What is an Intraductal Tubulopapillary Neoplasm?
Intraductal Tubulopapillary Neoplasm, often called ITPN, is a rare type of tumour that develops inside the ducts of the pancreas. The pancreas is an organ located behind the stomach that helps in digestion and blood sugar control. Inside the pancreas are small tubes called ducts, which carry digestive juices into the intestine. ITPN grows within these ducts.
This tumour is considered a precancerous or early cancerous condition. It is different from the more common pancreatic cancer (pancreatic ductal adenocarcinoma). Unlike many pancreatic cancers, ITPN tends to grow inside the duct rather than deeply invading surrounding tissues in early stages.
It is also different from another pancreatic condition called IPMN (Intraductal Papillary Mucinous Neoplasm). ITPN does not usually produce large amounts of mucus, which helps doctors distinguish between the two.
Incidence
ITPN is very rare. It usually affects adults, most commonly in middle-aged or older individuals. Both men and women can develop it. Because it is uncommon and its symptoms are often vague, it may be discovered incidentally during imaging tests done for other reasons.
Symptoms
Symptoms depend on the size and location of the tumour. Some people may have no symptoms at first. As the tumour grows and blocks the pancreatic duct, it can cause abdominal pain, especially in the upper abdomen, which may spread to the back.
Some patients develop nausea, vomiting, or unexplained weight loss. If the tumour blocks the bile duct, jaundice may occur, which causes yellowing of the skin and eyes. In certain cases, inflammation of the pancreas, known as pancreatitis, can develop due to duct blockage.
Because symptoms are often mild in early stages, diagnosis may sometimes be delayed.
Diagnosis
Diagnosis usually begins with imaging studies such as CT scan or MRI. These scans may show dilation of the pancreatic duct or a mass inside it. Endoscopic ultrasound may also be used for closer examination.
A biopsy or surgical removal of the tumour allows microscopic examination. Under the microscope, ITPN shows a characteristic tubular and papillary growth pattern. Unlike IPMN, it usually does not produce visible mucin (thick mucus).
Additional testing is performed to determine whether invasive cancer is present.
Treatment
The main treatment for ITPN is surgical removal of the affected part of the pancreas. The type of surgery depends on where the tumour is located. If the tumour is confined to the ducts and completely removed, surgery can be curative.
If invasive cancer is found, additional treatment such as chemotherapy may be considered.
Prognosis
The prognosis of ITPN is generally better than that of typical pancreatic adenocarcinoma. When diagnosed early and surgically removed, many patients have good long-term survival.
However, if the tumour has already become invasive or spread beyond the pancreas, the outcome becomes more serious. Early detection and complete surgical removal significantly improve survival chances. Regular follow-up is important to monitor for recurrence.
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