Endoscopic ultrasonography features of intraductal tubulopapillary neoplasm of the pancreas

doi:10.3877/cma.j.issn.2095-7157.2024.03.003

Abstract

Abstract:

Objective

To analyze the endoscopic ultrasound (EUS) features of the intraductal tubulopapillary neoplasm (ITPN) of the pancreas.

Methods

The data of patients with pancreatic ITPN diagnosed by postoperative pathology in Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University from January 1, 2019 to December 31, 2023 were retrospectively collected.The results of EUS, ultrasound elastography, contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) were described and analyzed.

Results

A total of 5 patients were enrolled in the study, the postoperative pathology of all patients was ITPN with invasive carcinoma.All patients underwent EUS and ultrasound elastography, 3 patients underwent CH-EUS, and 2 patients underwent EUS-FNA.On EUS images, all lesions appeared as hypoechoic masses, 4 patients had two-tone duct sign, and 2 patients had cork-of-wine-bottle sign.In ultrasound elastography, the elasticity scores of 5 patients were 3-5.On CH-EUS, 3 patients showed moderate-low enhancement, isoenhancement, and slightly hyperenhancement.Two patients underwent EUS-FNA, 1 patient was diagnosed as moderately to poorly differentiated adenocarcinoma, and the other was diagnosed as high-grade intraepithelial neoplasia or invasive adenocarcinoma.

Conclusion

The ITPN presents as a hypoechoic mass on EUS, with the characteristic signs being the presence of the two-tone duct sign and cork-of-wine-bottle sign.ITPN with invasive carcinoma shows moderate to higher stiffness on ultrasound elastography, and moderate to high enhancement on CH-EUS.EUS-FNA has certain diagnostic value for ITPN with invasive carcinoma.

Key words: Intraductal tubulopapillary neoplasm, Endoscopic ultrasound, Two-tone duct sign, Cork-of-wine-bottle sign

Congqiang Shen, Xinyu Tian, Nuermaimaiti Mireayi·, Yuhang Zhuang, Song Zhang, Chunyan Peng, Shuling Huang, Shanshan Shen, Wei Zhang, Ying Lv. Endoscopic ultrasonography features of intraductal tubulopapillary neoplasm of the pancreas[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2024, 11(03): 153-158.

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Figures/Tables 8

References 19

[1]	Kovacevic B，Latorre Añó P，Toxværd A，et al.Intraductal tubulopapillary neoplasm of the pancreas diagnosed by endoscopic ultrasonography-guided fine needle aspiration[J]. Endoscopy，2017，49(11): E266-267.
[2]	Khristenko E，Hank T，Gaida MM，et al.Imaging features of intraductal tubulopapillary neoplasm of the pancreas and its differentiation from conventional pancreatic ductal adenocarcinoma[J].Sci Rep，2022，12(1)：15557.
[3]	Basturk O，Adsay V，Askan G，et al.Intraductal Tubulopapillary Neoplasm of the Pancreas: A Clinicopathologic and Immunohistochemical Analysis of 33 Cases[J].Am J Surg Pathol, 2017，41(3)：313-325.
[4]	Mafficini A，Simbolo M，Shibata T，et al.Integrative characterization of intraductal tubulopapillary neoplasm (ITPN) of the pancreas and associated invasive adenocarcinoma[J]. Mod Pathol，2022，35(12)：1929-1943.
[5]	Basturk O，Berger MF，Yamaguchi H，et al.Pancreatic intraductal tubulopapillary neoplasm is genetically distinct from intraductal papillary mucinous neoplasm and ductal adenocarcinoma[J].Mod Pathol，2017，30(12)：1760-1772.
[6]	李惠凯，冯秀雪，令狐恩强．超声内镜在胰腺囊性肿瘤诊断中的作用[J].中华消化内镜杂志，2022，38(8)：593-598.
[7]	Liu WH，Su XJ，Fang X，et al.Preoperative diagnosis of multiple intraductal tubulopapillary neoplasms of the pancreas：dynamic imaging features from endoscopic ultrasound[J]. Endoscopy，2021，53(9): E345-347.
[8]	Huang DC，Bilal M，Gonzalez RS，et al.Not every cyst is an intraductal papillary mucosal neoplasm：a case of intraductal tubulopapillary neoplasm[J].Gastrointest Endosc，2020，92(4): 967-968.
[9]	Paolino G，Esposito I，Hong SM，et al.Intraductal tubulopapillary neoplasm (ITPN) of the pancreas：a distinct entity among pancreatic tumors[J].Histopathology，2022，81(3)：297-309.
[10]	李加美，徐嘉雯，王志意，等.46例胰腺导管内管状乳头状肿瘤临床及病理学分析[J].中华肝胆外科杂志，2023, 29(3): 190-194.
[11]	Kitano M，Yoshida T，Itonaga M，et al.Impact of endoscopic ultrasonography on diagnosis of pancreatic cancer[J].J Gastroenterol，2019，54(1)：19-32.
[12]	Kim HJ，Park MS，Chung T，et al.Multimodality imaging studies of intraductal tubulopapillary neoplasms of the pancreas[J].Diagn Interv Radiol，2019，25(4)：251-256.
[13]	Motosugi U，Yamaguchi H，Furukawa T，et al.Imaging studies of intraductal tubulopapillary neoplasms of the pancreas：2-tone duct sign and cork-of-wine-bottle sign as indicators of intraductal tumor growth[J].J Comput Assist Tomogr，2012，36(6)：710-717.
[14]	方旭，边云，蒋慧，等．胰腺导管内管状乳头状肿瘤的影像学表现与病理对照分析[J].中华放射学杂志，2021, 55(5): 551-554.
[15]	Conti CB，Mulinacci G，Salerno R，et al.Applications of endoscopic ultrasound elastography in pancreatic diseases：From literature to real life[J].World J Gastroenterol，2022, 28(9)：909-917.
[16]	Lee TH，Cha SW，Cho YD.EUS elastography：advances in diagnostic EUS of the pancreas [J].Korean J Radiol，2012，13(Suppl 1)：S12-16.
[17]	Iglesias-Garcia J，Larino-Noia J，Abdulkader I，et al.EUS elastography for the characterization of solid pancreatic masses[J].Gastrointest Endosc，2009，70(6)：1101-1108.
[18]	Yamaguchi A，Hamada T，Wada K，et al.A case of intraductal tubulopapillary neoplasm of the pancreas in a branch duct：a rare case report and literature review[J].BMC Gastroenterol, 2021，21(1)：162-170.
[19]	Yamashita Y，Kitano M．Endoscopic ultrasonography for pancreatic solid lesions[J].J Med Ultrason(2001)，2020，47(3): 377-387.

