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Mazzarella G, Muttillo EM, Coletta D, Picardi B, Rossi S, Rossi Del Monte S, Gomes V, Muttillo IA. Solid pseudopapillary tumor of the pancreas: A systematic review of clinical, surgical and oncological characteristics of 1384 patients underwent pancreatic surgery. Hepatobiliary Pancreat Dis Int 2024; 23:331-338. [PMID: 37236826 DOI: 10.1016/j.hbpd.2023.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Pancreatic solid pseudopapillary tumors (SPTs) are rare clinical entity, with low malignancy and still unclear pathogenesis. They account for less than 2% of exocrine pancreatic neoplasms. This study aimed to perform a systematic review of the main clinical, surgical and oncological characteristics of pancreatic SPTs. DATA SOURCES MEDLINE/PubMed, Web of Science and Scopus databases were systematically searched for the main clinical, surgical and oncological characteristics of pancreatic SPTs up to April 2021, in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) standards. Primary endpoints were to analyze treatments and oncological outcomes. RESULTS A total of 823 studies were recorded, 86 studies underwent full-text reviews and 28 met inclusion criteria. Overall, 1384 patients underwent pancreatic surgery. Mean age was 30 years and 1181 patients (85.3%) were female. The most common clinical presentation was non-specific abdominal pain (52.6% of cases). Mean overall survival was 98.1%. Mean recurrence rate was 2.8%. Mean follow-up was 4.2 years. CONCLUSIONS Pancreatic SPTs are rare, and predominantly affect young women with unclear pathogenesis. Radical resection is the gold standard of treatment achieving good oncological impact and a favorable prognosis in a yearly life-long follow-up.
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Affiliation(s)
- Gennaro Mazzarella
- Division of General and Emergency Surgery, San Filippo Neri Hospital, 00136 Rome, Italy; Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
| | - Edoardo Maria Muttillo
- Division of General and Emergency Surgery, San Filippo Neri Hospital, 00136 Rome, Italy; Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Diego Coletta
- Department of Surgical Sciences, Umberto I University Hospital, Sapienza University of Rome, 00136 Rome, Italy; Department of General Surgery, Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy
| | - Biagio Picardi
- Division of General and Emergency Surgery, San Filippo Neri Hospital, 00136 Rome, Italy
| | - Stefano Rossi
- Division of General and Emergency Surgery, San Filippo Neri Hospital, 00136 Rome, Italy
| | | | - Vito Gomes
- Department of Pathology, San Filippo Neri Hospital, 00136 Rome, Italy
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Coupier A, Khoury T, Gincul R, Fumex F, Lisotti A, Leblanc S, Napoléon B. Endoscopic ultrasound-guided radiofrequency ablation for solid pseudopapillary neoplasm of the pancreas. Endoscopy 2023; 55:E951-E952. [PMID: 37604456 PMCID: PMC10442209 DOI: 10.1055/a-2127-4890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Antoine Coupier
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Tawfik Khoury
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
- Galilee Medical Center, Gastroenterology, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Rodica Gincul
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Fabien Fumex
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy
| | - Sarah Leblanc
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Bertrand Napoléon
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
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Veron Sanchez A, Santamaria Guinea N, Cayon Somacarrera S, Bennouna I, Pezzullo M, Bali MA. Rare Solid Pancreatic Lesions on Cross-Sectional Imaging. Diagnostics (Basel) 2023; 13:2719. [PMID: 37627978 PMCID: PMC10453474 DOI: 10.3390/diagnostics13162719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Several solid lesions can be found within the pancreas mainly arising from the exocrine and endocrine pancreatic tissue. Among all pancreatic malignancies, the most common subtype is pancreatic ductal adenocarcinoma (PDAC), to a point that pancreatic cancer and PDAC are used interchangeably. But, in addition to PDAC, and to the other most common and well-known solid lesions, either related to benign conditions, such as pancreatitis, or not so benign, such as pancreatic neuroendocrine neoplasms (pNENs), there are solid pancreatic lesions considered rare due to their low incidence. These lesions may originate from a cell line with a differentiation other than exocrine/endocrine, such as from the nerve sheath as for pancreatic schwannoma or from mesenchymal cells as for solitary fibrous tumour. These rare solid pancreatic lesions may show a behaviour that ranges in a benign to highly aggressive malignant spectrum. This review includes cases of an intrapancreatic accessory spleen, pancreatic tuberculosis, solid serous cystadenoma, solid pseudopapillary tumour, pancreatic schwannoma, purely intraductal neuroendocrine tumour, pancreatic fibrous solitary tumour, acinar cell carcinoma, undifferentiated carcinoma with osteoclastic-like giant cells, adenosquamous carcinoma, colloid carcinoma of the pancreas, primary leiomyosarcoma of the pancreas, primary and secondary pancreatic lymphoma and metastases within the pancreas. Therefore, it is important to determine the correct diagnosis to ensure optimal patient management. Because of their rarity, their existence is less well known and, when depicted, in most cases incidentally, the correct diagnosis remains challenging. However, there are some typical imaging features present on cross-sectional imaging modalities that, taken into account with the clinical and biological context, contribute substantially to achieve the correct diagnosis.
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Affiliation(s)
- Ana Veron Sanchez
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
| | | | | | - Ilias Bennouna
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
| | - Martina Pezzullo
- Hôpital Universitaire de Bruxelles, Hôpital Erasme, 1070 Brussels, Belgium
| | - Maria Antonietta Bali
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
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Bansal LK, Kapur N, Gupta AK, Nagpal A, Chaudhary P. Solid Pseudopapillary Neoplasm - Case Series and Review of Literature. Indian J Surg Oncol 2022; 13:765-775. [PMID: 36687233 PMCID: PMC9845477 DOI: 10.1007/s13193-022-01560-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/24/2022] [Indexed: 01/25/2023] Open
Abstract
Solid-pseudopapillary neoplasm (SPN) is a variety of solid and cystic tumors of the pancreas. It was first described by Frantz in 1959. It is an unusual form of pancreatic carcinoma, with unknown etiopathogenesis, which accounts for about 0.17 to 2.7% of all pancreatic tumors. Here, we are describing 5 cases of pancreatic solid pseudopapillary neoplasm, out of 180 pancreatic tumors, operated in our institution in the 5-year period (2015-2020). Also, we have reviewed all available case series (from 2006 to 2020) in the literature, of pancreatic pseudopapillary neoplasm, for demographic information, etiopathogenesis, diagnosis, and extent of operation to establish the optimal management of this condition. Retrospective analysis of pancreatic tumors was carried out from February 2015 to January 2020. A total of 180 patients underwent pancreatic resection in this period for pancreatic tumor, out of which, the solid pseudopapillary neoplasm was confirmed in 5 cases (2.76%). Among these 5 cases, 4 cases (80%) were female and one (20%) male, with age group range from 14 to 45 years (mean age - 28 years). Abdominal pain was the most frequent presenting symptom (60%). Mean tumor diameter was 6.9 cm (range, 2-18 cm). Two patients were diagnosed preoperatively by CECT and MRI findings, and three patients were diagnosed preoperatively by percutaneous/USG-guided and CT-guided FNA cytology. Two patients underwent pancreatoduodenectomy; one patient underwent enucleation; and two patients underwent spleen preserving distal pancreatectomy. Four patients are alive and on regular follow-up, while one patient died on the 5th post-operative day due to post-operative sepsis.
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Affiliation(s)
- Lalit Kumar Bansal
- Department of Surgery, ABVIMS and Dr. Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Neeti Kapur
- Department of Surgery, ABVIMS and Dr. Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Arun Kumar Gupta
- Department of Surgery, ABVIMS and Dr. Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Ashutosh Nagpal
- Department of Surgery, ABVIMS and Dr. Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Poras Chaudhary
- Department of Surgery, ABVIMS and Dr. Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
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Bell PD, Singhi AD. Integrating Molecular Analysis into the Pathologic Evaluation of Pancreatic Cysts. Surg Pathol Clin 2022; 15:455-468. [PMID: 36049828 DOI: 10.1016/j.path.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
The development of cross-sectional imaging techniques has enhanced the detection of pancreatic cystic lesions (PCLs). PCLs are found in approximately 2% of the general population, often as incidentally detected lesions on computed tomography or MRI during the evaluation of other medical conditions. Broadly, PCLs are classified as mucinous or nonmucinous. Mucinous PCLs include mucinous cystic neoplasms and intraductal papillary mucinous neoplasms. Nonmucinous PCLs include pseudocysts, serous cystadenomas, solid pseudopapillary neoplasms, and cystic pancreatic neuroendocrine tumors, as well as cystic acinar cell carcinoma, cystic degeneration of pancreatic ductal adenocarcinoma, lymphoepithelial cyst, and others.
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Affiliation(s)
- Phoenix D Bell
- Department of Pathology, University of Pittsburgh Medical Center, 200 Lothrop St. Pittbsurgh, PA 15213, USA.
| | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh Medical Center, 200 Lothrop St. Pittbsurgh, PA 15213, USA
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Wang R, Li J, Tan CL, Liu XB, Chen YH. Prospects and applications of enucleation in solid pseudopapillary neoplasms of the pancreas. World J Gastrointest Oncol 2022; 14:1227-1238. [PMID: 36051095 PMCID: PMC9305568 DOI: 10.4251/wjgo.v14.i7.1227] [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: 03/13/2022] [Revised: 04/30/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare, low-grade, malignant neoplasms that are mostly seen in young women in the second and third decades of life and are quite uncommon in children. Standard resection for benign and borderline neoplasms of the pancreas is associated with a substantial risk of postoperative morbidity and long-term functional impairment, whereas enucleation leads to less morbidity and preserves healthy parenchyma as well as exocrine and endocrine function. Enucleation of SPNs has been increasingly reported to be feasible and safe for preserving the normal physiological function of the pancreas, especially in teenagers and children. This review summarizes findings published in recent years on the enucleation of SPNs as well as potential future developments and directions. Enucleation has undoubtedly come to stay as an alternative surgical procedure for SPNs. However, many questions remain unresolved, and future directions toward the best surgical indication, the prevention and intervention of complications, especially pancreatic fistula, intraoperative resection margin safety assessment, and long-term oncology prognosis remain to be evaluated and should be explored in future clinical trials.
