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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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Dumitrascu T. Preservation of Pancreatic Function Should Not Be Disregarded When Performing Pancreatectomies for Pancreatoblastoma in Children. Pediatr Rep 2024; 16:385-398. [PMID: 38804376 PMCID: PMC11130799 DOI: 10.3390/pediatric16020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/05/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
Complete surgical resection in the context of a multimodal approach has been associated with excellent long-term survival in children diagnosed with pancreatoblastoma (PB). Traditionally, curative intent surgery for PB implies standard pancreatic resections such as pancreaticoduodenectomies and distal pancreatectomies with splenectomies, surgical procedures that may lead to significant long-term pancreatic functional deficiencies. Postoperative pancreatic functional deficiencies are particularly interesting to children because they may interfere with their development, considering their long life expectancy and the significant role of pancreatic functions in their nutritional status and growth. Thus, organ-sparing pancreatectomies, such as spleen-preserving distal pancreatectomies and central pancreatectomies, are emerging in specific tumoral pathologies in children. However, data about organ-sparing pancreatectomies' potential role in curative-intent PB surgery in children are scarce. Based on the literature data, the current review aims to present the early and late outcomes of pancreatectomies in children (including long-term deficiencies and their potential impact on the development and quality of life), particularly for PB, and further explore the potential role of organ-sparing pancreatectomies for PB. Organ-sparing pancreatectomies are associated with better long-term pancreatic functional outcomes, particularly central pancreatectomies, and have a reduced impact on children's development and quality of life without jeopardizing their oncological safety. The long-term preservation of pancreatic functions should not be disregarded when performing pancreatectomies for PB in children. A subset of patients with PB might benefit from organ-sparing pancreatectomies, particularly from central pancreatectomies, with the same oncological results as standard pancreatectomies but with significantly less impact on long-term functional outcomes.
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Affiliation(s)
- Traian Dumitrascu
- Division of Surgical Oncology, Fundeni Clinical Institute, Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Fundeni Street no. 258, 022328 Bucharest, Romania
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3
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Jones RE, Zagory JA, Tatum M, Tsui WS, Murphy J. A retrospective analysis of pancreas operations in children. Transl Gastroenterol Hepatol 2021; 6:39. [PMID: 34423160 PMCID: PMC8343552 DOI: 10.21037/tgh-20-260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/12/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Operative intervention for pediatric pancreas diseases is rare. Our goal is to gain a better understanding of the indications and outcomes relating to pancreas surgery in children. We hypothesized that these operations are safe and effective in this population. METHODS With IRB approval, we performed a retrospective review of data of pediatric patients (<18 years) who underwent pancreas operations at Children's Medical Center in Dallas, Texas from January 2005 to December 2018. These procedures included distal, central and total pancreatectomy, pancreaticoduodenectomy, and lateral pancreatojejunostomy. Demographics, surgical indication, and operative and postoperative outcomes were examined. RESULTS Forty-six children underwent 47 pancreas operations. Pancreatic mass was the most common indication for resection (n=28, 60%), followed by traumatic injury (n=10, 21%) and chronic pancreatitis (n=8, 17%). The overall complication rate was 0.55 (range, 0-3) complications per procedure, including 4 pancreatic leaks. The overall unexpected hospital visit rate (emergency department and readmissions) was 0.76 (range, 0-6) visits per patient. There were no mortalities. CONCLUSIONS While pancreas operations are rare procedures in children, our data demonstrate clear indications in this population with an associated low complication rate. This retrospective series highlights the role of pancreas resection in children.
