Intraductal tubulopapillary neoplasm (ITPN) is one of the intraductal papillary neoplasms of the pancreas. ITPN is a distinct neoplasm with specific clinicopathological and molecular characteristics. ITPN is different from intraductal oncocytic papillary neoplasm (IOPN) of the pancreaticobiliary system. A summary report of ITPN in 128 patients by Gaetano Paolino and colleagues reveals the following core findings in ITPN:
It is most commonly found in the pancreatic head;
It is composed of closely packed tubulopapillary glands with high-grade dysplasia but no secreted mucin.
It distinctively differs from intraductal papillary mucinous neoplasms of the gastric pyloric gland type.
60% of cases are associated with adenocarcinoma, but only with rare nodal metastasis.
Positive for MUC1 (>90%) and MUC6 (70%) but negative for MUC2 and MUC5AC.
The classic pancreatic drivers such as KRAS, TP53, etc. were less altered in ITPN, whereas MCL amplifications, FGFR2 fusions, and PI3KCA mutations were commonly altered.
Survival analysis: ITPN with a "pure" branch duct involvement showed the lowest risk of recurrence.
Reference
Paolino, Gaetano et al. “Intraductal tubulopapillary neoplasm (ITPN) of the pancreas: a distinct entity among pancreatic tumors.” Histopathology vol. 81,3 (2022): 297-309. doi:10.1111/his.14698 https://pubmed.ncbi.nlm.nih.gov/35583805/
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