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Affiliation(s)
- Rui Wang
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu 610037, Sichuan Province, China
| | - Jing Li
- Department of Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610037, Sichuan Province, China
| | - Chun-Lu Tan
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu 610037, Sichuan Province, China
| | - Xu-Bao Liu
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu 610037, Sichuan Province, China
| | - Yong-Hua Chen
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu 610037, Sichuan Province, China
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Robotic enucleation of a solid pseudopapillary tumor in a pediatric patient. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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El Abbassi T, Elazhary A, Ouchane M, El Wassi A, Lefriyekh MR. Solid pseudopapillary tumors of the pancreas in young women: Case report. Int J Surg Case Rep 2021; 89:106592. [PMID: 34800803 PMCID: PMC8605423 DOI: 10.1016/j.ijscr.2021.106592] [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: 10/09/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Solid pseudopapillary tumor of the pancreas (SPTP) is a rare tumor of the exocrine pancreas, with undetermined etiopathogeny, which most often affects young women. The clinical and physical signs are non-specific and despite the progress of complementary examinations, Confirmation is usually anatomopathological. Surgical resection is the only curative treatment. CASE PRESENTATION We report the case of a 17-year-old girl, consulted for a left hypochondrium mass which imaging concluded to be a corporal-caudal tumor mass of the pancreas for which a complete surgical excision was performed and whose anatomopathological study confirmed a pseudo-papillary and solid tumor of the pancreas. The positive diagnosis of SPTP remains difficult and is usually made on pathological analysis with immunohistochemical study. DISCUSSION Solid pseudopapillary tumor of the pancreas is a rare anatomic-clinical entity, first described by Frantz in 1959. The clinical manifestations of SPTP are not specific. Biologically, no signs are predictive of SPTP and imaging usually shows a well encapsulated mass with both solid and cystic components. The curative treatment of SPTP is exclusively surgical and consists of a complete removal of the tumor with its capsule because of its degenerative potential SPTP has a good prognosis with a recurrence rate of 10-15% and 95% survival at 5 years. CONCLUSION Solid pseudopapillary tumor of the pancreas is a rare tumor of the exocrine pancreas. Its evolution is slow. Preoperative diagnosis remains difficult despite the progress of complementary examinations. Surgical resection is the only curative treatment. Its prognosis remains excellent.
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Affiliation(s)
- Taoufik El Abbassi
- Department of General Surgery I, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco
| | - Abdessamad Elazhary
- Department of General Surgery I, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco.
| | - Mohamed Ouchane
- Department of General Surgery I, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco
| | - Anas El Wassi
- Department of General Surgery I, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco
| | - M Rachid Lefriyekh
- Department of General Surgery I, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco
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9
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Abstract
Solid tumors of the pancreas encompass a variety of diagnoses with treatments ranging from observation to major abdominal surgery. Pancreatic ductal adenocarcinoma remains one of the most common and most lethal of these differential of diagnoses and requires a multimodality approach through a multidisciplinary team of specialists. This article reviews the classification, clinical presentation, and workup in differentiating solid tumors of the pancreas and serves as an additional tool for general surgeons faced with such a clinical finding, from a surgical oncology perspective.
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Affiliation(s)
- George Younan
- Department of Surgery, Inova Fair Oaks Hospital, Fairfax, VA, USA; Division of Hepato-Pancreato-Biliary Surgery, Virginia Surgery Associates, 13135 Lee Jackson Memorial Highway, Suite #305, Fairfax, VA 22033, USA.
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10
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Cohen SJ, Papoulas M, Graubardt N, Ovdat E, Loewenstein S, Kania-Almog J, Pasmanik-Chor M, Brazowski E, Cagnano E, Nachmany I, Lahat G, Klausner JM, Lubezky N. Micro-RNA Expression Patterns Predict Metastatic Spread in Solid Pseudopapillary Neoplasms of the Pancreas. Front Oncol 2020; 10:328. [PMID: 32232006 PMCID: PMC7082878 DOI: 10.3389/fonc.2020.00328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/25/2020] [Indexed: 12/17/2022] Open
Abstract
Solid pseudopapillary neoplasm (SPN) of pancreas is a rare pancreatic neoplasm with a low metastatic potential. Up to 10% of patients with localized disease at presentation will develop systemic metastases, usually in the peritoneum or the liver. Due to the rarity of SPNs and the overall excellent prognosis, reliable prognostic factors to predict malignant biological behavior remain undetermined. Therefore, we aimed to define clinical, histological, and microRNA patterns that are associated with metastatic disease. We conducted a retrospective single center study on all patients operated for SPN of pancreas between 1995 and 2018. Clinical and pathological data were collected, and expression patterns of 2,578 human microRNAs were analyzed using microRNA array (Affimetrix 4.1) in normal pancreases (NPs), localized tumors (LTs), and metastatic tumors (MTs). The diagnosis of SPN was confirmed in 35 patients who included 28 females and 3 males, with a mean age of 33.8 ± 13.9 years. The only clinical factor associated with metastases was tumor size (mean tumor size 5.20 ± 3.78 in LT vs. 8.13± 1.03 in MT, p < 0.012). Microscopic features of malignancy were not associated with metastases, nor were immunohistochemical stains, including the proliferative index KI67. Higher expressions of miR-184, miR-10a, and miR-887, and lower expressions of miR-375, miR-217, and miR-200c were observed in metastatic tissues on microarray, and validated by real-time polymerase chain reaction. Hierarchal clustering demonstrated that the microRNA expression pattern of MTs was significantly different from that of LTs. The only clinical factor associated with metastases of SPN of pancreas was tumor size. Histological features and immunohistological staining were not predictive of metastases. A panel of six microRNAs was differentially expressed in MTs, and these findings could potentially be used to predict tumor behavior. Validation of these results is needed in larger series.
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Affiliation(s)
- Shmuel Jaffe Cohen
- Surgical Division Research Laboratory, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michail Papoulas
- Department of Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nadine Graubardt
- Surgical Division Research Laboratory, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Esther Ovdat
- Department of Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shelly Loewenstein
- Surgical Division Research Laboratory, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Juliane Kania-Almog
- Surgical Division Research Laboratory, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Eli Brazowski
- Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Institute of Pathology, Tel-Aviv University, Tel-Aviv, Israel
| | - Emanuela Cagnano
- Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Institute of Pathology, Tel-Aviv University, Tel-Aviv, Israel
| | - Ido Nachmany
- Department of Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Guy Lahat
- Department of Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Joseph M Klausner
- Department of Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Lubezky
- Surgical Division Research Laboratory, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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11
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Erráez-Jaramillo PJ, Ortiz-Hidalgo C. [The histological and immunohistochemical diagnosis of solid pseudopapillary neoplasm of the pancreas and its differential diagnosis]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2019; 52:178-189. [PMID: 31213259 DOI: 10.1016/j.patol.2019.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 02/23/2019] [Accepted: 03/03/2019] [Indexed: 01/12/2023]
Abstract
Solid pseudopapillary neoplasm of the pancreas is a rare tumor of uncertain histogenesis, described separately by Gruber and Frantz, that accounts for between approximately 1% and 3% of pancreatic neoplasms. It is characterized by a cystic and solid pattern of growth patterns with formation of pseudopapillae. It occurs primarily in young women, although cases in children and older patients and men have been reported. The tumor is of low-grade malignant potential, as the majority of the cases are cured by simple but complete surgical resection. Knowledge of the unique morphologic characteristics of this neoplasm is essential for the correct diagnosis. We review herein the pathologic and immunohistochemical features of this neoplasm and its differential diagnosis with other pancreatic tumors.
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Affiliation(s)
| | - Carlos Ortiz-Hidalgo
- Departamento de Anatomía Patológica, Hospital y Fundación Médica Sur, Ciudad de México, México; Departamento de Biología Celular y Tisular, Escuela de Medicina, Universidad Panamericana, Ciudad de México, México.
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12
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Clinical and Pathological Features of Solid Pseudopapillary Neoplasms of the Pancreas: A Nationwide Multicenter Study in Japan. Pancreas 2018; 47:1019-1026. [PMID: 30059473 DOI: 10.1097/mpa.0000000000001114] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinicopathological features of solid pseudopapillary neoplasms (SPNs). METHODS In this retrospective study, 288 SPNs were analyzed. RESULTS Overall, 214 patients (74%) were female. Distant metastases occurred in 4 patients, and splenic vein tumor thrombus occurred in 1 patient. Although imaging findings showed large (>2.0 cm) SPNs with clear, regular border, and heterogeneous internal structure, small SPNs appeared as almost entirely solid. Surgical resection was performed in 278 cases. The 5-year survival rate was 98.8%. Six patients had tumor recurrence after the initial resection. The detection rate in typical pathological findings was low for small SPNs. Tumor extension to the pancreatic parenchyma was detected in greater than 70% of the cases. Tumor invasion to adjacent organs was detected in 13 cases. One was given a diagnosis of apparent high-grade malignant transformation. CONCLUSIONS The proportion of male cases was higher than that in previous studies, and there were statistically significant differences in the onset age and tumor diameter between male and female patients. Therefore, women seemed to have an early occurrence of SPNs, suggesting a difference in the developmental stage between men and women. Images and pathological findings of SPNs varied according to tumor size. Our findings indicated that SPN patients have excellent survival after margin-negative surgical resection.
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Wang P, Wei J, Wu J, Xu W, Chen Q, Gao W, Jiang K, Miao Y. Diagnosis and treatment of solid-pseudopapillary tumors of the pancreas: A single institution experience with 97 cases. Pancreatology 2018; 18:415-419. [PMID: 29548800 DOI: 10.1016/j.pan.2017.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES We evaluated the diagnoses and surgical management of solid pseudopapillary tumors of the pancreas (SPTP) in a single center setting. METHODS Demographic details, clinical presentations, imaging features, surgical strategies, and pathological findings of 97 consecutive patients who underwent surgery for pathologically confirmed SPTP between 2008 and 2016 were analyzed retrospectively. RESULTS A total of 97 patients with SPTP accounted for 2.15% of total pancreatic surgeries (N = 4508). The mean age at diagnosis was 31.6 ± 13.92 years (range: 7-83 years), and males:females were 85:12. Chief complaints were abdominal pain or discomfort (n = 50). The mean transverse tumor diameter was 53.2 ± 2.76 mm (range: 14-170 mm). Tumors were localized to the pancreatic head (38.1%; 37/97), neck (12.4%; 12/97), body and tail (49.5%; 48/97). There were no significant differences in age of onset, presenting symptoms, and sites between males and females. A significant difference was found in the maximum diameter of SPTP across different age groups. Partial pancreatectomy was performed for patient with tumor ≥ 5 cm, and enucleation was performed when tumor was smaller than 5 cm. Pancreatic fistula was the main complication. Immunohistochemical markers for endocrine, exocrine and epithelial factors were used for a final diagnosis. During a median follow-up of 54 months (range: 7-121 months), 84 patients were alive without evidence of recurrence, and 13 patients were lost to follow-up. CONCLUSION SPTP surgical resection is a safe procedure with low morbidity and mortality, which is also effective even in the presence of invasiveness and metastases. Accurate initial diagnoses and follow up are essential.