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Affiliation(s)
- R. Ellen Jones
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jessica A. Zagory
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Medical Center, 1935 Medical District Drive, Dallas, TX, USA
| | - Micah Tatum
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Wei Shan Tsui
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joseph Murphy
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Medical Center, 1935 Medical District Drive, Dallas, TX, USA
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4
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Solid pseudo papillary tumor of the pancreas in a 7-year-old girl. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kim MS, Park H, Lee S, Yoo SY, Cho SY, Lee SK, Jin DK. Clinical characteristics, treatment outcomes, and occurrence of diabetes mellitus after pancreatic resection of solid pseudopapillary tumor in children and adolescents: A single institution experience with 51 cases. Pancreatology 2021; 21:509-514. [PMID: 33509684 DOI: 10.1016/j.pan.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/25/2020] [Accepted: 01/15/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Solid pseudopapillary tumors (SPTs) are rare, but they comprise the majority of pediatric pancreatic neoplasms. However, studies on these conditions in pediatric patients are lacking. The aim of this study was to investigate the clinical characteristics and treatment outcomes in children and adolescents with SPTs. METHODS This retrospective study included 51 patients with SPTs who had undergone pancreatic tumor resection before the age of 19 years at Samsung Medical Center in Korea (from November 1994 to August 2020). We investigated the postoperative outcomes. RESULTS Of the 51 patients with SPTs (female, 88.2%), the median age at diagnosis was 14 years (range, 8-19). The most common symptom was abdominal pain (60.8%), and 14 patients (27.5%) were asymptomatic. The median maximal tumor diameter was 7 cm (range, 1.4-14), and the pancreatic body and/or tail were involved in 68.6% of patients. The short-term complication rate was 21.5%, and the recurrence rate was 5.9%. New-onset diabetes mellitus (NODM) occurred in four patients. CONCLUSIONS The ideal treatment for SPTs is complete resection of the tumor; however, long-term postoperative complications including NODM should be monitored carefully, particularly in children and adolescents.
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Affiliation(s)
- Min-Sun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyojung Park
- Department of Pediatrics, Seongnam Citizens Medical Center, Gyeonggi-do, Republic of Korea
| | - Sanghoon Lee
- Department of Pediatric Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - So Young Yoo
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Yoon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Suk-Koo Lee
- Department of Pediatric Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Kyu Jin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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6
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Xuan NM, Tuong TTK, Huy HQ. A Rare Case of Large Solid Pseudopapillary Tumor in a Child. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923990. [PMID: 32352951 PMCID: PMC7209905 DOI: 10.12659/ajcr.923990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/21/2020] [Accepted: 04/14/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Solid pseudopapillary tumor (SPT) is a rare disease with low-grade malignancy potential of the pancreas. SPT accounts from 0.13% to 2.7% of all exocrine pancreatic tumors. We report an unusual case with a large solid pseudopapillary tumor that was diagnosed and treated in our pediatric hospital. CASE REPORT A 15-year-old girl was incidentally found to have an abdominal mass on ultrasound examination. Computed tomography (CT) scans showed a well-defined tumor that was raised in part of the tail and body of the pancreas. The tumor size at greatest diameter was 18.2 cm. A mass excision was performed to remove the whole tumor, and the histopathological findings confirmed SPT without evidence of malignancy. CONCLUSIONS SPT is a rare disease that mostly affects young female patients. The clinical symptoms of this disease are unspecific. The prognosis of SPT is good, even in case of distant metastasis. Close follow-up is required to detect metastasis so the appropriate treatment method can be chosen.
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Affiliation(s)
- Ngo Minh Xuan
- Department of Pediatrics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Tran Thi Khanh Tuong
- Department of Internal Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Huynh Quang Huy
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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Ihara T, Nomura O, Mori T, Shimojima N. Early Diagnosis of a Pediatric Pancreatic Tumor by Abdominal Physical Examination: A Case Report. J Emerg Med 2020; 58:e211-e214. [PMID: 32317196 DOI: 10.1016/j.jemermed.2020.03.025] [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: 10/30/2019] [Revised: 02/19/2020] [Accepted: 03/18/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Detecting a neoplasm in pediatric patients with acute abdominal pain is difficult, especially when there is no palpable mass. Ihara's maneuver, which allows the physician to apply manual pressure directly on the pancreatic body, is a useful palpation method of diagnosing acute pancreatitis in children. We report a case of solid pseudopapillary neoplasm of the pancreas (SPNP) detected by Ihara's maneuver. CASE REPORT An otherwise healthy, 15-year-old male visited our emergency department with acute abdominal pain and nausea. His vital signs were appropriate for his age. A physical examination denied peritoneal signs, but Ihara's maneuver induced strong tenderness. His serum amylase and lipase were normal. A contrast-enhanced computed tomography scan revealed a well-defined, 2.2-cm, nonenhanced mass in the pancreatic tail. Laparoscopic distal pancreatectomy was performed, and the diagnosis of SPNP was confirmed. The patient was well postoperatively without any metastasis. SPNP is a rare neoplasm with low malignant potential. Although it typically occurs in young females, it has also been reported in children. The early diagnosis of SPNP is usually challenging because most patients do not have specific symptoms or laboratory findings. In the present case, the SPNP was difficult to detect by palpation because of its size, but Ihara's maneuver induced strong tenderness of the pancreas and led to a diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Ihara's maneuver has the potential to enable early diagnosis not only of pancreatitis but also of pancreatic tumors, such as SPNP.
