Presentation
Progressive diabetes mellitus. Nonspecific abdominal pain.
Patient Data
The pancreatic duct is irregularly dilated with soft tissue attenuation material. There are three superimposed hypoattenuating/cystic lesions with nodular poorly-enhancing walls. Also noted is an abrupt cut-off of the common bile duct with CBD dilatation and gallbladder hydrops.
Annotated images demonstrating features of ITPN.
The pancreatic duct is irregularly dilated and filled with heterogeneous soft tissue attenuation material (red arrows). Three hypoattenuating masses with nodular, poorly-enhancing soft tissue components in the body and tail of the pancreas (closed green arrows). Narrowing of the SMV (open orange arrow). Common bile duct is dilated to 19 mm in diameter (open green arrow), with gallbladder hydrops.
Case Discussion
Pancreatic intraductal tubulopapillary neoplams (ITPN) are rare tumors of the pancreas.
According to recent WHO classification, intraductal pancreatic neoplasms are classified as
- pancreatic intraductal neoplasia (PanIN)
- intraductal papillary mucinous neoplasm (IPMN)
- intraductal tubular neoplasm (ITN)
The ITN class of tumors is much more rare than the IPMN class of tumors, and imaging findings in ITN tumors are still being fully determined.
One imaging finding suggested for ITPNs is a "cork-in-bottle" appearance on CT and MRI. The soft tissue "cork" plugs the main pancreatic duct "bottle", causing dilatation of the upstream main pancreatic duct.
The diagnosis was made in the patient above after excision of the tumor.
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