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Affiliation(s)
- Peng Wang
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jishu Wei
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Junli Wu
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wenbin Xu
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Qiuyang Chen
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wentao Gao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Kuirong Jiang
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yi Miao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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Antoniou EA, Damaskos C, Garmpis N, Salakos C, Margonis GA, Kontzoglou K, Lahanis S, Spartalis E, Patsouras D, Kykalos S, Garmpi A, Andreatos N, Pawlik TM, Kouraklis G. Solid Pseudopapillary Tumor of the Pancreas: A Single-center Experience and Review of the Literature. ACTA ACUST UNITED AC 2018; 31:501-510. [PMID: 28652415 DOI: 10.21873/invivo.11089] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Solid pseudopapillary tumors (SPTs) of the pancreas are a rare occurrence, not exceeding 1-2% of all exocrine pancreatic tumors. SPT was first described in 1959 as "papillary tumor of the pancreas, benign or malignant" and affects mainly young women, in their second or third decade of age. These tumors are of low malignant potential, unclear pathogenesis, grow gradually and become considerably large before causing symptoms. A typical clinical presentation is often described by affected patients and, in some cases, an SPT is an incidental finding during the time the patient undergoes medical imaging studies for other health issues. SPT is frequently located at the head or tail of the pancreas. Metastases are rare but, when present, affect predominantly the liver. PATIENTS AND METHODS We report a series of five SPT cases in female patients 13-47 years old, presenting with almost identical symptoms of upper abdominal discomfort and non-tender palpable mass. Two out of five patients also reported vomiting, nausea and poor appetite as co-existing non-diagnostic symptoms. Only one patient presented without any symptoms. Tumor location and dimensions varied. One patient underwent a pancreatoduodenectomy (Whipple's procedure), while the remaining patients underwent distal pancreatectomy with concomitant splenectomy. RESULTS Perioperative morbidity and mortality was zero. All five patients are disease-free at a follow-up from 3 months to 13 years. Histopathology reports supported the diagnosis of SPT and no metastatic disease was present in any of the patients. CONCLUSION The overall prognosis of SPT of the pancreas is excellent due to its favorable biological features, even in the presence of distal metastasis. Although surgical resection is often curative, a close follow-up is advised in order to diagnose a possible local recurrence or distal metastasis and choose the proper therapeutic option for the patients.
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Affiliation(s)
- Efstathios A Antoniou
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Damaskos
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Garmpis
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Salakos
- Pediatric Surgery Department, ATTIKON University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Konstantinos Kontzoglou
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefanos Lahanis
- 401 Military Hospital Radiology Department, Athens, Greece.,Iatropolis Medical Center, CT/MRI Department, Athens, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens, Medical School, Athens, Greece
| | - Dimitrios Patsouras
- Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, U.K
| | - Stylianos Kykalos
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Garmpi
- Internal Medicine Department, "Laiko" General Hospital, University of Athens Medical School, Athens, Greece
| | | | - Timothy M Pawlik
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, U.S.A
| | - Gregory Kouraklis
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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15
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Wang X, Chen YH, Tan CL, Zhang H, Xiong JJ, Chen HY, Ke NW, Liu XB. Enucleation of pancreatic solid pseudopapillary neoplasm: Short-term and long-term outcomes from a 7-year large single-center experience. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2018. [PMID: 29525465 DOI: 10.1016/j.ejso.2018.01.085] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Enucleation is increasingly used for pancreatic solid pseudopapillary neoplasm (SPN) to preserve function of the pancreas. The data was limited due to rarity of this low-grade neoplasm. We sought to describe the indications, operative technique, short and long-term outcomes after enucleation with largest series of enucleated SPNs. METHODS Data collected retrospectively from 110 patients with SPN who underwent pancreatectomy between 2009 and 2016 in our institution were reviewed. Thirty-one patients underwent enucleation were identified for analysis, and compared with the 70 patients underwent conventional pancreatic resection. RESULTS Of the 31 patients, 27 (87.1%) were women, and the mean age was 29.8 years (range, 11-49 years). Enucleated SPNs were mostly located in the head/uncinate process of the pancreas (38.7%). Overall morbidity was 25.8%, mainly due to POPF (19.4%), and severe morbidity was only 6.5% with no death. Compared with conventional pancreatic resection, enucleation had a shorter duration of surgery (P < 0.001), less blood loss (P < 0.001), lower rate of exocrine insufficiency (P = 0.033) and comparable morbidity (P = 1), with no increased risk of tumor recurrence (P = 1). The rate of endocrine insufficiency after enucleation seemed lower (Nil vs. 4.5%, P = 0.55). CONCLUSIONS Enucleation of SPN of the pancreas appears to be feasible and safe for preserving exocrine and endocrine function of the gland. Enucleation with negative surgical margin seems adequate with no increased risk of tumor recurrence. Enucleation could be seriously considered as an alternative to conventional resection for this frequently young population.
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Affiliation(s)
- Xing Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yong-Hua Chen
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Chun-Lu Tan
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hao Zhang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jun-Jie Xiong
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hong-Yu Chen
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Neng-Wen Ke
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xu-Bao Liu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
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16
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Cuglievan B, Subbiah V, Wang H, Morani A, Meric-Bernstam F, Holla V, Herzog CE. Response to Mammalian Target of Rapamycin-Based Therapy and Incidental Finding of Lynch Syndrome in a Patient With Solid Pseudopapillary Neoplasm of the Pancreas With AKT1_E17K Mutation. JCO Precis Oncol 2018; 2. [PMID: 31650099 PMCID: PMC6812497 DOI: 10.1200/po.18.00182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Branko Cuglievan
- Division of Pediatrics and Patient Care, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Huamin Wang
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ajaykumar Morani
- Division of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX.,Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vijaykumar Holla
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cynthia E Herzog
- Division of Pediatrics and Patient Care, The University of Texas MD Anderson Cancer Center, Houston, TX
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17
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Carlotto JRM, Torrez FRA, Gonzalez AM, Linhares MM, Triviño T, Herani-Filho B, Goldenberg A, Lopes-Filho GDJ, Lobo EJ. SOLID PSEUDOPAPILLARY NEOPLASM OF THE PANCREAS. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 29:93-6. [PMID: 27438034 PMCID: PMC4944743 DOI: 10.1590/0102-6720201600020007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/18/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The solid pseudopapillary neoplasm is a rare tumor of the pancreas. However, it´s etiology still maintain discussions. AIM To analyze it´s clinical data, diagnosis and treatment. METHODS A retrospective study of medical records of all patients treated from January 1997 until July 2015. RESULTS Were identified 17 cases. Most patients were women (94.11%) and the average age was 32.88 years. The main complaint was abdominal mass (47.05%). The most frequent location was in the body/tail of the pancreas (72.22%) and the most frequently performed surgery was distal pancreatectomy with splenectomy (64.70%). No patient had metastases at diagnosis. Conservative surgery for pancreatic parenchyma was performed in only three cases. The rate of complications in the postoperative period was 35.29% and the main complication was pancreatic fistula (29.41%). No patient underwent adjuvant treatment. CONCLUSIONS The treatment is surgical and the most common clinical presentation is abdominal mass. Distal pancreatectomy with splenectomy was the most frequently performed surgery for its treatment.
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Affiliation(s)
- Jorge Roberto Marcante Carlotto
- Surgical Gastroenterology Division, Department of Surgery, School of Medicine, Federal University of São Paulo (EPM/UNIFESP)
| | - Franz Robert Apodaca Torrez
- Surgical Gastroenterology Division, Department of Surgery, School of Medicine, Federal University of São Paulo (EPM/UNIFESP).,Study Group of Pancreatic Diseases, São Paulo, SP, Brazil
| | - Adriano Miziara Gonzalez
- Surgical Gastroenterology Division, Department of Surgery, School of Medicine, Federal University of São Paulo (EPM/UNIFESP)
| | - Marcelo Moura Linhares
- Surgical Gastroenterology Division, Department of Surgery, School of Medicine, Federal University of São Paulo (EPM/UNIFESP)
| | - Tarcisio Triviño
- Surgical Gastroenterology Division, Department of Surgery, School of Medicine, Federal University of São Paulo (EPM/UNIFESP).,Study Group of Pancreatic Diseases, São Paulo, SP, Brazil
| | - Benedito Herani-Filho
- Surgical Gastroenterology Division, Department of Surgery, School of Medicine, Federal University of São Paulo (EPM/UNIFESP).,Study Group of Pancreatic Diseases, São Paulo, SP, Brazil
| | - Alberto Goldenberg
- Surgical Gastroenterology Division, Department of Surgery, School of Medicine, Federal University of São Paulo (EPM/UNIFESP).,Study Group of Pancreatic Diseases, São Paulo, SP, Brazil
| | - Gaspar de Jesus Lopes-Filho
- Surgical Gastroenterology Division, Department of Surgery, School of Medicine, Federal University of São Paulo (EPM/UNIFESP)
| | - Edson José Lobo
- Surgical Gastroenterology Division, Department of Surgery, School of Medicine, Federal University of São Paulo (EPM/UNIFESP).,Study Group of Pancreatic Diseases, São Paulo, SP, Brazil
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18
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Yao L, Xie ZB, Jin C, Jiang YJ, Li J, Yang F, Lin QJ, Fu DL. Radical resection and enucleation in Chinese adolescents with pancreatic tumors: A 15-year case series. Medicine (Baltimore) 2017; 96:e6438. [PMID: 28328854 PMCID: PMC5371491 DOI: 10.1097/md.0000000000006438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Pancreatic tumors rarely occur in adolescents, and the appropriateness of radical resection for these patients remains controversial.Medical records were retrospectively reviewed for patients younger than 19 years who underwent radical resection or limited resection (enucleation) between 2000 and 2015. Patient demographics, clinical characteristics, operative details, growth, and survival were analyzed.During the study period, 11 adolescents (mean age, 16.18 years; standard deviation, 1.99; interquartile range, 15.0-18.0) underwent radical resection (n = 7) or enucleation (n = 4) to treat solid pseudopapillary tumors (n = 5), pancreatic neuroendocrine tumors (n = 5), or pancreatic ductal adenocarcinoma (n = 1). None of the 7 patients who underwent radical resection experienced recurrence or serious complications, while 3 of 4 patients who underwent enucleation experienced recurrence (P = 0.02). Recurrence-free survival was slightly longer in patients who underwent radical resection, and this procedure did not appear to affect adolescent growth and development.Radical resection might be safe and effective for adolescents with pancreatic tumors.