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Affiliation(s)
- Takateru Ihara
- Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo, Japan
| | - Osamu Nomura
- Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo, Japan; Department of Emergency and Disaster Medicine, Hirosaki University, Aomori, Japan
| | - Takaaki Mori
- Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo, Japan
| | - Naoki Shimojima
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Duodenum-preserving pancreas head resection in the treatment of pediatric benign and low-grade malignant pancreatic tumors. HPB (Oxford) 2020; 22:306-311. [PMID: 31409540 DOI: 10.1016/j.hpb.2019.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/16/2019] [Accepted: 06/20/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND To investigate the safety, feasibility, and complications of using duodenum-preserving pancreas head resection (DPPHR) to treat pediatric benign and low-grade malignant pancreatic head tumors. METHODS Patients with pancreatic head tumors that underwent resection were retrospectively analyzed for perioperative factors and postoperative complications. RESULTS Thirty-five patients with a median age of 10 years at diagnosis were identified. Patients were divided by procedures into the DPPHR (n = 22), local enucleation (n = 7) and pylorus-preserving pancreatoduodenectomy (PPPD, n = 6) groups. No significant difference was found in operation time between the DPPHR and PPPD groups (P > 0.05). Significantly, longer drainage time, duration of somatostatin use and hospital stay were observed in the DPPHR group than in the PPPD group (P < 0.05). The incidences of short-term complications were not significantly different among the three groups (P > 0.05). The incidence of long-term complications was markedly lower in both the DPPHR and local enucleation groups than in the PPPD group (P < 0.05). CONCLUSION DPPHR might be a safe treatment option for pediatric patients with benign and low-grade malignant pancreatic head tumors. The incidence of long-term complications was significantly lower with DPPHR. However, perioperative management might be challenging for surgeons.
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9
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Snajdauf J, Rygl M, Petru O, Nahlovsky J, Frybova B, Durilova M, Mixa V, Keil R, Kyncl M, Kodet R, Whitley A. Indications and outcomes of duodenum-preserving resection of the pancreatic head in children. Pediatr Surg Int 2019; 35:449-455. [PMID: 30386905 DOI: 10.1007/s00383-018-4410-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 12/23/2022]
Abstract
AIM OF STUDY Duodenum-preserving resection of the pancreatic head (DPRPH) with Roux-en-Y pancreatojejunostomy is a procedure used to remove focal pathological lesions of the pancreatic head. Although predominantly used in adult patients, it is both safe and effective in children. The aim of this study was to review our experience with this procedure, with focus on its indications, complications and long-term outcomes. METHODS A retrospective analysis of pediatric patients who underwent DPRPH between 1994 and 2015 was performed. Patient files were reviewed for demographic, diagnostic, operative and histological details, postoperative complications. Patients were contacted telephonically and sent questionnaires to determine long-term outcomes. RESULTS The study cohort consists of 21 patients, 14 girls and 7 boys, with an average age of 11.72 years (range 3 months to 18.6 years), who underwent DPRPH with end-to-end anastomosis of the jejunum to the pancreatic body (Roux-en-Y anastomosis). In four cases the head and also part of the body of the pancreas was resected. In the remaining 17 cases, only the head of the pancreas was resected. Indications for DPRPH were solid pseudopapillary tumor of the pancreas (n = 10), trauma (n = 8), pancreas divisum (n = 1), focal congenital hyperinsulinism (n = 1) and pancreatic cyst (n = 1). The length of follow-up ranged from 1 to 22 years (average 9.66). One patient developed a biliary fistula, which closed spontaneously within 2 weeks after stent insertion. A recurrence of abdominal pain was reported in two patients, occurring at 7 months after the operation in one patient and at 1 year in the other. Pancreatic endocrine insufficiency did not occur in any of the 21 patients. Seven patients currently require a low fat diet, five of which need pancreatic enzyme supplementation. An additional two patients need enzyme supplementation without dietary restriction. CONCLUSION DPRPH is a safe and effective procedure for the treatment of large focal pathological lesions of the pancreatic head in children. As a less invasive procedure than pancreatoduodenectomy, it is more appropriate for the developing child.
