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Wu GZ, Lu LN, Lin HP, Wang XY, Yu SA, Yu M. Laparoscopic management of intraductal oncocytic papillary neoplasm of the pancreas: Two case reports and review of literature. World J Gastrointest Surg 2025; 17:105096. [DOI: 10.4240/wjgs.v17.i4.105096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2025] [Revised: 02/04/2025] [Accepted: 03/03/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Intraductal oncocytic papillary neoplasm (IOPN) of the pancreas is an extremely rare pancreatic tumor, with only sporadic cases reported in the literature. IOPN is difficult to diagnose and highly prone to misdiagnosis. IOPN carries a certain risk of progressing to invasive cancer. Surgical resection is the primary treatment for IOPN. According to the existing literature reports, the vast majority of patients with IOPN of the pancreas undergo open surgery, while only one case of laparoscopic surgery have been reported.
CASE SUMMARY This report presents two cases of IOPN in elderly female patients, aged 60 and 61. Both patients were asymptomatic, and their pancreatic masses were discovered incidentally. Preoperative diagnosis of IOPN is challenging and prone to misdiagnosis. In the first case, the patient underwent a laparoscopic distal pancreatectomy and splenectomy. The surgical procedure spanned 342 minutes, with an estimated intraoperative blood loss of around 100 mL. The patient experienced an uneventful postoperative recovery and was discharged on the 8th postoperative day. For the second case, a laparoscopic pancreaticoduodenectomy was performed. The operation lasted for 431 minutes with an intraoperative blood loss of approximately 50 mL. The patient also demonstrated a favorable postoperative course and was discharged on the 24th postoperative day. Postoperative pathology and immunohistochemistry confirmed the diagnosis of IOPN. No recurrence was observed in either patient after follow-up periods of 8 and 10 months, respectively.
CONCLUSION These cases demonstrate that laparoscopic surgery can be considered as one of the treatment options for IOPN of the pancreas.
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Affiliation(s)
- Guo-Zhen Wu
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Li-Na Lu
- Department of Gastroenterology, Wenrong Hospital of Jinhua City, Jinhua 321000, Zhejiang Province, China
| | - Hai-Ping Lin
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Xin-Yu Wang
- Department of Radiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Shi-An Yu
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Min Yu
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
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Castillo-López G, González Vázquez S, Merchán Gómez B, Alonso-Sierra M, Prieto de Frías C, Lapuente Sastre F, Rotellar F, Areán Cuns C, López-Ferrer P, Riesco López JM. Intraductal oncocytic papillary neoplasm of the pancreas. GASTROENTEROLOGIA Y HEPATOLOGIA 2025; 48:502278. [PMID: 39433173 DOI: 10.1016/j.gastrohep.2024.502278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 10/13/2024] [Accepted: 10/14/2024] [Indexed: 10/23/2024]
Affiliation(s)
- Guillermo Castillo-López
- Gastroenterology Department, Clínica Universidad de Navarra, Universidad de Navarra, Madrid, España.
