# A case of pancreatic ductal adenocarcinoma growing within the pancreatic duct mimicking an intraductal tubulopapillary neoplasm

## TL;DR

A case of pancreatic cancer was initially mistaken for a different type of tumor but was correctly diagnosed using genetic testing.

## Contribution

This case highlights the diagnostic challenges of intraductal pancreatic tumors and the value of genetic testing in accurate diagnosis.

## Key findings

- The tumor initially appeared as an intraductal tubulopapillary neoplasm but was reclassified as pancreatic ductal adenocarcinoma.
- Genomic profiling detected KRAS and TP53 mutations, confirming the PDAC diagnosis.
- The patient remained recurrence-free for 15 months after surgery and chemotherapy.

## Abstract

We herein report a case of pancreatic ductal adenocarcinoma (PDAC) that developed within the pancreatic duct and was initially diagnosed as an intraductal tubulopapillary neoplasm (ITPN). A 76-year-old man presented with weight loss and main pancreatic duct dilation. The imaging studies revealed a 30-mm hypovascular tumor within the main duct of the pancreatic head. An endoscopic examination with a biopsy revealed high-grade atypical epithelial cells with immunostaining patterns suggestive of ITPN. Following robot-assisted pancreaticoduodenectomy, postoperative pathology revealed conflicting features: nodular/cribriform infiltrations typical of ITPN and non-lobular replacement with scattered infiltrations characteristic of PDAC. A comprehensive genomic profiling test detected KRAS and TP53 mutations, leading to the final diagnosis of PDAC (fT3N1aM0, stage IIB). The patient received adjuvant S-1 chemotherapy and remained recurrence-free for 15 months post-surgery. This case highlights the diagnostic challenges of differentiating intraductal pancreatic tumors and demonstrates the utility of integrating genetic testing with conventional diagnostic modalities for an accurate diagnosis and appropriate treatment selection.

The online version contains supplementary material available at 10.1007/s12328-025-02098-y.