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Affiliation(s)
- Jiri Snajdauf
- Department of Pediatric Surgery, Institute of Postgraduate Medicine, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Michal Rygl
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Ondrej Petru
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Jiri Nahlovsky
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.
| | - Barbora Frybova
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Marianna Durilova
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Vladimir Mixa
- Department of Anesthesiology and Intensive Care Medicine, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Radan Keil
- Department of Internal Medicine, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Martin Kyncl
- Department of Radiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Roman Kodet
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Adam Whitley
- Department of Surgery, University Hospital Kralovske Vinohrady, Prague, Czech Republic.,Department of Anatomy, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
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Crocoli A, Grimaldi C, Virgone C, De Pasquale MD, Cecchetto G, Cesaro S, Bisogno G, Cecinati V, Narciso A, Alberti D, Ferrari A, Dall'Igna P, Spada M, Inserra A. Outcome after surgery for solid pseudopapillary pancreatic tumors in children: Report from the TREP project-Italian Rare Tumors Study Group. Pediatr Blood Cancer 2019; 66:e27519. [PMID: 30362240 DOI: 10.1002/pbc.27519] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/12/2018] [Accepted: 10/01/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Solid pseudopapillary pancreatic tumors (SPPT) are an extremely rare entity in pediatric patients. Even if the role of radical surgical resection as primary treatment is well established, data about follow-up after pancreatic resection in children are scant. METHODS A retrospective review of data from the Italian Pediatric Rare Tumor Registry (TREP) was performed. Short-term (<30 days) and long-term complications of different surgical resections, as well as long-term follow-up were evaluated. RESULTS From January 2000 to present, 43 patients (male:female = 8:35) were enrolled. The median age at diagnosis was 13.2 years (range, 7-18). Nine children had an incidental diagnosis, whereas 26 complained of abdominal pain and 4 of palpable mass. Tumors arose either from the head of pancreas (n = 14) or from body/tail (n = 29): only one patient presented with metastatic disease. Resection was complete in all patients (cephalic duodenopancreatectomy vs distal resection). At follow-up (median, 8.4 years; range, 0-17 years), one recurrence occurred in a patient with intraoperative rupture. All patients are alive. Three pancreatic fistulas occurred in the body/tail group, whereas four complications occurred in the head group (one ileal ischemia, two stenosis of the pancreatic duct, and one chylous fistula). CONCLUSION Surgery is the best therapeutic option for these tumors; hence, complete resection is mandatory. Extensive resections, including cephalic duodenopancreatectomy, are safe when performed in specialized centers. Long-term follow-up should be aimed to detect tumor recurrence and to evaluate residual pancreatic function.
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Affiliation(s)
- Alessandro Crocoli
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chiara Grimaldi
- Department of Pediatric Surgery and Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Calogero Virgone
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | | | - Giovanni Cecchetto
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Simone Cesaro
- Pediatric Hematology-Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Valerio Cecinati
- Pediatric Hematology and Oncology Unit, Department of Hematology, Transfusion Medicine and Biotechnology, Pescara, Italy
| | - Alessandra Narciso
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Daniele Alberti
- Pediatric Surgery Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Patrizia Dall'Igna
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Marco Spada
- Department of Pediatric Surgery and Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Inserra
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Mylonas KS, Doulamis IP, Tsilimigras DI, Nasioudis D, Schizas D, Masiakos PT, Kelleher CM. Solid pseudopapillary and malignant pancreatic tumors in childhood: A systematic review and evidence quality assessment. Pediatr Blood Cancer 2018; 65:e27114. [PMID: 29697193 DOI: 10.1002/pbc.27114] [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: 11/09/2017] [Revised: 02/22/2018] [Accepted: 03/18/2018] [Indexed: 12/15/2022]
Abstract
A systematic review of 32 studies reporting on 489 children with pancreatic tumors was performed. The most prevalent histologic subtype was solid pseudopapillary tumor (SPT) (61.3%). Pancreaticoduodenectomy was the most commonly performed operation (48%). Neoadjuvant chemo/radiotherapy was utilized in 3.9, 36.2, 25, and 27.8% of patients with SPTs, pancreatoblastomas (PBLs), neuroendocrine tumors, and exocrine carcinomas, respectively. Adjuvant chemotherapy (75.6%) and radiation (34%) were most commonly utilized in PBLs. All-cause mortality was highest in exocrine carcinomas (50%). Overall, 98.8% of patients with SPTs survived. PBL exhibited the highest recurrence rate (14.7%) within a mean of 23.5 months.
