Successfully resected pancreatic tumor in pregnancy

Solid pseudopapillary epithelial neoplasm of pancreas in pregnancy: A case report and review of literature

The solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas is an uncommon tumor that accounts for approximately 1%-2% of exocrine pancreatic neoplasms. It predominantly affects female in their second and third decades of life. In this case report, we present a clinical scenario of a 21-year-old pregnant woman who incidentally discovered a solid cystic lesion in her pancreas, exhibiting features suggestive of SPEN. The patient underwent surgery during the second trimester. Management of pregnant females with SPEN poses challenges due to the absence of definitive treatment guidelines, particularly in determining the ideal timing for surgical intervention. Notably, during pregnancy, the presence of a small SPEN does not necessarily require immediate resection. However, if the tumor is of significant size, it can give rise to complications such as tumor rupture, multivisceral resection, recurrence, spontaneous abortion, intrauterine growth restriction, or premature delivery if not addressed. In the existing literature, a common finding is that approximately two-thirds of pregnant females with SPEN underwent surgery in the second trimester, often without complications for the mother or fetus. All these tumors were larger than 8 cm. The decision to operate before or after birth can be individualized based on team discussion. However, delay in surgery may lead to larger tumors and higher risks like bleeding, rupture, multivisceral resection, and recurrence. Therefore, second-trimester surgery seems safer, and lessens dangers, emergency surgery, and tumor recurrence.

Pancreatic Cystic Neoplasms and Pregnancy: A Systematic Review of Surgical Cases and a Case Report of a Fully Laparoscopic Distal Pancreatectomy

BACKGROUND

Mucinous cystic neoplasms and solid pseudopapillary neoplasms are the most common pancreatic tumors occurring in women of fertile age and in pregnant women. The aim of this study is to provide an updated literature review on this association and to present a fully laparoscopic resection of a pregnancy-associated pancreatic cystic neoplasm.

MATERIALS AND METHODS

A systematic literature review was performed using PubMed (MEDLINE), Scopus, Ovid, ISI Web of Science, and Google Scholar for searching. The syntax was (pancr*) AND (cyst*) AND (pregn*) AND (tumor). Only English-language articles describing pancreatic surgical resections were included.

RESULTS

Forty-seven case reports were included. The mean age of the patients was 29.6±5.3. Nine patients (20%) required emergency surgery, 4 (9%) due to cyst rupture, and 5 (11%) due to hemorrhage. Four patients (9%) suffered a miscarriage, and 2 (5%) opted for pregnancy termination; the rest of the women delivered a healthy newborn (86%, n=36). Thirty percent (n=14) of the resected neoplasms were malignant, and among mucinous cystic lesions, this raised to 45% (n=11). All patients diagnosed during the third trimester were resected postpartum, whereas 26/34 (76%) of patients diagnosed during the first 2 trimesters underwent surgery before delivery.

CONCLUSIONS

The most worrisome complications in pregnancy-associated pancreatic cysts are bleeding or rupture. Mucinous cystic neoplasm has a tendency to grow during pregnancy. A postpartum resection was generally preferred when the cystic neoplasm was diagnosed during the third trimester. This report is the first to describe a fully laparoscopic pancreatic resection.

Solid pseudopapillary neoplasm of pancreas with distant metastasis during pregnancy: a diagnostic and treatment challenge

Solid pseudopapillary neoplasms (SPNs) are rare pancreatic cystic neoplasms occurring predominantly in young women and diagnosis is often a challenge. This report describes the case of a 23-year-old primigravida who presented with abnormally elevated liver blood tests at 24 weeks of gestation. Imaging studies were suggestive of SPN with metastatic liver disease. A multidisciplinary team approach decided on a preterm caesarean delivery of a healthy female child at 36 weeks of gestation. Subsequently, a CT-guided biopsy was performed, with confirmation of SPN in the anatomopathological study. Subpartial pancreatectomy, partial gastrectomy, cholecystectomy, total splenectomy and partial hepatectomy were successfully performed. A 3-month control CT scan and positron emission tomography-CT studies revealed disease recurrence with pulmonary and liver metastatic disease. The patient was started on a palliative chemotherapy protocol with good tolerance. To our knowledge this is the first case of a SPN described in pregnancy with distant metastasis and disseminated recurrence after surgical treatment.