Pancreatic intraductal tubulopapillary neoplasm (ITPN)

Case contributed by Dr Matt A. Morgan


Progressive diabetes mellitus. Nonspecific abdominal pain.

Patient Data

Age: 60-70Y
Gender: Male

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. 

Case Discussion

Pancreatic intraductal tubulopapillary neoplams (ITPN) are rare tumors of the pancreas.

According to recent WHO classification, intraductal pancreatic neoplasms are classified as

The ITN class of tumours is much more rare than the IPMN class of tumours, and imaging findings in ITN tumours 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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Case information

rID: 33512
Case created: 15th Jan 2015
Last edited: 7th Jul 2016
Inclusion in quiz mode: Included

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