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Affiliation(s)
- Konstantinos S Mylonas
- Department of Pediatric Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Pediatrics Working Group, Society of Junior Doctors, Athens, Greece
| | - Ilias P Doulamis
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Diamantis I Tsilimigras
- Surgery Working Group, Society of Junior Doctors, Athens, Greece.,First Department of Surgery, Laiko General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Nasioudis
- Surgery Working Group, Society of Junior Doctors, Athens, Greece.,Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dimitrios Schizas
- Surgery Working Group, Society of Junior Doctors, Athens, Greece.,First Department of Surgery, Laiko General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Peter T Masiakos
- Department of Pediatric Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Cassandra M Kelleher
- Department of Pediatric Surgery, Massachusetts General Hospital, Boston, Massachusetts
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13
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Does Computed Tomography Have the Ability to Differentiate Aggressive From Nonaggressive Solid Pseudopapillary Neoplasm? J Comput Assist Tomogr 2018; 42:405-411. [PMID: 29287021 DOI: 10.1097/rct.0000000000000698] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of the study was to assess the ability of contrast-enhanced computed tomography (CECT) to differentiate aggressive from nonaggressive solid pseudopapillary neoplasms (SPNs). MATERIALS AND METHODS Forty treatment-naive patients with pathologically proven pancreatic SPNs were included. Imaging characteristics were determined by consensus of 3 radiologists blinded to histopathologic aggressiveness. All patients underwent 4-phase CECT using a pancreatic protocol. The regions of interest of the tumor and the normal pancreas were documented on all phases. Lymph nodes were considered metastatic if greater than 1.0 cm in short-axis diameter.Fisher exact and Wilcoxon rank-sum tests were used to compare between aggressive and nonaggressive tumors. RESULTS No significant difference was noted between imaging covariates, such as internal hemorrhage, calcification, wall thickness perceptibility, vascular invasion, margins, cystic component, and pancreatic and biliary ductal dilation. Tumors with greater than 62.5 Hounsfield units and progressive enhancement during the delayed phase had aggressive characteristics (P = 0.03). CONCLUSIONS On delayed phase CECT, pathologically aggressive SPNs may show greater enhancement than nonaggressive SPNs.
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14
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Solid Pseudopapillary Neoplasm of the Pancreas in Children and Adults: A National Study of 369 Patients. J Pediatr Hematol Oncol 2018; 40:e233-e236. [PMID: 29240036 DOI: 10.1097/mph.0000000000001049] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor in children, with current evidence limited to single-center studies. We examined treatment and clinical outcomes for pediatric and adult SPN with a national data set. METHODS The 2004 to 2013 National Cancer Data Base was queried to identify all patients diagnosed with SPN. The cohort was stratified by age (pediatric and adult) defined as below 18 years and 18 years and above, respectively. Baseline characteristics and unadjusted outcomes were compared. RESULTS We identified 21 pediatric and 348 adult patients with SPN. Both groups displayed similar demographic composition. Patients were commonly female (90.5% [pediatric] vs. 85.9% [adult], P=0.56) and white (66.7% vs. 68.3%, P=0.74). Tumor location was similar between adults and children. Median tumor size was similar between children and adults (5.9 vs. 4.9 cm, P=0.41). Treatment strategies did not vary between groups. Partial pancreatectomy was the most common resection strategy (71.4% vs. 53.1%, P=0.80). Both groups experienced low mortality (0.0% vs. 0.7% at 5 y, P=0.31). CONCLUSIONS This study provides the largest comparison of pediatric and adult SPN to date. Children with SPN have similar disease severity at presentation, receive similar treatments, and demonstrate equivalent postoperative outcomes compared with their adult counterparts.