| | | | - Beatriz Merchán Gómez
- Gastroenterology Department, Clínica Universidad de Navarra, Universidad de Navarra, Madrid, España
| | - Maite Alonso-Sierra
- Gastroenterology Department, Clínica Universidad de Navarra, Universidad de Navarra, Madrid, España
| | - César Prieto de Frías
- Gastroenterology Department, Clínica Universidad de Navarra, Universidad de Navarra, Madrid, España
| | | | - Fernando Rotellar
- Department of Surgery, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, España
| | - Carolina Areán Cuns
- Pathology Department, Clínica Universidad de Navarra, Universidad de Navarra, Madrid, España
| | - Pilar López-Ferrer
- Pathology Department, Clínica Universidad de Navarra, Universidad de Navarra, Madrid, España
| | - José María Riesco López
- Gastroenterology Department, Clínica Universidad de Navarra, Universidad de Navarra, Madrid, España
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3
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Lucocq J, Haugk B, Joseph N, Hawkyard J, White S, Mownah O, Menon K, Furukawa T, Inoue Y, Hirose Y, Sasahira N, Mittal A, Samra J, Sheen A, Feretis M, Balakrishnan A, Ceresa C, Davidson B, Pande R, Dasari BVM, Tanno L, Karavias D, Helliwell J, Young A, Nunes Q, Urbonas T, Silva M, Gordon-Weeks A, Barrie J, Gomez D, van Laarhoven S, Nawara H, Doyle J, Bhogal R, Harrison E, Roalso M, Zaharia C, Ciprani D, Aroori S, Ratnayake B, Koea J, Capurso G, Bellotti R, Stättner S, Alsaoudi T, Bhardwaj N, Jeffery F, Connor S, Cameron A, Jamieson N, Roberts K, Soreide K, Gill AJ, Pandanaboyana S. Invasive intraductal oncocytic papillary neoplasms (IOPN) and adenocarcimoma arising from intraductal papillary mucinous neoplasms (A-IPMN) of the pancreas: comparative analysis of clinicopathological features, patterns of recurrence and survival: a multicentre study. HPB (Oxford) 2024; 26:1421-1428. [PMID: 39084948 DOI: 10.1016/j.hpb.2024.07.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/07/2024] [Accepted: 07/15/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Intraductal oncocytic papillary neoplasms (IOPNs) of the pancreas are now considered a separate entity to intraductal papillary mucinous neoplasms (IPMN). Invasive IOPNs are extremely rare, and their recurrence patterns, response to adjuvant chemotherapy and long-term survival outcomes are unknown. METHODS Consecutive patients undergoing pancreatic resection (2010-2020) for invasive IOPNs or adenocarcinoma arising from IPMN (A-IPMN) from 18 academic pancreatic centers worldwide were included. Outcomes of invasive IOPNs were compared with A-IPMN invasive subtypes (ductal and colloid A-IPMN). RESULTS 415 patients were included: 20 invasive IOPN, 331 ductal A-IPMN and 64 colloid A-IPMN. After a median follow-up of 6-years, 45% and 60% of invasive IOPNs had developed recurrence and died, respectively. There was no significant difference in recurrence or overall survival between invasive IOPN and ductal A-IPMN. Overall survival of invasive IOPNs was inferior to colloid A-IPMNs (median time of survival 24.4 months vs. 86.7, months, p = 0.013), but the difference in recurrence only showed borderline significance (median time to recurrence, 22.5 months vs. 78.5 months, p = 0.132). Adjuvant chemotherapy, after accounting for high-risk features, did not reduce rates of recurrence in invasive IOPN (p = 0.443), ductal carcinoma (p = 0.192) or colloid carcinoma (p = 0.574). CONCLUSIONS Invasive IOPNs should be considered an aggressive cancer with a recurrence rate and prognosis consistent with ductal type A-IPMN.
