A resected case of recurrent ITPN in the remnant pancreas after pancreatoduodenectomy
Abstract Background Since intraductal tubulopapillary neoplasm (ITPN) is a rare disease, the clinical features of ITPN, especially the characteristics related to recurrence, have not been revealed. We performed a total remnant pancreatectomy for a patient whose ITPN recurred 16 months after pancreat...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2019-02-01
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| Series: | Surgical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s40792-019-0590-0 |
| _version_ | 1811324988531146752 |
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| author | Kenju Ko Yasunori Nishida Kotaro Sasahara Hirofumi Kishimoto Otagiri Noriaki Katsunori Tauchi Koji Azuhata Kayoko Higuchi |
| author_facet | Kenju Ko Yasunori Nishida Kotaro Sasahara Hirofumi Kishimoto Otagiri Noriaki Katsunori Tauchi Koji Azuhata Kayoko Higuchi |
| author_sort | Kenju Ko |
| collection | DOAJ |
| description | Abstract Background Since intraductal tubulopapillary neoplasm (ITPN) is a rare disease, the clinical features of ITPN, especially the characteristics related to recurrence, have not been revealed. We performed a total remnant pancreatectomy for a patient whose ITPN recurred 16 months after pancreatoduodenectomy (PD). We report useful findings to clarify how ITPN reoccurs based on this experience and previously reported cases. Case presentation A 61-year-old male patient was diagnosed with pancreatic cancer and underwent PD. However, a postoperative pathologic examination diagnosed ITPN with invasive cancer. After receiving adjuvant chemotherapy, he was hospitalized for pancreatitis 16 months after the operation. He was diagnosed as having recurrence near the pancreato-jejunal anastomosis based on detailed examinations and underwent a remnant total pancreatectomy. From the results of the histopathological examination, he was found to have a recurrence of ITPN as a polypoid mass without invasion distant from the surgical stump of the first operation. Furthermore, tumor cells floating in the main pancreatic duct distant from the main tumor were observed at three locations. Review of the literature Including our case, five cases of recurrence in the remnant pancreas after surgery for ITPN have been reported. Recurrence in the main pancreatic duct was observed in four of these five cases. The primary tumor, which recurred in the remnant pancreas after surgery, was characterized as being relatively small and less invasive; however, Ki-67 labeling index was high. In immunohistochemical examination, the expression of MUC6, which is not one of characteristics of ITPN, tended to be positive. Conclusion In this case, tumor cells were floating inside the pancreatic duct at several locations. From the results of this case and a review of previous reports, the cause of ITPN recurrence in this case seemed to be due to tumor cells leaving the tumor and implanting into the pancreatic duct. |
| first_indexed | 2024-04-13T14:25:17Z |
| format | Article |
| id | doaj.art-77b5876dc0b84da99127c2fce81a9451 |
| institution | Directory Open Access Journal |
| issn | 2198-7793 |
| language | English |
| last_indexed | 2024-04-13T14:25:17Z |
| publishDate | 2019-02-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj.art-77b5876dc0b84da99127c2fce81a94512022-12-22T02:43:21ZengSpringerOpenSurgical Case Reports2198-77932019-02-01511810.1186/s40792-019-0590-0A resected case of recurrent ITPN in the remnant pancreas after pancreatoduodenectomyKenju Ko0Yasunori Nishida1Kotaro Sasahara2Hirofumi Kishimoto3Otagiri Noriaki4Katsunori Tauchi5Koji Azuhata6Kayoko Higuchi7Department of Surgery, Aizawa HospitalDepartment of Surgery, Aizawa HospitalDepartment of Surgery, Aizawa HospitalDepartment of Surgery, Aizawa HospitalDepartment of Surgery, Aizawa HospitalDepartment of Surgery, Aizawa HospitalDepartment of Pathology, Aizawa HospitalDepartment of Pathology, Okinawa Kyoudo HospitalAbstract Background Since intraductal tubulopapillary neoplasm (ITPN) is a rare disease, the clinical features of ITPN, especially the characteristics related to recurrence, have not been revealed. We performed a total remnant pancreatectomy for a patient whose ITPN recurred 16 months after pancreatoduodenectomy (PD). We report useful findings to clarify how ITPN reoccurs based on this experience and previously reported cases. Case presentation A 61-year-old male patient was diagnosed with pancreatic cancer and underwent PD. However, a postoperative pathologic examination diagnosed ITPN with invasive cancer. After receiving adjuvant chemotherapy, he was hospitalized for pancreatitis 16 months after the operation. He was diagnosed as having recurrence near the pancreato-jejunal anastomosis based on detailed examinations and underwent a remnant total pancreatectomy. From the results of the histopathological examination, he was found to have a recurrence of ITPN as a polypoid mass without invasion distant from the surgical stump of the first operation. Furthermore, tumor cells floating in the main pancreatic duct distant from the main tumor were observed at three locations. Review of the literature Including our case, five cases of recurrence in the remnant pancreas after surgery for ITPN have been reported. Recurrence in the main pancreatic duct was observed in four of these five cases. The primary tumor, which recurred in the remnant pancreas after surgery, was characterized as being relatively small and less invasive; however, Ki-67 labeling index was high. In immunohistochemical examination, the expression of MUC6, which is not one of characteristics of ITPN, tended to be positive. Conclusion In this case, tumor cells were floating inside the pancreatic duct at several locations. From the results of this case and a review of previous reports, the cause of ITPN recurrence in this case seemed to be due to tumor cells leaving the tumor and implanting into the pancreatic duct.http://link.springer.com/article/10.1186/s40792-019-0590-0Intraductal tubulopapillary neoplasm (ITPN)RecurrenceRemnant pancreas |
| spellingShingle | Kenju Ko Yasunori Nishida Kotaro Sasahara Hirofumi Kishimoto Otagiri Noriaki Katsunori Tauchi Koji Azuhata Kayoko Higuchi A resected case of recurrent ITPN in the remnant pancreas after pancreatoduodenectomy Surgical Case Reports Intraductal tubulopapillary neoplasm (ITPN) Recurrence Remnant pancreas |
| title | A resected case of recurrent ITPN in the remnant pancreas after pancreatoduodenectomy |
| title_full | A resected case of recurrent ITPN in the remnant pancreas after pancreatoduodenectomy |
| title_fullStr | A resected case of recurrent ITPN in the remnant pancreas after pancreatoduodenectomy |
| title_full_unstemmed | A resected case of recurrent ITPN in the remnant pancreas after pancreatoduodenectomy |
| title_short | A resected case of recurrent ITPN in the remnant pancreas after pancreatoduodenectomy |
| title_sort | resected case of recurrent itpn in the remnant pancreas after pancreatoduodenectomy |
| topic | Intraductal tubulopapillary neoplasm (ITPN) Recurrence Remnant pancreas |
| url | http://link.springer.com/article/10.1186/s40792-019-0590-0 |
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