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Lee CW, Namgoong JM, Kim DY, Kim SC, Lee SY, Cho Y, Kwon H. Perioperative Outcomes and Surgical Indications of Minimally Invasive Pancreatectomy for Solid Pseudopapillary Tumor in Pediatric Patients. ACTA ACUST UNITED AC 2018. [DOI: 10.13029/aps.2018.24.2.76] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Chong Won Lee
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung-Man Namgoong
- Division of Pediatric Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Dae Yeon Kim
- Division of Pediatric Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Seong Chul Kim
- Division of Pediatric Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Soo Young Lee
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yujeong Cho
- Division of Pediatric Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Hyunhee Kwon
- Division of Pediatric Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
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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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Irtan S, Galmiche-Rolland L, Elie C, Orbach D, Sauvanet A, Elias D, Guérin F, Coze C, Faure-Conter C, Becmeur F, Demarche M, Galifer RB, Galloy MA, Podevin G, Aubert D, Piolat C, De Lagausie P, Sarnacki S. Recurrence of Solid Pseudopapillary Neoplasms of the Pancreas: Results of a Nationwide Study of Risk Factors and Treatment Modalities. Pediatr Blood Cancer 2016; 63:1515-21. [PMID: 27186826 DOI: 10.1002/pbc.25986] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/11/2016] [Accepted: 02/26/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Solid pseudopapillary neoplasms of the pancreas (SPPN) can relapse very late, but little is known about risk factors for recurrence and optimal treatment. We aimed to identify risk factors for recurrence and to analyze treatment modalities in all French pediatric cases of SPPN over the past 20 years. MATERIAL AND METHODS Data were collected from pediatric oncologists and surgeons, and also from adult pancreatic surgeons in order to identify late recurrences. RESULTS Fifty-one patients (41 girls) were identified. Median age at diagnosis was 13.1 years [8.7-17.9]. Abdominal pain was the commonest presenting symptom (32/49, 65%). The tumor was located in the pancreatic head in 24 patients (47%). Preoperative biopsy or cytology was performed in 14 cases (28%). All patients were operated with a median of 23 days [0-163] after diagnosis. The rate of postoperative morbidity was 29%. With a median follow-up of 65 months [0.3-221], the overall and event-free survival was 100% and 71%, respectively. Seven patients (13.7%) relapsed with a median of 43 months [33-94] after initial surgery. Six were treated surgically, either alone (n = 3) or with perioperative chemotherapy (n = 2) or hyperthermic intraperitoneal chemotherapy (n = 1). One patient in whom further treatment was not feasible was still alive at last news. Risk factors for recurrence were positive surgical margins (P = 0.03) and age less than 13.5 years at diagnosis (P = 0.03). CONCLUSIONS SPPN recurrence in this pediatric series was a rare and late event that did not undermine overall survival. Complete surgical removal of recurrent tumors appears to be the best option.