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MESH Headings
- Humans
- Female
- Male
- Aged
- Neoplasm Recurrence, Local
- Middle Aged
- Pancreatic Intraductal Neoplasms/pathology
- Pancreatic Intraductal Neoplasms/mortality
- Pancreatic Intraductal Neoplasms/surgery
- Carcinoma, Pancreatic Ductal/mortality
- Carcinoma, Pancreatic Ductal/surgery
- Carcinoma, Pancreatic Ductal/pathology
- Carcinoma, Pancreatic Ductal/therapy
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/mortality
- Pancreatic Neoplasms/surgery
- Pancreatectomy
- Retrospective Studies
- Neoplasm Invasiveness
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/surgery
- Adenocarcinoma, Mucinous/therapy
- Chemotherapy, Adjuvant
- Carcinoma, Papillary/mortality
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/surgery
- Carcinoma, Papillary/therapy
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Affiliation(s)
| | - Beate Haugk
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Nejo Joseph
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Jake Hawkyard
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Steve White
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Omar Mownah
- Department of Hepatobiliary & Pancreatic Surgery, King's College Hospital, Denmark Hill, London, UK
| | - Krishna Menon
- Department of Hepatobiliary & Pancreatic Surgery, King's College Hospital, Denmark Hill, London, UK
| | - Takaki Furukawa
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Hepato-Biliary-Pancreatic Medicine Department, Tokyo, Japan
| | - Yosuke Inoue
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Hepato-Biliary-Pancreatic Medicine Department, Tokyo, Japan
| | - Yuki Hirose
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Hepato-Biliary-Pancreatic Medicine Department, Tokyo, Japan
| | - Naoki Sasahira
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Hepato-Biliary-Pancreatic Medicine Department, Tokyo, Japan
| | | | - Jas Samra
- Royal North Shore Hospital, Sydney, NSW, Australia
| | - Amy Sheen
- New South Wales Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Michael Feretis
- Cambridge Hepatobiliary and Pancreatic Surgery Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Anita Balakrishnan
- Cambridge Hepatobiliary and Pancreatic Surgery Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Carlo Ceresa
- Hepatobiliary and Pancreatic Surgery Unit, The Royal Free Hospital, London, UK
| | - Brian Davidson
- Hepatobiliary and Pancreatic Surgery Unit, The Royal Free Hospital, London, UK
| | - Rupaly Pande
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, UK
| | - Bobby V M Dasari
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, UK
| | - Lulu Tanno
- Hepatobiliary and Pancreatic Surgery Unit, University Hospital Southampton, Southampton, UK
| | - Dimitrios Karavias
- Hepatobiliary and Pancreatic Surgery Unit, University Hospital Southampton, Southampton, UK
| | - Jack Helliwell
- Hepatobiliary and Pancreatic Surgery Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alistair Young
- Hepatobiliary and Pancreatic Surgery Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Quentin Nunes
- Department of Hepatopancreatobiliary Surgery, East Lancashire Teaching Hospitals NHS Trust, UK
| | - Tomas Urbonas
- Oxford Hepato-Pancreato-Biliary (HPB) Surgical Unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Michael Silva
- Oxford Hepato-Pancreato-Biliary (HPB) Surgical Unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Alex Gordon-Weeks
- Oxford Hepato-Pancreato-Biliary (HPB) Surgical Unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Jenifer Barrie
- Nottingham Hepato-Pancreatico-Biliary (HPB) Service, Nottingham University Hospitals NHS Foundation Trust, UK
| | - Dhanny Gomez
- Nottingham Hepato-Pancreatico-Biliary (HPB) Service, Nottingham University Hospitals NHS Foundation Trust, UK
| | - Stijn van Laarhoven
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals Bristol & Weston NHS Foundation Trust, UK
| | - Hossam Nawara
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals Bristol & Weston NHS Foundation Trust, UK
| | - Joseph Doyle
- Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Ricky Bhogal
- Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Ewen Harrison
- Department of Clinical Surgery, University of Edinburgh, UK
| | - Marcus Roalso
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Norway
| | - Claudia Zaharia
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Norway
| | - Debora Ciprani
- Hepatopancreatobiliary Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Somaiah Aroori
- Hepatopancreatobiliary Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Bathiya Ratnayake
- Hepato-pancreatico-biliary/Upper Gastrointestinal Unit, North Shore Hospital, Auckland, New Zealand
| | - Jonathan Koea
- Hepato-pancreatico-biliary/Upper Gastrointestinal Unit, North Shore Hospital, Auckland, New Zealand
| | - Gabriele Capurso
- Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Ruben Bellotti
- Department of Visceral, Transplant and Thoracic Surgery, Centre of Operative Medicine, Medical University of Innsbrusk, 6020 Innsbruck, Austria
| | - Stefan Stättner
- Department of Visceral, Transplant and Thoracic Surgery, Centre of Operative Medicine, Medical University of Innsbrusk, 6020 Innsbruck, Austria
| | - Tareq Alsaoudi
- Leicester Hepatopancreatobiliary Unit, University Hospitals of Leicester NHS Trust, UK
| | - Neil Bhardwaj
- Leicester Hepatopancreatobiliary Unit, University Hospitals of Leicester NHS Trust, UK
| | - Fraser Jeffery
- Department of General and Vascular Surgery, Christchurch Hospital, Canterbury District Health Board, New Zealand
| | - Saxon Connor
- Department of General and Vascular Surgery, Christchurch Hospital, Canterbury District Health Board, New Zealand
| | - Andrew Cameron
- Wolfson Wohl Cancer Research Centre, Research Institute of Cancer Sciences, University of Glasgow, UK
| | - Nigel Jamieson
- Wolfson Wohl Cancer Research Centre, Research Institute of Cancer Sciences, University of Glasgow, UK
| | - Keith Roberts
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, UK
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Norway
| | - Anthony J Gill
- Royal North Shore Hospital, Sydney, NSW, Australia; New South Wales Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Sanjay Pandanaboyana
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK.
