Solid-pseudopapillary neoplasm of the pancreas: radiological-pathological correlation

Solid pseudopapillary tumor of the pancreas mistaken for gastrointestinal stromal tumor: A case report

Solid pseudopapillary epithelial neoplasms of the pancreas are rare entities, first described in 1959 by Frantz. These tumors represent less than 2% of pancreatic cancers and mainly affect young women. They can reach a significant size and its radiological features can lead to diagnostic pitfalls, such as gastrointestinal stromal tumors, which are rare soft-tissue sarcomas that can appear anywhere along the gastrointestinal tract. Clinicians and radiologists need to be aware of the existing diagnostic pitfalls between these two entities, because of their possible similarities. We report here the case of a 33-year-old woman with a solid pseudopapillary epithelial neoplasms of the pancreas initially misdiagnosed as an exophytic gastric stromal tumor.

Differential diagnosis of pancreatic cancer from other solid tumours arising from the periampullary area on MDCT

PURPOSE

To investigate CT features and differential diagnosis of pancreatic adenocarcinoma compared to other solid tumours arising in the periampullary area.

MATERIALS AND METHODS

One hundred and ninety-five patients with pathologically proven, solid periampullary tumours, including pancreatic adenocarcinoma (n = 98), neuroendocrine tumours (n = 52), gastrointestinal stromal tumours (n = 31), and solid pseudopapillary neoplasms (n = 14), underwent preoperative CT. Two radiologists reviewed CT features and rated the possibility of pancreatic adenocarcinoma.

RESULTS

Statistically common findings for pancreatic adenocarcinoma included: patient age >50 years; ill-defined margin; completely solid mass; homogeneous enhancement; hypoenhancement on arterial and venous phases; atrophy; and duct dilatation. Statistically common findings for GIST included: heterogeneous enhancement; hyperenhancement on arterial and venous phases; rim enhancement; and prominent feeding arteries. The hyperenhancement on arterial and venous phases is statistically common in NET, and heterogeneous enhancement, hypoenhancement on the arterial and venous phases are statistically common in SPN. Diagnostic performance of CT for differentiating pancreatic adenocarcinomas from other solid periampullary tumours was 0.962 and 0.977 with excellent interobserver agreement (κ = 0.824).

CONCLUSION

CT is useful not only for differentiating pancreatic adenocarcinoma form other solid tumours but also for differentiating between other solid tumours, including NET, SPN, and GIST, arising in the periampullary area.

KEY POINTS

• Periampullary tumours arise within 2 cm of major duodenal papilla. • Many mass-forming periampullary tumours can be completely removed by minimal surgery. • Accurate differentiation of pancreatic adenocarcinoma from other solid tumours is important. • CT is useful for differentiating pancreatic adenocarcinoma from other solid tumours. • CT is useful for characterization of periampullary tumours other than adenocarcinomas.

[Pseudopapillary and solid tumor of the pancreas: a rare cause of abdominal mass]

La tumeur pseudopapillaire et solide du pancréas (TPPSP) est une tumeur rare, c'est une cause rare de masse abdominale. Elle touche surtout les jeunes femmes. Elle est d’étiopathogénie encore peu connue, caractérisée par un potentiel malin atténué avec un risque d'extension locale faible et d’évolution métastatique rare. Elle reste de bon pronostic après exérèse chirurgicale complète. Nous rapportons un cas chez une adolescente révélé par une masse épigastrique peu douloureuse. L’échographie abdominale complétée par la tomodensitométrie ont confirmés le diagnostique de tumeur pancréatique. L’étude anatomopathologique et immunohistologique étaient en faveur d'une TPPSP.

Imaging of pediatric pancreatic neoplasms with radiologic-histopathologic correlation

OBJECTIVE

The purpose of this article is to describe the imaging features of pediatric pancreatic tumors with pathologic correlation. Epithelial and nonepithelial lesions are described. Pancreatic imaging protocols, clinical presentation, and management are also detailed.

CONCLUSION

Pancreatic neoplasms are rare in children and vary widely between benign and malignant causes and between cystic and solid lesions. Epithelial tumors are most common and include solid pseudopapillary tumor, pancreatoblastoma, islet cell neoplasms, and cystic lesions.