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19
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Gremida A, Altaee A, Darji K, Rustagi T, McCarthy D. Acute Pancreatitis: Nothing to SPiT At. Dig Dis Sci 2017; 62:583-587. [PMID: 28108891 DOI: 10.1007/s10620-017-4457-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/11/2017] [Indexed: 12/09/2022]
Affiliation(s)
- Anas Gremida
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
| | - Ahmad Altaee
- Department of Internal Medicine, Saint Louis University, Saint Louis, MO, USA
| | - Kavita Darji
- Department of Internal Medicine, Saint Louis University, Saint Louis, MO, USA
| | - Tarun Rustagi
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Denis McCarthy
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
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20
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Solid pseudopapillary neoplasm-Case report of a rare pancreatic tumor. Int J Surg Case Rep 2017; 33:148-150. [PMID: 28327418 PMCID: PMC5358903 DOI: 10.1016/j.ijscr.2017.02.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 02/26/2017] [Accepted: 02/27/2017] [Indexed: 01/08/2023] Open
Abstract
Solid pseudopapillary neoplasm is a rare pancreatic tumor. Most patients are female and within the second or third decade of life. The radiologic features are crucial for an accurate diagnosis. Tumor size has not been shown to be a predictor of resectability. Surgical resection is the treatment of choice with an excellent long-term prognosis.
Introduction Solid pseudopapillary neoplasm (SPN) is a rare pancreatic tumor. Most patients are female within the second or third decade of life with only a small minority concerning children. Frequently described as low malignant potential tumors, surgical resection remains the main treatment. Presentation of case The authors present a case of a SPN diagnosed in a 17-year-old Caucasian girl with vomiting and abdominal pain localized to the right upper quadrant. CT scans and MRI scans showed the presence of a well-defined tumor arising from the pancreatic head with 14 cm of greater diameter. Pylorus-preserving pancreatoduodenectomy was performed and histopathology confirmed a SPN with complete resection and no evidence of malignancy. Discussion SPN are usually found incidentally hence the importance of an accurate radiologic diagnosis. Symptoms may be present such as abdominal pain or vomiting due to compression, namely in large tumors. A surgical approach is usually indicated aiming complete resection, with tumor size not predicting resectability. Conclusion Solid pseudopapillary tumors of the pancreas are extremely rare and usually have an excellent long-term prognosis after surgical resection.
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21
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Lubezky N, Papoulas M, Lessing Y, Gitstein G, Brazowski E, Nachmany I, Lahat G, Goykhman Y, Ben-Yehuda A, Nakache R, Klausner JM. Solid pseudopapillary neoplasm of the pancreas: Management and long-term outcome. Eur J Surg Oncol 2017; 43:1056-1060. [PMID: 28238521 DOI: 10.1016/j.ejso.2017.02.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 01/29/2017] [Accepted: 02/01/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Solid pseudopapillary neoplasm (SPN) of pancreas is a rare pancreatic neoplasm with a low metastatic potential. Our aim was to study the clinical-pathological characteristics, and long-term outcome of this tumor. MATERIALS Rretrospective single center study of patients operated for SPN of pancreas. Clinical and pathological data were collected. RESULTS From 1995 to 2016, 1320 patients underwent pancreatic resection. SPN was confirmed in 32 cases (2.46%), including 29 (90.6%) female and three (9.4%) male, with a mean age of 28.4 ± 12.2 years. SPN was the most common pathology among female patients under age of 40 (72.4%). Abdominal pain was the most frequent presenting symptom (48%), whereas none of the patients presented with jaundice. Mean tumor diameter was 5.9 cm (range, 0.9-14 cm). All patients underwent margin-negative surgical resection. Two patients demonstrated gross malignant features, including liver metastases at presentation (n = 1), and adjacent organ and vascular invasion (n = 1). Microscopic malignant features were present in thirteen patients (40.6%). Recurrence occurred in the retroperitoneal lymph nodes (n = 1, 7 years post resection) and in the liver (n = 2, 1 and 5 years post resection). Mean follow-up was 49.2 months (range, 1-228 months). Five and 10-year disease-free survival was 96.5% and 89.6% respectively. CONCLUSIONS SPNs are low-grade tumors with a good prognosis. Margin-negative surgical resection is curative in most patients. However, almost 15% of patients demonstrate malignant features including invasion of adjacent organs or metastatic disease. Patients with malignant disease are still expected to have long survival, and aggressive surgical approach is advocated.
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Affiliation(s)
- N Lubezky
- The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel.
| | - M Papoulas
- The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel
| | - Y Lessing
- The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel
| | - G Gitstein
- Institute of Pathology, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel
| | - E Brazowski
- Institute of Pathology, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel
| | - I Nachmany
- The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel
| | - G Lahat
- The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel
| | - Y Goykhman
- The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel
| | - A Ben-Yehuda
- The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel
| | - R Nakache
- The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel
| | - J M Klausner
- The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel
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22
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Ersen A, Agalar AA, Ozer E, Agalar C, Unek T, Egeli T, Ozbilgin M, Astarcioglu I, Olguner M, Obuz F, Sagol O. Solid-Pseudopapillary neoplasm of the pancreas: A clinicopathological review of 20 cases including rare examples. Pathol Res Pract 2016; 212:1052-1058. [DOI: 10.1016/j.prp.2016.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/17/2016] [Accepted: 09/12/2016] [Indexed: 02/07/2023]
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23
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Marchegiani G, Andrianello S, Massignani M, Malleo G, Maggino L, Paiella S, Ferrone CR, Luchini C, Scarpa A, Capelli P, Mino-Kenudson M, Lillemoe KD, Bassi C, Castillo CFD, Salvia R. Solid pseudopapillary tumors of the pancreas: Specific pathological features predict the likelihood of postoperative recurrence. J Surg Oncol 2016; 114:597-601. [PMID: 27471041 DOI: 10.1002/jso.24380] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/01/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Since their introduction in the WHO classification, the incidence of solid pseudopapillary tumors (SPTs) of the pancreas has progressively increased, mainly because of the widespread use of cross-sectional imaging. Few recent studies have analyzed the biological behavior of SPTs, but reliable data on long-term follow-up are needed. METHODS Retrospective analysis of two Institutions with high caseload, The Department of General Surgery-Pancreas Institute, University of Verona Hospital Trust and the Department of General Surgery, Massachusetts General Hospital, Harvard Medical School, was carried out. Data from 131 consecutive resections for SPT performed during the last three decades were collected and analyzed. RESULTS The majority of patients were female (86.3%) with a median age of 33 (7-68) years. The prevalent location was the pancreatic tail (33.5%). Applying the WHO criteria, 16 (12.2%) SPTs were considered malignant due to the presence of at least pancreatic parenchyma (9.9%), perineural (4.6%), and/or angiovascular invasion (2.3%). After a median of 62 months after surgery, only two patients had a recurrence (1.5%). Both of them fulfilled the WHO criteria for malignant SPT (vs. 10.7% of those who did not recur, P = 0.01), had an infiltrative growth pattern (vs. 10.8%, P = 0.01), pancreatic parenchyma invasion (vs. 9.7%, P = 0.01) and capsular invasion (vs. 4.9%, P = 0.004). CONCLUSION Overall, SPTs are associated with excellent survival results after surgical resection. Disease recurrence is extremely rare, and might occur if the primary tumor presents with either pancreatic parenchyma or capsule invasion. J. Surg. Oncol. 2016;114:597-601. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Giovanni Marchegiani
- Department of General and Pancreatic Surgery, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy
| | - Stefano Andrianello
- Department of General and Pancreatic Surgery, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy
| | - Marta Massignani
- Department of General and Pancreatic Surgery, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy
| | - Giuseppe Malleo
- Department of General and Pancreatic Surgery, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy
| | - Laura Maggino
- Department of General and Pancreatic Surgery, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy
| | - Salvatore Paiella
- Department of General and Pancreatic Surgery, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy
| | - Cristina R Ferrone
- Department of General Surgery, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - Claudio Luchini
- Department of Diagnostic and Public Health, ARC-Net Research Centre-University of Verona Hospital Trust, Verona, Italy
| | - Aldo Scarpa
- Department of Diagnostic and Public Health, ARC-Net Research Centre-University of Verona Hospital Trust, Verona, Italy
| | - Paola Capelli
- Department of Diagnostic and Public Health, ARC-Net Research Centre-University of Verona Hospital Trust, Verona, Italy
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - Keith D Lillemoe
- Department of General Surgery, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy
| | | | - Roberto Salvia
- Department of General and Pancreatic Surgery, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy.
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24
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De Marchi G, Paiella S, Luchini C, Amodio A, Rusev B, Bassi C, Manfredi R, Frulloni L. A rare case of three different tumors in the same pancreatic specimen: a case report and brief review of the literature. J Gastrointest Oncol 2016; 7:E52-7. [PMID: 27284489 DOI: 10.21037/jgo.2016.01.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Solid pseudopapillary tumors (SPT) of the pancreas are rare neoplasms mainly affecting young women. Pancreatic serous cystadenomas (SCAs) and pancreatic neuroendocrine tumors (PanNETs) account for about 2% of all pancreatic neoplasms. The combination of these three lesions, to our knowledge, has never been described in literature. Here we report a case of combined SPT, SCA and PanNET affecting a 33-year-old woman.
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Affiliation(s)
- Giulia De Marchi
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Salvatore Paiella
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Claudio Luchini
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Antonio Amodio
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Borislav Rusev
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Claudio Bassi
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Riccardo Manfredi
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Frulloni
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
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Mirminachi B, Farrokhzad S, Sharifi AH, Nikfam S, Nikmanesh A, Malekzadeh R, Pourshams A. Solid Pseudopapillary Neoplasm of Pancreas; A Case Series and Review Literature. Middle East J Dig Dis 2016; 8:102-8. [PMID: 27252816 PMCID: PMC4885608 DOI: 10.15171/mejdd.2016.14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND
Information regarding solid pseudopapillary neoplasm (SPN) of the pancreas
is limited in Iran. We aimed to review the clinicocytopathological features and
follow-up of patients with SPN of pancreas who were diagnosed in a single
center in Iran.
