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Codjia T, Marique L, Aussilhou B, Ftériche FS, de Mestier L, Rebours V, Cros J, Ruszniewski P, Lévy P, Lesurtel M, Sauvanet A, Dokmak S. Outcome and survival were similar with laparoscopic and open pancreatectomy in 102 solid pseudopapillary neoplasms. Surg Endosc 2024; 38:2169-2179. [PMID: 38448620 DOI: 10.1007/s00464-024-10708-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/21/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Solid pseudopapillary neoplasms of the pancreas (SPNP) are rare tumors predominantly in young women. We report the largest single-center cohort study comparing resection of SPNP by laparoscopic approach (LA) and the open approach (OA). METHOD Between 2001 and 2021, 102 patients (84% women, median age: 30) underwent pancreatectomy for SPNP and were retrospectively studied. Demographic, perioperative, pathological, early and the long-term results were evaluated between patients operated by LA and those by OA. RESULTS Population included 40 LA and 62 OA. There were no significant differences in demographics data between the groups. A preoperative biopsy by endoscopic ultrasound was performed in 45 patients (44%) with no difference between the groups. Pancreatoduodenectomy (PD) was less frequently performed by LA (25 vs 53%, p = 0.004) and distal pancreatectomy (DP) was more frequently performed by LA (40 vs 16%, p = 0.003). In the subgroup analysis by surgical procedure, LA-PD was associated with one mortality, less median blood loss (180 vs 200 ml, p = 0.034) and fewer harvested lymph nodes (11 vs 15, p = 0.02). LA-DP was associated with smaller median tumor size on imaging (40 vs 80mm, p = 0.048), shorter surgery (135 vs 190 min, p = 0.028), and fewer complications according to the median comprehensive complication index score (0 vs 8.7, p = 0.048). LA-Central pancreatectomy was associated with shorter surgery (160 vs 240, p = 0.037), less median blood loss (60 vs 200, p = 0.043), and less harvested lymph nodes (5 vs 2, p = 0.025). After a median follow-up of 60 months, two recurrences (2%) were observed and were unrelated to the approach. CONCLUSIONS The LA for SPNP appears to be safe, should be applied cautiously in case of PD for large lesion, and was not associated with recurrence.
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Affiliation(s)
- Tatiana Codjia
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Lancelot Marique
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Béatrice Aussilhou
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Fadhel Samir Ftériche
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Louis de Mestier
- AP-HP, Hôpital Beaujon, Department of Gastroenterology and Pancreatic Diseases, DMU DIGEST, University Paris Cité, Clichy, France
| | - Vinciane Rebours
- AP-HP, Hôpital Beaujon, Department of Gastroenterology and Pancreatic Diseases, DMU DIGEST, University Paris Cité, Clichy, France
| | - Jérome Cros
- AP-HP, Hôpital Beaujon, Department of Pathology, University Paris Cité, Clichy, France
| | - Philippe Ruszniewski
- AP-HP, Hôpital Beaujon, Department of Gastroenterology and Pancreatic Diseases, DMU DIGEST, University Paris Cité, Clichy, France
| | - Philippe Lévy
- AP-HP, Hôpital Beaujon, Department of Gastroenterology and Pancreatic Diseases, DMU DIGEST, University Paris Cité, Clichy, France
| | - Mickael Lesurtel
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Alain Sauvanet
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Safi Dokmak
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France.
