Imaging evolution of pancreatic intraductal oncocytic papillary neoplasm presenting with recurrent pancreatitis: A case report and literature review

Intraductal oncocytic papillary neoplasm (IOPN) of the pancreas is a distinct type of pancreatic intraductal epithelial neoplasm with malignant potential. Although the long-term prognosis is generally favorable, accurate preoperative diagnosis remains a challenge. The present study reported the case of a 54-year-old female patient with an initial clinical manifestation of recurrent pancreatitis. Serial contrast-enhanced CT performed over 2 consecutive years documented progressive enlargement of the pancreatic lesion from 2.5 to 3.5 cm along with parallel growth of the intralesional solid mural nodule from 1.1 to 2.1 cm, newly developed main pancreatic duct dilatation and relative hypoenhancement of the nodule compared with normal pancreatic parenchyma despite visible contrast uptake. After the patient underwent radical pancreatic resection, postoperative histopathology confirmed pancreatic IOPN with high-grade dysplasia with no evidence of invasive carcinoma. IOPN lacks pathognomonic clinical features; typical imaging findings include mixed cystic-solid lesions with mural nodules, variable pancreatic duct dilatation, the absence of peripancreatic neoplastic invasion and mural nodules demonstrating moderate enhancement inferior to surrounding pancreatic tissue. The present report systematically summarizes the clinicoradiological and pathological characteristics of pancreatic IOPN and discusses diagnostic strategies for differentiating IOPN from other pancreatic intraductal cystic neoplasms.