March 3, 2026Open Access

A Case of Difficult Diagnosis between Intraductal Tubulopapillary Neoplasm and Intraductal Papillary Mucinous Neoplasm

Key Points

Diagnosis faced challenges between intraductal tubulopapillary neoplasm and intraductal papillary mucinous neoplasm.
Immunostaining showed positive markers for MUC2 and MUC5AC, indicating potential for IPMN.
Assessment included biopsy and pancreatic duct imaging, revealing ductal anomalies.
Clinical and pathological findings highlight the complexities in distinguishing between these neoplasms.

Abstract

副膵管に結節性腫瘍として観察され，膵管内管状乳頭腫瘍（ITPN）と膵管内乳頭粘液性腫瘍（IPMN）との鑑別が困難であった膵管内腫瘍を経験したので報告する．症例は56歳，男性．健診での腹部エコーで膵管拡張を指摘された．副膵管内に結節性腫瘍を，また，副乳頭部十二指腸粘膜に陥凹を伴うびらんを認め，生検にて腺癌と診断された．さらに，膵管造影により膵管癒合不全を認めた．以上より，ITPNおよび十二指腸浸潤と診断し，亜全胃温存膵頭十二指腸切除術を施行した．標本では，副膵管内に15×9mm大の腫瘍を認め，粘液を含まない異型上皮が乳頭状・管状に増生しており，一部に十二指腸筋層への浸潤を認めた．免疫染色では，MUC1・MUC6が陰性，MUC2・MUC5ACが陽性であった．臨床所見ではITPNを積極的に疑ったが，免疫染色の結果からはIPMNを疑う所見となり確定診断に至らなかった．

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Discussion

Authors

Zen Naito

Yoshinori Suzuki

Yo Kawarada

Journals

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

Actions

Institutions

Hokkaido University

Tonan Hospital

References and Citations

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A Case of Difficult Diagnosis between Intraductal Tubulopapillary Neoplasm and Intraductal Papillary Mucinous Neoplasm

Key Points

Abstract

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Discussion

Authors

Journals

Actions

Institutions

References and Citations

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Discussion

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