Invasive adenocarcinoma associated with intraductal tubulopapillary neoplasm in young adult mimicking alcoholic pancreatitis and pseudocysts.

Intraductal tubulopapillary neoplasm (ITPN) of the pancreas is a rare tumor that is often difficult to diagnose preoperatively because of nonspecific symptoms and atypical imaging findings. Accurate identification is important, as ITPN carries a significant risk of associated invasive carcinoma. We report a case of ITPN with carcinoma in a 30-year-old man who presented with recurrent alcoholic pancreatitis, pancreatic pseudocysts, and a pancreatic duct stricture. Distal pancreatectomy revealed ITPN with invasive carcinoma. He received adjuvant FOLFIRINOX, but developed locally recurrent adenocarcinoma 17 months later, requiring completion total pancreatectomy. Postoperative therapy included chemoradiation with gemcitabine, nab-paclitaxel, and capecitabine, and on maintenance gemcitabine two years after the second surgery. This case illustrates the diagnostic and therapeutic challenges of ITPN in young adults and underscores the need to distinguish it from more common pancreatic diseases. Notably, carcinoma arising from ITPN may have a more favorable prognosis than conventional pancreatic ductal adenocarcinoma.