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Baba H, Yamada Y, Tada K, Kuboyama Y, Fukuzawa K, Iwaki K, Motomura M, Takaji R, Shimada R, Takaki H, Asayama Y. Pancreatic mixed acinar-neuroendocrine carcinoma with intraductal growth: A case report with radiologic-pathologic correlations. Radiol Case Rep 2023; 18:4422-4430. [PMID: 37929047 PMCID: PMC10624768 DOI: 10.1016/j.radcr.2023.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 11/07/2023] Open
Abstract
Pancreatic mixed acinar-neuroendocrine carcinomas are rare malignant tumors of the pancreas. They are composed histologically of both acinar and neuroendocrine cells. The pancreatic duct is known to be an important site of tumor growth for acinar cell carcinomas, neuroendocrine tumors, and intraductal tubulopapillary neoplasms. To the best of our knowledge, there has been only 1 report of a mixed acinar-neuroendocrine carcinoma growing into the pancreatic duct and no reports detailing imaging findings with this tumor. We here report a 69-year-old man who presented with worsening glycemic control. Multiphase contrast-enhanced computed tomography and magnetic resonance imaging revealed a well-circumscribed mass with poor contrast enhancement in the pancreatic tail region of the pancreatic duct. The intraductal mass showed diffusion restriction on magnetic resonance imaging. These imaging findings are consistent with the expansive, smooth-surfaced polypoid tumor of low vascularity and high cellularity that was diagnosed pathologically. Mixed acinar-neuroendocrine carcinomas should be included in the differential diagnosis of intraductal tumors of the pancreas with poor contrast enhancement and diffusion restriction.
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Affiliation(s)
- Hiroshi Baba
- Department of Radiology, Oita Red Cross Hospital, Chiyo-machi, Oita, Japan
| | - Yasunari Yamada
- Department of Radiology, Oita Red Cross Hospital, Chiyo-machi, Oita, Japan
| | - Kazuhiro Tada
- Department of Surgery, Oita Red Cross Hospital, Chiyo-machi, Oita , Japan
| | - Yusuke Kuboyama
- Department of Pathology, Oita Red Cross Hospital, Chiyo-machi, Oita, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Chiyo-machi, Oita , Japan
| | - Kentaro Iwaki
- Department of Surgery, Oita Red Cross Hospital, Chiyo-machi, Oita , Japan
| | - Mitsuteru Motomura
- Hepato-Biliary-Pancreatic Internal Medicine, Oita Red Cross Hospital, Chiyo-machi, Oita, 870-0033, Japan
| | - Ryo Takaji
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Ryuichi Shimada
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Hajime Takaki
- Department of Radiology, Oita Red Cross Hospital, Chiyo-machi, Oita, Japan
| | - Yoshiki Asayama
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
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