METHODS
Seven patients with SPN of the pancreas were diagnosed during January
2010 to March 2015 at the Digestive Disease Research Institute of Tehran University
of Medical Sciences. The patients were reviewed prospectively.
RESULTS
Six out of the 7 patients were female and the mean age of all the patients
was 29.4 years ranging from 15 to 61 years. The most common clinical presentation
was nonspecific abdominal pain (N=6). The tumors were located
mostly in head and neck of the pancreas. SPN was diagnosed in all patients
by fine needle aspiration through endosonography (EUS-FNA). All patients
underwent surgery. Histological findings of surgical tissues were consistent
with EUS-FNA. The postoperative follow-up period of about 14 months was
uneventful.
CONCLUSION
SPN of the pancreas is a rare pancreatic tumor which affects primarily
young women. EUS-guided FNA could play an important role in preoperative
diagnosis of SPN of the pancreas.
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Affiliation(s)
- Babak Mirminachi
- Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Solmaz Farrokhzad
- Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran ; Qazvin Health Center, Qazvin University of Medical Science, Qazvin, Iran
| | - Amir Houshang Sharifi
- Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Nikfam
- Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Pourshams
- Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Hongjian X, Dujuan L, Shuang X, Yuewu Z, Lingfei K. Solid Pseudopapillary Tumor of the Pancreas in a 50-Year-Old Man: A Case Report and Review of the Literature. Case Rep Pancreat Cancer 2016; 2:23-27. [PMID: 30631811 PMCID: PMC6319678 DOI: 10.1089/crpc.2016.0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: A solid pseudopapillary tumor (SPT) of the pancreas is a rare neoplasm with low malignancy, constituting about 2% of pancreatic tumors, which mainly occurs in young women. Case Presentation: We herein report a case of a small SPT arising from the head of the pancreas in an asymptomatic 50-year-old man. This patient was admitted to our department at Henan Provincial People's Hospital for the evaluation of a pancreatic mass and a pancreatic resection was performed. Histology revealed the lesion to be an SPT of the pancreas, with the characteristic pseudopapilla formation, central degeneration, and capsule formation. The tumor was positive for vimentin, CD10, α1-antichymotrypsin, α1-antitrypsin, β-catenin, neuron-specific enolase, synaptophysin, and progesterone receptor. Conclusion: We diagnosed an SPT in the patient based on these histological findings and immunophenotype.
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Affiliation(s)
- Xie Hongjian
- Department of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Li Dujuan
- Department of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Xue Shuang
- Department of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Zhao Yuewu
- Department of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Kong Lingfei
- Department of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
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Afridi SA, Kazaryan AM, Marangos IP, Røsok BI, Fretland ÅA, Yaqub S, Edwin B. Laparoscopic surgery for solid pseudopapillary tumor of the pancreas. JSLS 2016; 18:236-42. [PMID: 24960486 PMCID: PMC4035633 DOI: 10.4293/108680813x13753907291837] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives: Solid pseudopapillary tumors of the pancreas are rare and occur most frequently in young women. They have an uncertain pathogenesis and unclear clinical behavior. Our aim was to evaluate the clinical presentation of solid pseudopapillary tumors and assess the efficacy of treatment with minimally invasive surgery. Methods: From March 1997 to February 2011, 13 of 273 patients who underwent laparoscopic procedures on the pancreas were found to have solid pseudopapillary tumors. There were 12 female patients and 1 male patient. The median age was 21 years (range, 15–77 years). Abdominal pain was the most common presenting symptom (n = 9). Tumors were incidentally found in 3 patients on computed tomography scans obtained for other reasons. Results: Enucleation of the tumor was performed in 4 patients, including 3 in whom the tumor was located in the head of the pancreas. Eight patients underwent distal pancreatectomy with splenectomy, whereas spleen-preserving distal pancreatectomy was performed in one case. The median tumor size was 6 cm (range, 1.5–11 cm), the median operative time was 197 minutes (range, 68–320 minutes), and the median blood loss was 50 mL (range, <50–750 mL). Distal resections were performed with a linear stapler. Four patients had postoperative complications. The median length of hospital stay was 5 days (range, 2–12 days). During a median follow-up period of 11 months (range, 3–121 months), no local recurrences or distant metastases were found. Conclusion: Laparoscopic resections and enucleations of solid pseudopapillary tumors of the pancreas can be performed safely and with adequate resection margins even if the tumors are located in the head of the organ.
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Affiliation(s)
- Shabbir A Afridi
- Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Airazat M Kazaryan
- Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway; Department of Surgery, Skien Hospital, Sykehuset Telemark Health Trust, Skien, Norway
| | - Irina Pavlik Marangos
- Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Bård I Røsok
- Department of Hepatopancreatobiliary Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Åsmund A Fretland
- Department of Hepatopancreatobiliary Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Sheraz Yaqub
- Department of Hepatopancreatobiliary Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Bjørn Edwin
- Intervention Centre, Oslo University Hospital-Rikshospitalet, 0027, Oslo, Norway; Department of Hepatopancreatobiliary Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.
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28
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Tajima H, Takamura H, Kitagawa H, Nakayama A, Shoji M, Watanabe T, Tsukada T, Nakanuma S, Okamoto K, Sakai S, Kinoshita J, Makino I, Nakamura K, Hayashi H, Oyama K, Inokuchi M, Nakagawara H, Miyashita T, Ninomiya I, Fushida S, Fujimura T, Wakayama T, Iseki S, Ikeda H, Ohta T. Multiple liver metastases of pancreatic solid pseudopapillary tumor treated with resection following chemotherapy and transcatheter arterial embolization: A case report. Oncol Lett 2015; 9:1733-1738. [PMID: 25789032 PMCID: PMC4356297 DOI: 10.3892/ol.2015.2967] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 01/19/2015] [Indexed: 12/19/2022] Open
Abstract
A 33-year-old female was diagnosed with a solid pseudopapillary tumor (SPT) of the pancreas and multiple liver metastases at the Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital (Kanazawa, Japan). Distal pancreatectomy and postoperative systemic chemotherapy with gemcitabine (GEM) and S-1, an oral fluoropyrimidine derivative, was administered, however, liver metastases became enlarged and local recurrence occurred. Therefore, the patient was referred to the Department of Gastroenterologic Surgery at the Graduate School of Medicine (Kanazawa, Japan) for hepatic arterial infusion (HAI) chemotherapy. Oral S-1 (80 mg/m2) was administered as well as HAI chemotherapy with GEM (1,000 mg/standard liver volume). Following 18 cycles, tumor sizes were reduced and 18-fluorodeoxyglucose positron emission tomography (18FDG-PET) examination revealed obvious reduction of tumor FDG uptake. Transarterial tumor embolization (TAE) was performed for the previously unresectable right subphrenic liver tumor, and the other tumors were surgically resected. The resected tumors were diagnosed as liver metastases and a local recurrence of SPT in the postoperative pathological examination, which revealed that the resected tumors were composed of sheets of bland cells, which were positive for CD10, CD56, vimentin, neuron-specific enolase and α-antitrypsin. The postoperative course was uneventful, and the patient is currently under observation at an outpatient clinic; postoperative adjuvant chemotherapy with oral S-1 has continued, and additional TAE is planned. In the future, if the middle segment of the liver becomes enlarged, surgery for the residual right lobe tumor may be possible. This case demonstrates one method of SPT treatment: Preoperative HAI chemotherapy with GEM, plus oral S-1 and TAE. If complete resection can be achieved, the majority of patients with SPT have a favorable prognosis. In patients with unresectable metastases from SPT, it is crucial to conduct systematic multimodal treatment to maximize treatment success.
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Affiliation(s)
- Hidehiro Tajima
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Hiroyuki Takamura
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Hirohisa Kitagawa
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Akira Nakayama
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Masatoshi Shoji
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Toshifumi Watanabe
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Tomoya Tsukada
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Shinichi Nakanuma
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Koichi Okamoto
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Seisho Sakai
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Jun Kinoshita
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Isamu Makino
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Keishi Nakamura
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Hironori Hayashi
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Katsunobu Oyama
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Masafumi Inokuchi
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Hisatoshi Nakagawara
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Tomoharu Miyashita
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Itasu Ninomiya
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Sachio Fushida
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Takashi Fujimura
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Tomohiko Wakayama
- Department of Histology and Embryology, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Shoichi Iseki
- Department of Histology and Embryology, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Hiroko Ikeda
- Division of Pathology, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Tetsuo Ohta
- Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan
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Predicting recurrence of pancreatic solid pseudopapillary tumors after surgical resection: a multicenter analysis in Korea. Ann Surg 2015; 260:348-55. [PMID: 24743622 DOI: 10.1097/sla.0000000000000583] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Solid pseudopapillary tumors (SPTs) of the pancreas are still considered a surgical enigma. Many clinical research trials have failed to identify prognostic factors that predict the malignant behavior of SPTs. MATERIALS AND METHODS This work was a retrospective multicenter study that included a total of 17 medical institutions. Data from 351 patients who underwent surgical resection from January 1990 to December 2008 were retrospectively collected using standardized case report forms requesting clinicopathologic features. RESULTS Thirty-four patients (9.7%) were male, and 317 (90.3%) were female, with a mean age of 36.8 ± 12.4 years. Recently, minimally invasive (P < 0.001) and parenchyma or function-preserving limited surgeries (P = 0.016) have been more frequently applied for the treatment of pancreatic SPTs. Ninety-eight patients (27.9%) had microscopic malignant features. Only 9 patients (2.6%) experienced tumor recurrence after the initial pancreatic SPT resection. Multivariate analysis showed that a tumor size larger than 8 cm [Exp (β) = 7.385, P = 0.018], microscopic malignant features [Exp (β) = 10.009, P = 0.011], and stage IV [Exp (β) = 42.003, P = 0.002] were significant prognostic factors for tumor recurrence. When combined with stage IV, the microscopic malignant features and 2010 World Health Organization definition of solid pseudopapillary carcinoma more successfully differentiated future recurrence risk groups (P < 0.001). CONCLUSIONS More specific pathologic descriptions need to be employed in pathologic report forms to provide proper information to predict SPT recurrence after resection. Future studies emphasizing the standardized pathologic evaluation of pancreatic SPTs may unveil the enigmatic nature of pancreatic SPTs.
