to the final diagnosis of PDAC (fT3N1aM0, stage IIB). The patient received adjuvant S-1 chemotherapy and remained recurrence-free for 15 months post-surgery. This case highlights the diagnostic challenges of differentiating intraductal pancreatic tumors and demonstrates the utility of integrating genetic testing with conventional diagnostic modalities for an accurate diagnosis and appropriate treatment selection.

胰管腺癌生长于胰管内,与导管内管状乳头状肿瘤相似。
我们在此报告一例胰管腺癌(PDAC),其在胰管内发展,最初被诊断为导管内管状乳头状肿瘤(ITPN)。76岁男性,体重下降,主胰管扩张。影像学检查显示胰头主管内有一个30毫米的低血管性肿瘤。内镜检查和活检显示高级别非典型上皮细胞,免疫染色模式提示ITPN。在机器人辅助胰十二指肠切除术后,术后病理显示出相互矛盾的特征:典型的ITPN结节状/筛网状浸润和PDAC特征的分散浸润的非小叶置换。综合基因组谱检测检测到KRAS和TP53突变,最终诊断为PDAC (fT3N1aM0,分期IIB)。患者接受辅助S-1化疗,术后15个月无复发。本病例强调了鉴别导管内胰腺肿瘤的诊断挑战,并展示了将基因检测与传统诊断方式相结合的效用,以获得准确的诊断和适当的治疗选择。
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来源期刊
Clinical Journal of Gastroenterology
Clinical Journal of Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
2.00
自引率
0.00%
发文量
182
期刊介绍: The journal publishes Case Reports and Clinical Reviews on all aspects of the digestive tract, liver, biliary tract, and pancreas. Critical Case Reports that show originality or have educational implications for diagnosis and treatment are especially encouraged for submission. Personal reviews of clinical gastroenterology are also welcomed. The journal aims for quick publication of such critical Case Reports and Clinical Reviews.
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