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Affiliation(s)
- Sabine Irtan
- Department of Pediatric Surgery, Necker Enfants-Malades Hospital-Université Paris Descartes, Sorbonne Paris Cite, Paris, France
| | - Louise Galmiche-Rolland
- Department of Pathology, Necker Enfants-Malades Hospital-Université Paris Descartes, Sorbonne Paris Cite, Paris, France
| | - Caroline Elie
- Clinical Research Unit/Clinical Investigation Centre, Necker Enfants-Malades Hospital, Paris, France
| | - Daniel Orbach
- Department of Pediatrics, Adolescents, Young Adults, Institut Curie, Groupe Fracture, French Rare Pediatric Tumors Group, Paris, France
| | - Alain Sauvanet
- Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, Hôpital Beaujon, Clichy, France
| | - Dominique Elias
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Florent Guérin
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud, Bicêtre Hospital, Université Paris XI, Le Kremlin-Bicêtre, France
| | - Carole Coze
- Department of Pediatric Hematology-Oncology, Aix-Marseille Univ and APHM, Hôpital d' Enfants de La Timone, Marseille, France
| | | | - François Becmeur
- Department of Pediatric Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Martine Demarche
- Department of Pediatric Surgery, CHR de la Citadelle, Liège, Belgium
| | - René Benoît Galifer
- Department of Pediatric Surgery, Lapeyronie-Arnaud de Villeneuve Hospital, Montpellier, France
| | - Marie Agnès Galloy
- Department of Pediatric Surgery, Children's Hospital Nancy-Brabois University Hospital, Vandoeuvre-lès-Nancy, France
| | - Guillaume Podevin
- Department of Pediatric Surgery, University Hospital, Angers, France
| | - Didier Aubert
- Department of Pediatric Surgery, University Hospital, Besançon, France
| | - Christian Piolat
- Department of Pediatric Surgery, University Hospital, Grenoble, France
| | - Pascal De Lagausie
- Department of Pediatric Surgery, Aix-Marseille Univ and APHM, Hôpital d'Enfants de La Timone, Marseille, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Necker Enfants-Malades Hospital-Université Paris Descartes, Sorbonne Paris Cite, Paris, France
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Nasher O, Hall NJ, Sebire NJ, de Coppi P, Pierro A. Pancreatic tumours in children: diagnosis, treatment and outcome. Pediatr Surg Int 2015; 31:831-5. [PMID: 26174862 DOI: 10.1007/s00383-015-3727-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2015] [Indexed: 12/24/2022]
Abstract
PURPOSE Pancreatic tumours in children are exceedingly rare and as a result constitute a diagnostic and therapeutic challenge to paediatric surgeons. We reviewed our experience with these rare entities. METHODS Retrospective single institution study on all paediatric pancreatic tumours over a period of 38 years (1973-2011) and literature review. We recorded data relating to the clinical features at presentation, diagnostic evaluation, treatment and outcome. RESULTS Fourteen patients were identified (eight male). The most common symptoms at presentation were abdominal pain, anorexia and vomiting. Two cases were discovered incidentally. There were 12 primary and 2 metastatic tumours. Tumour types were solid pseudopapillary neoplasm (n = 6), insulinoma (n = 3), pancreatoblastoma (n = 1), congenital pancreatic cyst (n = 1), Burkitt lymphoma of the pancreas (n = 1) and metastatic lesions of other primary tumours (n = 2). Twelve were treated with surgical resection including 2 laparoscopically. Post-surgical complications included acute pancreatitis (n = 2) and pancreatic pseudocyst (n = 2). There was one death from a metastatic tumour and treatment is ongoing in one patient. The remainder has survived. CONCLUSION Paediatric pancreatic tumours are rare entities and are usually benign. Clinical symptoms are often non-specific and presentation may be late due to tumour inactivity in case of endocrine neoplasms. For most tumours, surgical resection is the optimal treatment which may be successfully performed laparoscopically when the lesion is in the body or tail of the pancreas. Long-term outcome is generally good.
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Affiliation(s)
- Omar Nasher
- Department of Paediatric Surgery, UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
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Mahida JB, Thakkar RK, Walker J, Shen R, Kenney BD, Prasad V, Aldrink JH. Solid pseudopapillary neoplasm of the pancreas in pediatric patients: A case report and institutional case series. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Jurić I, Pogorelić Z, Stepan JG, Kuzmić IP. Extremely rare presentation of Frantz's tumour: synchronous localisation in the pancreatic head and tail. Scott Med J 2014; 59:e8-e12. [PMID: 25035290 DOI: 10.1177/0036933014543222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Solid pseudopapillary tumour of the pancreas is a rare lesion with low malignant potential occurring predominantly in young women. This is a report of an extremely rare occurrence of synchronous presentation of pseudopapillary tumour in the pancreatic head and tail of a 16-year-old female patient. CASE PRESENTATION The patient presented with a three-month intermittent upper abdominal pain and swelling. Computed tomography scan showed two separate masses, involving the pancreatic head and tail. The patient underwent surgery, where successful tumour enucleation of both tumours was performed. Histological report confirmed solid pseudopapillary tumour of the pancreas with the low malignant potential. CONCLUSION To the best of our knowledge, this is the first report of synchronous presentation of pseudopapillary tumour of the pancreas.