Solid pseudopapillary tumour (Frantz's tumour) of the pancreas in childhood

An 11-year-old girl presented with acute pancreatitis and mass in the head of the pancreas. MRI revealed a heterogeneous right-upper quadrant retroperitoneal mass measuring 6.8×6.1×5.5 cm arising from the pancreatic head. Endoscopic ultrasound with fine-needle aspirate revealed a solid pseudopapillary tumour (SPT) of the pancreas. The patient underwent a pylorus-preserving Whipple procedure. Pathology confirmed SPT. First described by Frantz, SPT represents less than 3% of all exocrine tumours. It is especially rare in children and shows different clinical features compared with adults. In our patient, tumour cells were arranged at the periphery of fibrovascular cores, but they did not show definite gland formation, keratinisation or cytoplasmic pigment accumulation. A periodic acid-Schiff stain without diastase did not show appreciable glycogen within the tumour cells, classic for Frantz's tumour. The literature, diagnosis, management and pathogenesis on this rare entity in children are reviewed and discussed.

Solid pseudopapillary tumour of the pancreas in children: clinical and computed tomography manifestation

PURPOSE

The purpose of our study was to retrospectively assess imaging features of computed tomography (CT) and clinical characteristics of children with solid pseudopapillary tumours (SPTs) of the pancreas in comparison with those of SPTs in adults.

MATERIALS AND METHODS

CT images and clinical data of 86 patients with histopathologically proven SPTs were reviewed. Eighteen patients were classified as children (≤18 years old), and 68 were classified as adults (>18 years old) according to age at diagnosis. Statistical analysis was performed using the χ (2) test and the Student's t test.

RESULTS

Eighteen patients (15 girls and three boys) were children, with an average age of 15.1 years at operation. Abdominal pain or discomfort was the most common manifestation in children (66.7%). Mean tumour size in children was significantly larger than in adults (9.1 vs. 5.7 cm; p=0.001). Except for tumour size, no significant statistical difference was observed in clinical factors or imaging features between SPTs in children and adults.

CONCLUSIONS

Ours is the largest single-centre study to demonstrate the features of pancreatic SPT in children. SPT diagnosis should always be considered when a large pancreatic mass with typical imaging is found in a child, especially in adolescent girls.

Imaging features of solid pseudopapillary tumor of the pancreas on multi-detector row computed tomography

AIM: To retrospectively analyze the imaging features of solid-pseudopapillary tumors (SPTs) of the pancreas on multi-detector row computed tomography (MDCT) and define the imaging findings suggestive of malignant potential.

METHODS: A total of 24 consecutive cases with surgically and pathologically confirmed SPTs of the pancreas underwent preoperative abdominal MDCT studies in our hospital. All axial CT images, CT angiographic images, and coronally and sagittally reformed images were obtained. The images were retrospectively reviewed at interactive picture archiving and communication system workstations.

RESULTS: Of the 24 cases of SPTs, 11 cases (45.8%) occurred in the pancreatic head and seven (29.1%) in the tail. Eighteen were pathologically diagnosed as benign and six as malignant. MDCT diagnosis of SPTs was well correlated with the surgical and pathological results (Kappa = 0.6, P < 0.05). The size of SPTs ranged from 3 to 15 cm (mean, 5.8 cm). When the size of the tumor was greater than 6 cm (including 6 cm), the possibilities of vascular (8 vs 1) and capsular invasion (9 vs 0) increased significantly (P < 0.05). Two pathologically benign cases with vascular invasion and disrupted capsule on MDCT presented with local recurrence and hepatic metastases during follow-up about 1 year after the resection of the primary tumors.

CONCLUSION: Vascular and capsular invasion with superimposed spread into the adjacent pancreatic parenchyma and nearby structures in SPTs of the pancreas can be accurately revealed by MDCT preoperatively. These imaging findings are predictive of the malignant potential associated with the aggressive behavior of the tumor, even in the pathologically benign cases.

Clinical features and surgical treatment for solid pseudo-papillary tumor of the pancreas

AIM: To summarize the clinical features of and surgical treatment for solid pseudo-papillary tumor of the pancreas (SPTP).

METHODS: Eleven cases of SPTP diagnosed between January 2001 and April 2008 in our hospital were retrospectively analyzed. The main indicators included clinical features, B ultrasound and CT scan characteristics, pathological results and follow-up, etc.

