[Solid pseudopapillary pancreas tumors--often neglected]

Ultrasonic diagnosis of solid pseudopapillary tumor of the pancreas: Causes of misdiagnosis

AIM: To study the ultrasound diagnosis and causes of misdiagnosis of solid pseudopapillary tumor of pancreas (SPTP).

METHODS: Ultrasonic and clinical data for 11 patients with pathologically confirmed SPTP who underwent surgical treatment from June 2008 to June 2011 at our hospital were analyzed retrospectively.

RESULTS: All cases had a single round or oval-shaped, mixed slightly low echo mass. The tumor had a clear boundary in 9 cases and a complete capsule in 8 cases. Ten cases had no post-tumor echo attenuation. Adjacent tissue or organ compression and displacement were observed in 9 cases. Eight cases showed little blood flow in and around the tumor. All cases showed no dilatation in the pancreatic duct and bile duct, except for 1 case showing slight widening of distal pancreatic duct. Five cases of SPTP were diagnosed by ultrasound before operation; three cases were highly suspected to have SPTP after fully considering the age, sex, and CT findings. Because of irregular tumor morphology and capsule, local thickening or lobulated convex growth, unclear surrounding tissue, complicated structure and echo of internal tumor, three cases were misdiagnosed.

CONCLUSION: SPTP display a group of "sonographic signs", which are important clues to and basis for the diagnosis of SPTP. Main reasons for misdiagnosis are complicated and diverse.

Diagnosis and surgical treatment of solid pseudopapillary neoplasm of the pancreas: analysis of 24 cases

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.