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30
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Ud Din N, Arshad H, Ahmad Z. Solid pseudopapilllary neoplasm of the pancreas. A clinicopathologic study of 25 cases from Pakistan and review of Literature. Ann Diagn Pathol 2014; 18:358-62. [DOI: 10.1016/j.anndiagpath.2014.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/06/2014] [Indexed: 11/30/2022]
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31
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Suzuki S, Hatori T, Furukawa T, Shiratori K, Yamamoto M. Clinical and pathological features of solid pseudopapillary neoplasms of the pancreas at a single institution. Dig Surg 2014; 31:143-50. [PMID: 24970563 DOI: 10.1159/000363420] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 05/05/2014] [Indexed: 12/13/2022]
Abstract
AIMS The aim of this study was to determine the clinicopathological features and surgical management of solid pseudopapillary neoplasms (SPNs) of the pancreas at a single institution. METHODS We investigated 34 patients (5 males and 29 females) who underwent surgery for pathologically confirmed SPNs between 1994 and 2012. RESULTS Clinical symptoms were absent in 58.8% of the patients. The median tumor diameter was 42.7 mm. All tumors were successfully removed by R0 resection. Pathologically, 5.9% had duodenum invasion and 2.9% had pancreatic serosal invasion, but there was no lymph node metastasis. Radiological findings showed calcification in 39.4% of the patients, capsule formation in 51.5%, cystic components in 69.7%, solid components in 93.9% and internal bleeding in 36.4%. Immunohistochemically, neuron-specific enolase was positive in 100% of the patients, nuclear accumulation of β-catenin in 100% and CD10 in 78.8%. There were no recurrences reported at the median follow-up (67 months). Regarding gender differences, the cystic component in radiological imaging was the only significant finding among the features studied (p = 0.01). CONCLUSIONS R0 resection with appropriate procedures appears to be sufficient for patients with SPNs, even for locally invasive tumors. There were no significant differences between genders except for the cystic component on radiological imaging.
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Affiliation(s)
- Shuji Suzuki
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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32
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Patnayak R, Jena A, Parthasarathy S, Vijaylaxmi B, Lakshmi AY, Rukmangadha N, Chowhan AK, Phaneendra BV, Reddy MK. Solid and cystic papillary neoplasm of pancreas: A clinic-pathological and immunohistochemical study: A tertiary care center experience. South Asian J Cancer 2014; 2:153-7. [PMID: 24455605 PMCID: PMC3892525 DOI: 10.4103/2278-330x.114141] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Solid pseudopapillary tumor of the pancreas (SPT) is a rare tumor of low malignant potential, mostly described in young women. Materials and Methods: In this retrospective study from January 2000 - December 2010, there were 50 pancreatic tumors. In this period, four SPTs were encountered, which were analyzed with respect to clinical, imaging, histopathological, and immunohistochemical findings. Results: There was a female preponderance with mean age of 22.2 years. Two of the tumors were located in head of the pancreas and two in the body and tail region. On imaging, majority were large cystic tumors. Histopathologically, they exhibited extensive necrosis and presence of pseudo papillae in viable areas. Immunohistochemically, they were positive for alpha-1-anti-trypsin, alpha-1-anti-chymotrypsin, vimentin, CD10, and CD99. Progesterone receptor and p53 exhibited mild positivity in all of the four cases, whereas neuron specific enolase (NSE), synaptophysin, and chromogranin showed focal positivity in one case. Conclusion: Despite its non-specific clinical, imaging, and even immunohistochemical features, characteristic gross and microscopic findings provide reliable diagnosis of SPTs.
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Affiliation(s)
- Rashmi Patnayak
- Department of Pathology, Sri Venkateswar Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Amitabh Jena
- Department of Surgical Oncology, Sri Venkateswar Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Sriram Parthasarathy
- Department of Surgical Gastroenterology, Sri Venkateswar Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Bodagala Vijaylaxmi
- Department of Radiology, Sri Venkateswar Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Amancharla Y Lakshmi
- Department of Radiology, Sri Venkateswar Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Nandyala Rukmangadha
- Department of Pathology, Sri Venkateswar Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Amit K Chowhan
- Department of Pathology, Sri Venkateswar Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Bobbit V Phaneendra
- Department of Pathology, Sri Venkateswar Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Mandyam K Reddy
- Department of Pathology, Sri Venkateswar Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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Saligram S, Fan F, Oropeza-Vail M, Gholami P, Olyaee M. Accuracy of Endoscopic Ultrasound-guided Fine Needle Aspiration in Diagnosing Solid Pseudopapillary Tumor. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 5:716-20. [PMID: 24404556 PMCID: PMC3877535 DOI: 10.4103/1947-2714.123270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: Solid pseudopapillary tumors are rare pancreatic tumors. Accurate preoperative diagnosis helps in planning of the surgery. Aim: This study was to evaluate accuracy of endoscopic ultrasound-guided fine needle aspiration and immunohistochemistry in diagnosing solid pseudopapillary tumors. Materials and Methods: A retrospective review was performed by reviewing medical records to identify patients treated for solid pseudopapillary tumors over a 5-year period. Patients who were noted to have pancreatic lesions by computer tomography abdomen underwent endoscopic ultrasound. Fine needle aspiration was obtained from each of these lesions and subjected to immunohistochemistry. Results: Five patients were identified. Endoscopic ultrasound was able to identify the pancreatic lesions in all five patients noted in computer tomography abdomen. Solid pseudopapillary tumors were diagnosed by immunohistochemistry. All five patients underwent surgery and the resected lesions confirmed solid pseudopapillary tumors in 80% patients. Conclusion: Endoscopic ultrasound-guided fine needle aspiration has a higher degree of accuracy in diagnosing solid pseudopapillary tumors.
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Affiliation(s)
- Shreyas Saligram
- Department of Gastroenterology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS-66106, USA
| | - Fang Fan
- Department of Gastroenterology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS-66106, USA
| | - Melissa Oropeza-Vail
- Department of Gastroenterology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS-66106, USA
| | - Parviz Gholami
- Department of Gastroenterology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS-66106, USA
| | - Mojtaba Olyaee
- Department of Gastroenterology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS-66106, USA
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Dixon M, Cannon J, Kagedan D, Rowsell C, Milot L, Ko YJ, Coburn N. Management of Metastatic Solid Pseudopapillary Cancer of the Pancreas: A Case Report. World J Oncol 2013; 4:201-204. [PMID: 29147356 PMCID: PMC5649928 DOI: 10.4021/wjon692w] [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] [Accepted: 07/11/2013] [Indexed: 11/29/2022] Open
Abstract
Solid pseudopapillary tumors (SPT) of the pancreas are rare neoplasms predominantly found in females. The tumors are often histologically benign and patient outcomes are correspondingly favorable. This report presents the case of a 21-year-old woman who presented with metachronous metastatic SPT, and details the diagnosis and management of this patient. The patient underwent a distal pancreatectomy for resection of the primary neoplasm with negative margins. A surveillance ultrasound performed at 43 months post-operatively revealed new hepatic lesions; these lesions were surgically resected and pathologically demonstrated to be metastatic SPT of the pancreas. This case report demonstrates the potential for latent metastasis of resected SPT, imaging characteristics of metastatic disease, the need for surveillance of patients following resection of SPT of the pancreas and a review of relevant literature on SPT.
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Affiliation(s)
- Matthew Dixon
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - John Cannon
- Department of Biology, Carleton College, Northfield, MN, USA
| | - Daniel Kagedan
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Corwyn Rowsell
- Department of Anatomical Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Laurent Milot
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Yoo-Joung Ko
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Natalie Coburn
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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35
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Chong A, Ha JM, Kwon SY. Multiple Diagnostic Imaging of a Patient with Solid Pseudopapillary Tumour of the Pancreas: EUS, CT and FDG PET/CT. Nucl Med Mol Imaging 2013; 48:82-4. [PMID: 24900144 DOI: 10.1007/s13139-013-0227-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/04/2013] [Accepted: 08/12/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ari Chong
- Department of Nuclear Medicine, Chosun University Hospital, 588 Seoseok-dong, dong-gu, Gwangju, 501-757 Republic of Korea
| | - Jung-Min Ha
- Department of Nuclear Medicine, Chosun University Hospital, 588 Seoseok-dong, dong-gu, Gwangju, 501-757 Republic of Korea
| | - Seong Young Kwon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Gwangju, South Korea
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36
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FDG PET/CT findings of solid pseudopapillary tumor of the pancreas with CT and MRI correlation. Clin Nucl Med 2013; 38:e118-24. [PMID: 23354028 DOI: 10.1097/rlu.0b013e318270868a] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this study was to evaluate retrospectively (18)F-FDG PET/CT findings of solid pseudopapillary tumor of the pancreas (SPTP). PATIENTS AND METHODS FDG PET/CT findings were reviewed in 8 patients with SPTP confirmed by pathology. Early PET/CT scans were performed 1 hour after FDG injection in all 8 patients. After an interval of 1 hour, delayed PET/CT scans were performed in 6 patients. All patients underwent enhanced CT and 4 patients underwent MRI. RESULTS A total of 8 tumors were detected in all 8 patients. CT and MRI findings included encapsulation (n = 2), solid and cystic components (n = 4), focal calcification (n = 7), and weak enhancement during the arterial phase on enhanced CT or MRI and increasing enhancement during the portal venous phase (n = 8). All the tumors showed increased FDG uptake. The mean SUVmax of all tumors was 8.9, with a high variability of SUVmax among lesions ranging from 2.5 to 29.1. The tumors (n = 6) with high cellularity had stronger FDG uptake, whereas the tumors (n = 2) with low cellularity had relatively low FDG uptake. The tumors (n = 6) with pancreatic parenchymal, vascular, or perineural invasions had intense FDG uptake, whereas the tumors (n = 2) without invasions had slight-to-moderate FDG uptake. Two tumors with relatively high proliferative index had very strong FDG uptake, whereas those (n = 6) with low proliferative index or negative Ki-67 staining result had relatively lower FDG uptake. On delayed FDG PET/CT images, The SUVmax of SPTP increased in 4 patients and slightly decreased in 2 patients. CONCLUSIONS CT or MRI demonstrated morphological features of SPTP and FDG PET/CT that reflected the histopathological composition of the tumors. FDG uptake of SPTP may be related to tumor cellularity, proliferative index, or histological malignancy. Familiarity with the morphological and functional imaging findings of SPTP may be helpful for correct diagnosis and appropriate treatment.