RESULTS: Two cases of tumors were located in the pancreatic head, one tumor was in the neck of pancreas and 8 tumors were in the body and tail of pancreas. There were no specific clinical manifestations except 2 cases with acute abdominal pain. Solid and solid-cystic masses of low echo were found in pancreas under ultrasonic examinations. CT scan showed masses of low density in pancreas, while irregular enhancement appeared in the circumference of all tumors in enhanced CT scan sequences. Tumor markers in patients' serum were all negative except one case. Pancreaticoduodenectomy was performed on 3 cases. Simple resection of tumor was performed on 3 cases. Five patients underwent distal pancreatectomy and spleen resection. Ten patients were followed up with the average time of 23.7 months. No evidence of relapses and metastasis in these cases was found.

CONCLUSION: Solid pseudo-papillary tumor of pancreas is one of rare pancreatic neoplasm with low malignant potential, affecting primarily young women. Patients with SPTP have a favorable outcome after surgical treatment.

Liver transplantation for multiple liver metastases from solid pseudopapillary tumor of the pancreas

Solid pseudopapillary tumor (SPT) of the pancreas usually shows a benign clinical course. However, sometimes, distant metastasis may occur. Even in such case, the prognosis is good only if metastatic lesions are resected completely. We report the case of a 14-year-old girl with SPT of the pancreas and unresectable synchronous liver metastasis who underwent successful living donor liver transplantation. For 2 years, she has been disease free. This is the first report on transplantation to relieve liver metastasis of SPT.

Imaging Spectrum of Cystic Pancreatic Lesions: Learn from Atypical Cases

The classic radiologic findings of cystic pancreatic masses have been well recognized; however, diagnosing those lesions is still challenging since many cases show unusual radiologic findings. We reviewed the computed tomography, magnetic resonance, and endoscopic retrograde cholangiopancreatography findings of many pathologically proven cystic pancreatic masses and selected various atypical but instructive cases as well as rare pathologic cases from the past 10 years in our institution. This article presents atypical as well as rare pathologic cases of cystic pancreatic masses and correlates them with pathologic findings to obtain diagnostic clues to perform a correct diagnosis.

Central pancreatectomy with pancreaticogastrostomy in children

Children requiring surgical intervention for pancreatic disease may be at risk long term for exocrine insufficiency and glucose intolerance. Pediatric surgeons must balance the need to perform adequate surgical resection while preserving as much normal pancreatic parenchyma as possible. Neoplasms of the middle pancreatic segment with low malignant potential and isolated trauma to the pancreatic body or neck represent 2 conditions where extensive pancreatic resection is unnecessary. Central pancreatectomy for such lesions is well described in adults. Reconstruction of the distal pancreatic remnant is traditionally performed via Roux-en-Y pancreaticojejunostomy. Pancreaticogastrostomy is an alternative approach that has been used to reconstruct the distal pancreas in the adults. Pancreaticogastrostomy offers several technical advantages over pancreaticojejunostomy. Because children may be uniquely susceptible to the long-term consequences of excessive pancreatic resection, 2 cases using this technique of central pancreatectomy with pancreaticogastrostomy are described.

Four cases of solid pseudopapillary tumors of pancreas: Imaging findings and pathological correlations

OBJECTIVE

Solid pseudopapillary tumor of the pancreas (SPTP tumor) is a rare pancreatic neoplasm with low malignant potential, which usually affects female patients in the second or third decades of life. It is a non-functional, slow-growing neoplasm that very often reaches considerable size before the first symptoms appear. Symptomatology is frequently related to tumor size. Surgical excision is usually curative in most cases. Infrequently the tumor can appear in male patients or in aged women, which can make the diagnosis more difficult. Some patients develop liver metastases in the follow-up that can be resected. Our purpose is to review the radiological and pathological findings of SPTP with emphasis on these infrequent cases.

SUBJECTS AND METHODS

The medical records and radiological findings of patients who underwent surgery for SPTP between 2000 and 2005 were retrospectively reviewed. Study eligibility required that patients had undergone surgical resection and that a SPTP had been pathologically proved.

RESULTS

Four cases of solid pseudopapillary tumor of the pancreas were diagnosed and treated in our institution in the study period. Two of the patients, developed on follow-up liver metastases, and peritoneal, hepatic, and nodal metastases, respectively.

CONCLUSION

Solid pseudopapillary tumors are well-encapsulated neoplasms that usually have a good prognosis after surgical excision. A malignant behavior is uncommon and in this case lymph node involvement, hepatic metastases and occasionally peritoneal invasion may also occur. Resection of liver metastases can prolong the long-term survival of the patients.