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Affiliation(s)
- Ivo Jurić
- Pediatric Surgeon (Attending Physician), Department of Pediatric Surgery, Split University Hospital Centre and Split University School of Medicine, Croatia
| | - Zenon Pogorelić
- Pediatric Surgeon (Attending Physician), Department of Pediatric Surgery, Split University Hospital Centre and Split University School of Medicine, Croatia
| | | | - Ivana Prusac Kuzmić
- Pathologist (Attending Physician), Department of Pathology, Split University Hospital Centre and Split University School of Medicine, Croatia
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Duodenum-preserving pancreatic head resection in solid pseudopapillary neoplasm-Report of a case. Int J Surg Case Rep 2014; 5:567-70. [PMID: 25105768 PMCID: PMC4201024 DOI: 10.1016/j.ijscr.2014.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 06/28/2014] [Accepted: 07/02/2014] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Solid pseudopapillary neoplasm (SPPN) was first characterized by Virginia Frantz in 1959. The duodenum-preserving pancreatic head resection (DPPHR) has been described as treatment for low-grade malignant tumors of the head of the pancreas including eight cases of SPPN. PRESENTATION OF CASE: A 16-year-old white female patient presented with abdominal pain and dyspepsia. Computed tomography scan of abdomen showed a 10 × 9 × 10 cm3 lesion on the pancreatic head. After radiological diagnosis of SPPN the patient was submitted to DPPHR. Resection was achieved with clear margins. Immunohistochemical study demonstrated positivity for progesterone receptor, β-catenin, cytoplasmic paranuclear dot-like CD99, negativity for chromogranin and S100 protein and Ki 67 index of 1%. DISCUSSION A large encapsulated pancreatic mass with well-defined borders that contains areas of calcifications and intratumoral hemorrhage on CT scan in a young female is virtually diagnostic of an SPPN. A particular dot-like intracytoplasmic expression of CD99 appears to be highly unique for SPPN CONCLUSION DPPHR should be considered in cases of SPPN in the pancreas head if there is no compromise with oncologic radicality.
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Park JY, Kim SG, Park J. Solid pseudopapillary tumor of the pancreas in children: 15-year experience at a single institution with assays using an immunohistochemical panel. Ann Surg Treat Res 2014; 86:130-5. [PMID: 24761421 PMCID: PMC3994619 DOI: 10.4174/astr.2014.86.3.130] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 11/11/2013] [Accepted: 11/11/2013] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The aim of this study was to analyze the clinicopathological characteristics of solid pseudopapillary tumor (SPT) of the pancreas and to utilize an immunohistochemical panel to identify specific markers of the disease. METHODS Eleven patients diagnosed with and treated for SPT of the pancreas over the past 15 years were retrospectively analyzed. RESULTS The 11 patients consisted of 8 females and 3 males, of mean age at operation of 13.5 years (range, 10 to 18 years). The most frequent presenting symptom was abdominal pain and/or mass. One patient was referred with hemoperitoneum due to traumatic tumor rupture. The lesions were located in the body, head and tail of the pancreas in four, four, and three patients, respectively. Mean tumor diameter was 7.9 cm (range, 2.5 to 15 cm). Surgical procedures included distal pancreatectomy with splenectomy in four patients, pylorus preserving pancreaticoduodenectomy in four, distal pancreatectomy in two, and subtotal pancreatectomy with splenectomy in one. Mean follow-up was 60.5 months (range, 15 to 126 months). All patients remain alive without tumor recurrence. Immunohistochemical staining showed that all tumors were positive for β-catenin, progesterone receptor (PR), vimentin, and CD99. However, all tumors were negative for E-cadherin and cytokeratin 7 expression. CONCLUSION Patients with SPT of the pancreas have an excellent prognosis after surgical excision. Immunohistochemically, E-cadherin/β-catenin, PR, vimentin, and CD99 would help establish the diagnosis of SPT of the pancreas, although the results of immunohistochemical staining were found to have an indistinct complex immunoprofile.
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Affiliation(s)
- Ji Young Park
- Department of Pathology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang Geol Kim
- Department of Surgery, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jinyoung Park
- Department of Surgery, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Korea
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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: 51] [Impact Index Per Article: 4.3] [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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