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Jarry J, Bodin R, Peycru T, Nunez M, Collet D, Cunha AS. Role of laparoscopic distal pancreatectomy for solid pseudopapillary tumor. JSLS 2013; 16:552-8. [PMID: 23484563 PMCID: PMC3558891 DOI: 10.4293/108680812x13462882736970] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Since the first case report regarding laparoscopic distal pancreatectomy (DP) for solid pseudopapillary tumor (SPT), few additional articles have been published. The objective of this study was to evaluate the feasibility, safety, and long-term outcome of the laparoscopic DP based on a series of adult SPT patients. METHODS In a single-center study, we screened all adult patients undergoing a laparoscopic DP for SPT. Preoperative, operative, and postoperative data were retrospectively analysed and compared to the results of open DP for SPT published in the medical literature. RESULTS From April 2000 to June 2010, 5 adult female patients (median age 34 y) underwent a laparoscopic DP for an SPT. No conversion to open surgery was required. The median size of the tumor was 45 mm. The postoperative mortality rate was 0%, and serious complications (Dindo IV) occurred in 2 patients. The postoperative quality of life was not significantly altered by the laparoscopic procedure. At a median follow-up of 60 mo, all patients were alive and without evidence of local recurrence, distant metastasis, diabetes, or exocrine insufficiency. CONCLUSION Laparoscopy may offer an alternative to open surgery in the treatment of SPT of the distal pancreas in adult female patients. The laparoscopic procedure impacts neither the oncologic outcome nor the quality of life. However, due to the risk of postoperative complications, this procedure should be reserved for specialized centers.
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Affiliation(s)
- Julien Jarry
- Department of Digestive Surgery, Robert Picqué Hospital, Villenave d'Ornon, France.
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Li J, Cao X, Fang Y, Liao ZE, Liu YY, Huang BD, Han YJ. Overexpression of hTERT in potentially malignant colorectal laterally spreading tumors. Mol Med Rep 2013; 7:1409-12. [PMID: 23525166 DOI: 10.3892/mmr.2013.1376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 02/27/2013] [Indexed: 11/06/2022] Open
Abstract
Human telomerase reverse transcriptase (hTERT) is the main subunit of the core enzyme telomerase, which consists of three subunits. Telomeres are essential for chromosomal stability and integrity, protecting the ends of chromosomes from degradation and preventing chromosomal end fusions and recombination. A loss of telomere function is a major mechanism for the generation of chromosomal abnormalities. Telomere shortening leads to mutations, chromosome rearrangements and translocations. Colorectal laterally spreading tumors (LSTs) are a special type of superficial colorectal tumor. They are considered to have a high malignancy potential. The aim of the present study was to characterize the expression of hTERT in an LST cell line and paraffin sections. Immunohistochemistry was utilized to examine the protein expression of hTERT in the LST cell line, 48 resected LSTs, 48 protruded-type colorectal adenomas (PAs) and 48 normal mucosa samples. Statistical analyses were applied to test the associations between hTERT expression and clinicopathological parameters. The present study demonstrated that the positive expression levels of hTERT in LSTs, PAs and normal mucosa were 60.4, 22.9 and 10%, respectively. Compared with polypi and normal mucosa, the expression levels of hTERT were significantly increased in LSTs. The expression of hTERT was also observed in the LST cell line. The expression of hTERT was significantly higher in LSTs, which may indicate a potential for malignancy.
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Affiliation(s)
- Jun Li
- Department of Traditional Chinese Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, PR China
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Morikawa T, Onogawa T, Maeda S, Takadate T, Shirasaki K, Yoshida H, Ishida K, Motoi F, Naitoh T, Rikiyama T, Katayose Y, Egawa S, Unno M. Solid pseudopapillary neoplasms of the pancreas: an 18-year experience at a single Japanese Institution. Surg Today 2012; 43:26-32. [PMID: 23114787 DOI: 10.1007/s00595-012-0345-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 09/07/2011] [Indexed: 12/13/2022]
Abstract
PURPOSE This study investigated the clinicopathological features and surgical management of solid pseudopapillary neoplasms at a single institution in Japan. METHODS Seventeen patients (the largest series in Japan) those underwent surgery for pathologically confirmed solid pseudopapillary neoplasms were retrospectively reviewed. RESULTS Sixteen patients were women and their mean age was 34.1 years. Most patients were asymptomatic (n = 11), and the average tumor diameter was 51.8 mm. The most common imaging characteristic was tumors of solid and cystic type (n = 10), which were most commonly located in the pancreatic body (n = 7). All patients underwent surgical exploration, i.e., distal pancreatectomies in 7 patients (laparoscopically performed in 2); middle pancreatectomies, 4; pancreaticoduodenectomies, 4; enucleation, 1; and liver resection, 1. No surgical mortalities occurred, and postsurgical complications occurred in 9 patients. Four patients had malignant tumors. One patient with liver metastases experienced recurrence, which was well controlled by paclitaxel. The remaining patients were disease free at a median follow-up of 51 months. CONCLUSIONS Solid pseudopapillary neoplasms can be treated by complete tumor resection with limited resection or a minimally invasive approach when applicable. The combination of surgical resection and chemotherapy may therefore prolong survival, even in malignant cases.
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Affiliation(s)
- Takanori Morikawa
- Division of Hepato-Biliary-Pancreatic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8574, Japan
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Cai H, Zhou M, Hu Y, He H, Chen J, Tian W, Deng Y. Solid-pseudopapillary neoplasms of the pancreas: clinical and pathological features of 33 cases. Surg Today 2012; 43:148-54. [PMID: 22825652 DOI: 10.1007/s00595-012-0260-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 12/15/2011] [Indexed: 02/06/2023]
Abstract
PURPOSE Solid-pseudopapillary neoplasms (SPNs) are rare pancreatic tumors, with a low potential for malignancy. The clinical and pathological features of 33 SPNs were reviewed. METHODS This study conducted a retrospective analysis of 33 patients who underwent surgery for a pathologically confirmed SPN from 2000 to 2011. RESULTS Thirty of the 33 patients (91 %) were female, and the median age at diagnosis was 29.2 years (range 12-59). The most common symptom was abdominal discomfort with dull pain (58 %). Others included asymptomatic lesions that were only detected incidentally during imaging (21 %), a palpable abdominal mass (15 %) and indigestion (6 %). All 33 patients underwent surgery with a curative intent and 3 (9 %) underwent laparoscopic surgery. The mean diameter of the tumors was 4.9 cm (range 2-15 cm), and they occurred in the head (9, 27 %), neck (5, 15 %), body or tail (19, 58 %) of the pancreas. One patient had lymph node metastases, one patient had portal venous invasion and 8 patients had perineural invasion. The patient follow-up ranged from 4 to 118 months, and 32 patients were alive and well without recurrence. One patient relapsed 10 months after distal pancreatectomy with splenectomy and underwent a second surgery via laparotomy. Unfortunately, the patient died of multiple organ failure 12 days after the second surgery. CONCLUSION SPNs are rare neoplasms with malignant potential but excellent prognosis. Adequate surgical resection, including laparoscopic surgery, may therefore be performed safely and is associated with a long-term survival, even in invasive cases.
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Affiliation(s)
- Hongke Cai
- Department of Surgical Oncology, Second Affiliated Hospital, Zhejiang University College of Medicine, No. 88 Jiefang Road, Zhejiang, People's Republic of China
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Krug S, Bartsch DK, Schober M, Librizzi D, Pfestroff A, Burbelko M, Moll R, Michl P, Gress TM. Successful selective internal radiotherapy (SIRT) in a patient with a malignant solid pseudopapillary pancreatic neoplasm (SPN). Pancreatology 2012; 12:423-7. [PMID: 23127531 DOI: 10.1016/j.pan.2012.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 07/14/2012] [Accepted: 07/16/2012] [Indexed: 12/11/2022]
Abstract
Solid pseudopapillary neoplasms of the pancreas (SPNs, Gruber-Frantz-Tumor) are a rare entity representing 1-5% of all exocrine pancreatic tumors. The pseudocystic lesions preferentially affect young females <30 years, are mostly benign (∼90%) and normally present with unspecific symptoms. We describe the case of a 16-years-old Asian woman that was initially diagnosed with an SPN in the pancreatic head with mesenterial and hepatic metastases. After diagnosis, an extensive tumor resection was performed including pyloric-preserving pancreatic head resection followed by sequential resection of all hepatic metastases. After the patient was diagnosed with a hepatic recurrence and high intrahepatic tumor load, we chose a multimodal procedure and performed a selective internal radiotherapy (SIRT). Four years after SIRT and 10 years after initial diagnosis of metastatic SPN, the patient is in a good condition without any evidence for hepatic recurrence. This case represents a rare clinical course of a malignant and invasive SPN with an exceptionally long survival despite of high initial tumor burden. The selective internal radiotherapy is a suitable approach for inducing long-term remissions of the strongly vascularized liver metastases.
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Affiliation(s)
- S Krug
- Department of Gastroenterology, Endocrinology and Metabolism, Philipps-University Marburg, Marburg, Germany
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Salvia R, Malleo G, Marchegiani G, Pennacchio S, Paiella S, Paini M, Pea A, Butturini G, Pederzoli P, Bassi C. Pancreatic resections for cystic neoplasms: from the surgeon's presumption to the pathologist's reality. Surgery 2012; 152:S135-42. [PMID: 22766364 DOI: 10.1016/j.surg.2012.05.019] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 05/11/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Current guidelines for the management of pancreatic cystic neoplasms are based on the assumption that these lesions can be classified correctly on the basis of features of cross-sectional imaging. However, a certain degree of overlap between different lesions exists, and little is known about the rate of inaccurate preoperative diagnoses. To address this issue, preoperative and final pathologic diagnoses of patients resected for a presumed pancreatic cystic neoplasm were compared. METHODS Retrospective analysis was undertaken of patients managed operatively between 2000 and 2010. Preoperative workup was reviewed to identify diagnostic pitfalls and potential risk factors for incorrect preoperative characterization of cystic lesions presumed to be neoplastic. RESULTS We analyzed 476 patients. Final pathologic diagnosis matched the preoperative diagnosis in 78% of cases. The highest accuracy was reached for solid pseudopapillary neoplasms (95%) and for main duct/mixed duct intraductal papillary mucinous neoplasms (81%). Surprisingly, 23 cysts (5%) were found to be ductal adenocarcinoma, whereas 45 patients (9%) underwent a pancreatic resection for a non-neoplastic condition. The use of a routine radiologic workup, including contrast-enhanced ultrasonography and magnetic resonance imaging, was associated with a favorably correct characterization of the cystic lesion. Endoscopic ultrasonography did not seem to improve diagnostic accuracy. Increased levels of serum carbohydrate antigen (CA)19-9 resulted as risk factors for an incorrect diagnosis as well as for a final diagnosis of a ductal adenocarcinoma. CONCLUSION The overall rate of inaccurate preoperative diagnoses in a tertiary care center with a broad experience in pancreatology approached 22%. Serum CA19-9 is an important complementary tool within the context of preoperative investigation of cystic neoplasms of the pancreas.
