Endoscopic Ultrasound-Guided Fine Needle Aspiration Diagnosis of Pancreatic Intraductal Tubulopapillary Neoplasm: A Cytology Case Report.
Ayesha Usman, Shweta Gera, Amarpreet Bhalla et al.
✦ AI-curated · Sources linked
Case in brief
An 82-year-old woman had a pancreatic head mass and miliary pulmonary nodules that raised radiologic concern for pancreatic adenocarcinoma. Endoscopic ultrasound-guided fine-needle aspiration showed papillary fronds and tubular cell clusters without intracellular or extracellular mucin. Cell-block sections demonstrated tubular, cribriform, and papillary architecture with focal high-grade dysplasia. Diffuse MUC1 positivity, patchy CK7 and CK19 expression, and negativity for MUC2, GATA3, and TTF-1 supported intraductal tubulopapillary neoplasm (ITPN).
What made this case unusual
The pancreatic mass and pulmonary nodules suggested adenocarcinoma, but FNA identified ITPN, a rare intraductal tumor. The absence of mucin and the combined architectural and immunophenotypic findings helped distinguish it from intraductal papillary mucinous neoplasm and other pancreatic neoplasms.
Diagnostic / clinical pearl
In limited pancreatic FNA samples, consider ITPN when tubular, cribriform, or papillary architecture is present without mucin; correlate morphology with immunophenotype to distinguish it from intraductal papillary mucinous neoplasm and other tumors.