病例	性别	年龄(岁)	症状	起病时间	术前考虑诊断	部位	病理诊断结果	MUC1	MUC2	MUC6	MUC5AC
1	女	27	腹痛	1年半	恶性肿瘤	头部	ITPN伴浸润性癌	＋	－	－	－
2	女	69	腹痛	半年	IPMN	体尾部	ITPN伴浸润性癌	＋	－	－	－
3	女	55	腹痛	半个月	AIP或恶性肿瘤	头部	ITPN伴浸润性癌	局灶＋	－	－	－
4	男	55	腹痛	2年	SPT	尾部	ITPN伴浸润性癌	＋	－	－	－
5	男	60	腹泻伴消瘦	3个月	IPMN	头部	ITPN伴浸润性癌	＋	－	＋	局灶＋

病例	性别	年龄(岁)	症状	起病时间	术前考虑诊断	部位	病理诊断结果	MUC1	MUC2	MUC6	MUC5AC
1	女	27	腹痛	1年半	恶性肿瘤	头部	ITPN伴浸润性癌	＋	－	－	－
2	女	69	腹痛	半年	IPMN	体尾部	ITPN伴浸润性癌	＋	－	－	－
3	女	55	腹痛	半个月	AIP或恶性肿瘤	头部	ITPN伴浸润性癌	局灶＋	－	－	－
4	男	55	腹痛	2年	SPT	尾部	ITPN伴浸润性癌	＋	－	－	－
5	男	60	腹泻伴消瘦	3个月	IPMN	头部	ITPN伴浸润性癌	＋	－	＋	局灶＋

病例	部位	回声改变	病灶长径(mm)	主胰管扩张	肝内外胆管扩张	双色征	酒瓶塞征
1	头部	低回声	38.2	无	肝内外胆管扩张	有	无
2	体尾部	低回声	65.4	有	肝内外胆管未见扩张	有	有
3	头部	低回声	38.9	有	肝内外胆管未见扩张	有	有
4	尾部	低回声	66.7	无	肝内外胆管未见扩张	无	无
5	头部	低回声	29.1	有	肝内外胆管未见扩张	有	无

病例	部位	回声改变	病灶长径(mm)	主胰管扩张	肝内外胆管扩张	双色征	酒瓶塞征
1	头部	低回声	38.2	无	肝内外胆管扩张	有	无
2	体尾部	低回声	65.4	有	肝内外胆管未见扩张	有	有
3	头部	低回声	38.9	有	肝内外胆管未见扩张	有	有
4	尾部	低回声	66.7	无	肝内外胆管未见扩张	无	无
5	头部	低回声	29.1	有	肝内外胆管未见扩张	有	无

病例	超声弹性成像评分	CH-EUS
1	4～5	中-低增强
2	4	N/A
3	5	等增强
4	5	稍高增强
5	3	N/A

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