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Affiliation(s)
- Roberto Salvia
- Unit of General Surgery B, Pancreas Institute, G.B. Rossi Hospital, Department of Surgery, University of Verona Hospital Trust, Verona. Italy.
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Speer AL, Barthel ER, Patel MM, Grikscheit TC. Solid pseudopapillary tumor of the pancreas: a single-institution 20-year series of pediatric patients. J Pediatr Surg 2012; 47:1217-22. [PMID: 22703796 DOI: 10.1016/j.jpedsurg.2012.03.026] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 03/06/2012] [Indexed: 12/25/2022]
Abstract
PURPOSE Solid pseudopapillary tumor (SPT) of the pancreas is a rare neoplasm. The objective of this study was to review our institution's experience and provide an update on current management in the pediatric population. METHODS Our pathology database identified all patients with SPT for a 20-year period (1991-2011). Demographics, clinical characteristics, operative details, pathology, and outcomes data were retrospectively reviewed. RESULTS Eleven patients with SPT were identified. Most were female and Hispanic. Median age at resection was 14 years (9-17 years). Most patients presented with abdominal pain. Diagnostic imaging was most commonly an ultrasound or computed tomography. All tumors were resected en bloc. Median greatest tumor diameter was 5 cm (3.5-12 cm). Median length of stay was 8 days (5-19 days). Complications included pancreatic leak, chyle leak, delayed gastric emptying, fat malabsorption, and incisional keloid. Recurrence developed after 2.5 years in 1 patient with positive surgical margins. There were no metastases or deaths. Median follow-up was 1.4 years (0.6-5.9 years). CONCLUSION This pediatric series of SPT from a single institution corroborates previous reports in the literature. In our experience, SPT behaves like a low-grade malignancy and has an excellent prognosis. Surgical resection is dictated by tumor location and remains the treatment of choice.
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Affiliation(s)
- Allison L Speer
- Children's Hospital Los Angeles, Department of Pediatric Surgery, Los Angeles, CA 90027, USA
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Navarro S, Ferrer J, Bombí JA, López-Boado MA, Ayuso JR, Ginés A, Fernández-Esparrach G, Vaquero E, Cuatrecasas M, Fernández-Cruz L. [Pseudopapillary solid tumor of the pancreas: report of 6 cases]. Med Clin (Barc) 2012; 138:114-8. [PMID: 22036462 DOI: 10.1016/j.medcli.2011.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 09/06/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Solid pseudopapillary neoplasms (SPNs) are rare tumours of the exocrine pancreas. Although they can develop metastasis, the prognosis is good. The aim of this study was to describe the characteristics of these tumours attended in our hospital. PATIENTS AND METHOD All cases of SPN in the database of the Pathology Department between 1991 and 2010 were included. Age, sex, symptoms, type of surgery, pathologic and immunohistochemical characteristics, and clinical evolution were analyzed. RESULTS Six cases were identified; all of them were women with a median age of 27.5 years. One patient presented haemoperitoneum, 2 abdominal pain and 3 were diagnosed incidentally. The most frequent localization was the pancreatic tail (n=4) and the median size was 7.7 cm. Four tumours were benign and 2 carcinomas. One of them had liver and lymph node metastases. Ki-67 proliferation index was low (1-3%). After a median follow-up of 33.5 months, all patients were alive and without evidence of relapse. CONCLUSION SPNs occur in young women. In most cases surgical resection is curative. A low mitotic index confers a good prognosis and a long survival.
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Affiliation(s)
- Salvador Navarro
- Servicio de Gastroenterología, Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBERehd, Barcelona, España.
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Guo N, Zhou QB, Chen RF, Zou SQ, Li ZH, Lin Q, Wang J, Chen JS. Diagnosis and surgical treatment of solid pseudopapillary neoplasm of the pancreas: analysis of 24 cases. Can J Surg 2012; 54:368-74. [PMID: 21939604 DOI: 10.1503/cjs.011810] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Our aim was to summarize our experience with the diagnosis and surgical treatment of solid pseudopapillary neoplasm (SPN) of the pancreas to provide a reference for the management of this rare condition. METHODS We collected and analyzed retrospective data on the clinical presentation, laboratory investigations, radiologic imaging, pathology and operative details of patients with SPN of the pancreas diagnosed between February 2001 and December 2009. RESULTS In all, 23 of 24 patients were women, and the mean age of all patients was 31 years. The most common clinical presentation was vague abdominal pain. Abdominal imaging showed solid or solid cystic masses in the pancreas, mostly in the tail or head of the gland. All patients were treated surgically. There were no postoperative deaths. After follow-up ranging from 4 to 109 months (median 68 mo), 20 of 22 patients who underwent curative resection were alive with no evidence of disease recurrence. Of the 2 patients with R1 resections, 1 died 42 months after surgery, whereas the other underwent a second operation and was alive after 36 months' follow-up. CONCLUSION Solid pseudopapillary neoplasm of the pancreas is a relatively indolent tumour. The initial diagnosis of SPN of the pancreas is suggested by radiologic imaging findings but should be considered in the context of clinical and histopathologic characteristics. We advocate for complete surgical resection once SPN is diagnosed.
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Affiliation(s)
- Ning Guo
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 Yan-Jiang Xi Rd., GuangZhou, China
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Zampieri N, Schiavo N, Capelli P, Scarpa A, Bassi C, Camoglio FS. Pseudopapillary tumor in pediatric age: clinical and surgical management. Pediatr Surg Int 2011; 27:1271-5. [PMID: 21789668 DOI: 10.1007/s00383-011-2947-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2011] [Indexed: 01/22/2023]
Abstract
BACKGROUND Solid pseudopapillary tumors of the pancreas are rare exocrine pancreatic tumors. Through a review of pediatric cases in a single Institution, we present the clinical and surgical management of this neoplasm. METHODS We retrospectively reviewed the clinical charts of patients treated at our unit between 1995 and 2009 for SPT. Clinical and surgical management were analyzed and reported. RESULTS During the study period 11 patients underwent surgery for pseudopapillary tumor. Five patients were treated with duodenum-preserving pancreatic head resection and six patients with splenopancreasectomy with a Roux-en-Y pancreatic jejunostomy. Patients did not show recurrence and are currently disease free. Blood tests, Ultrasound, Computed tomography and Magnetic Resonance Imaging were not useful to preoperatively identify the nature of the pancreatic masses. CONCLUSION Solid pseudopapillary tumor is a rare condition that should be taken into account for the differential diagnosis of pancreatic masses in pediatric age. Due to its favourable prognosis, surgical removal should be planned and done following the intraoperative findings.
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Affiliation(s)
- Nicola Zampieri
- Department of Surgical Sciences, Pediatric Surgical Unit, Policlinico G. B.Rossi, University of Verona, piazzale Scuro n. 1, Piazzale L. A. Scuro, 37134, Verona, Italy.
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Kang CM, Choi SH, Hwang HK, Lee WJ, Chi HS. Minimally invasive (laparoscopic and robot-assisted) approach for solid pseudopapillary tumor of the distal pancreas: a single-center experience. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2011; 18:87-93. [PMID: 20676697 DOI: 10.1007/s00534-010-0316-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND/PURPOSE A single-institutional experiences of solid pseudopapillary tumor (SPT) in the distal pancreas were retrospectively reviewed with special reference to a minimally invasive approach. METHODS Thirty-five patients with SPT of the distal pancreas treated during the past 20 years were retrospectively evaluated. We divided the patients into 2 groups based on the surgical approach: the laparoscopic/robot-assisted surgery (LR) group and the conventional open surgery (O) group. We reviewed the chronological changes and characteristics of SPT. A comparative analysis of the two groups (LR vs. O) was conducted in terms of perioperative surgical outcomes. RESULTS The discovery of relatively small SPTs without symptoms seemed to be increasing (p < 0.05). Eleven of the 35 patients were assigned to the LR group. Ten patients were female and 1 was male, and they had a median age of 32 years (range 24-62 years) and a median tumor size of 3.6 cm (range 1-8.5 cm). Eight patients underwent laparoscopic distal pancreatectomy with or without splenectomy, and the remaining 3 underwent robot-assisted central pancreatectomy with pancreaticogastrostomy. In the comparative analysis of the LR and O groups, smaller tumor size, earlier oral intake, and shorter hospital stay, without increasing morbidity, were noted in the LR group (p < 0.05). CONCLUSIONS A minimally invasive (laparoscopic/robot-assisted) approach for SPT of the distal pancreas is thought to be more appropriate than and preferable to conventional open surgery in well-selected patients.
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Affiliation(s)
- Chang Moo Kang
- Division of Bilio-Pancreas, Department of Surgery, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea
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Vasdev V, Bhakuni D, Narayanan K, Jain R. Intramedullary fat necrosis, polyarthritis and panniculitis with pancreatic tumor: a case report. Int J Rheum Dis 2011; 13:e74-8. [PMID: 21199459 DOI: 10.1111/j.1756-185x.2010.01548.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Acute polyarthritis can occur in non-rheumatic systemic illnesses, presenting a diagnostic dilemma. We present an extremely rare case presenting as acute polyarthritis, panniculitis and medullary fat necrosis with underlying pancreatic pathology. This case report describes a young woman presenting with panniculits, pancreatic tumour, polyarthritis and intra-osseus fat necrosis with a fatal outcome. The medical fraternity needs to be aware of this potentially fatal albeit rare musculoskeletal complication secondary to a pancreatic pathology.
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Affiliation(s)
- Vivek Vasdev
- Department of Rheumatology & Clinical Immunology, Army hospital R & R, New Delhi, India.
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Zuriarrain A, Nir I, Bocklage T, Rajput A. Pseudopapillary tumor of the pancreas in a 17-year-old girl. J Clin Oncol 2011; 29:e395-6. [PMID: 21343547 DOI: 10.1200/jco.2010.33.5364] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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