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Chen J, Zong L, Wang P, Liu Y, Zhang H, Chang X, Lu Z, Li W, Ma Y, Yu S, Chen J. Solid Pseudopapillary Neoplasms of the Pancreas: Clinicopathologic Analysis and a Predictive Model. Mod Pathol 2023; 36:100141. [PMID: 36813115 DOI: 10.1016/j.modpat.2023.100141] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/27/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023]
Abstract
Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare. They are considered low-grade malignancies, and a small percentage of patients experience recurrence or metastasis. It is critical to investigate associated biological behavior and identify patients at a risk of relapse. This was a retrospective study of 486 patients with SPNs who were diagnosed between 2000 and 2021. Their clinicopathologic features, including 23 parameters and prognoses were analyzed. Six patients (1.2%) presented with synchronous liver metastasis. A total of 21 patients experienced recurrence or metastasis postoperatively. The overall and disease-specific survival rates were 99.8% and 100%, respectively. The 5- and 10-year relapse-free survival (RFS) rates were 97.4% and 90.2%, respectively. Tumor size, lymphovascular invasion, and the Ki-67 index were independent predictors of relapse. Furthermore, a Peking Union Medical College Hospital-SPN risk model was built to evaluate the risk of relapse and compared it with the American Joint Committee on Cancer tumor staging system (eighth edition, 2017). Risk factors included 3 parameters: tumor size (>9 cm), lymphovascular invasion status (presence), and Ki-67 index (>1%). Risk grades were available for 345 patients, who were divided into 2 groups: (1) low risk (n = 124) and (2) high risk (n = 221). The group with no risk factors was designated as low risk and had a 10-year RFS of 100%. The group associated with 1 to 3 factors was designated as high risk, with a 10-year RFS of 75.3%. Receiver operating characteristic curves were generated, and the area under the curve was 0.791 for our model and 0.630 for the American Joint Committee on Cancer with respect to the cancer staging system. We validated our model in independent cohorts and demonstrated a sensitivity of 98.3%. In conclusion, SPNs are low-grade malignant neoplasms that rarely metastasize, and the 3 selected pathologic parameters can be used to predict their behavior. A novel Peking Union Medical College Hospital-SPN risk model was proposed for routine application to guide the patient counseling in clinical practice.
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Affiliation(s)
- Jingci Chen
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liju Zong
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pengyan Wang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yilin Liu
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongkai Zhang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyan Chang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhaohui Lu
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wencai Li
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yihui Ma
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuangni Yu
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jie Chen
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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3
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Zou Z, Feng L, Peng B, Liu J, Cai Y. Laparoscopic parenchyma-sparing resections for solid pseudopapillary tumors located in the head of pancreas. BMC Surg 2023; 23:140. [PMID: 37208624 DOI: 10.1186/s12893-023-02028-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/06/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Solid pseudopapillary tumor (SPT) of the pancreas is a rare low-grade malignant tumor. Here, we aimed to determine the safety and feasibility of laparoscopic parenchyma-sparing pancreatectomy for SPT located in the pancreatic head. METHODS From July 2014 to February 2022, 62 patients with SPT located in the pancreatic head were operated laparoscopically in two institutions. These patients were divided into two groups according to the operative strategy: laparoscopic parenchyma-sparing pancreatectomy (27 patients, group 1) and laparoscopic pancreaticoduodenectomy (35 patients, group 2). The clinical data were retrospectively collected and analyzed in terms of demographic characteristics, perioperative variables, and long-term follow-up outcomes. RESULTS The demographic characteristics of the patients in the two groups were comparable. Compared to the patients in group 2, those in group 1 required less operative time (263.4 ± 37.2 min vs. 332.7 ± 55.6 min, p < 0.001) and experienced less blood loss (105.1 ± 36.5mL vs. 188.3 ± 150.7 mL, p < 0.001). None of the patients in group 1 had tumor recurrence or metastasis. However, 1 (2.5%) patient in group 2 showed liver metastasis. CONCLUSION Laparoscopic parenchyma-sparing pancreatectomy is a safe and feasible approach for SPT located in the pancreatic head, with favorable long-term functional and oncological results.
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Affiliation(s)
- Zhengdong Zou
- Divison of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lu Feng
- Department of Operation Room of Anesthesia Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Bing Peng
- Divison of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jianhua Liu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Yunqiang Cai
- Divison of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Kloth C, Haggenmüller B, Beck A, Wagner M, Kornmann M, Steinacker JP, Steinacker-Stanescu N, Vogele D, Beer M, Juchems MS, Schmidt SA. Diagnostic, Structured Classification and Therapeutic Approach in Cystic Pancreatic Lesions: Systematic Findings with Regard to the European Guidelines. Diagnostics (Basel) 2023; 13:diagnostics13030454. [PMID: 36766560 PMCID: PMC9914853 DOI: 10.3390/diagnostics13030454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/01/2023] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
Due to the increasing use of cross-sectional imaging techniques and new technical possibilities, the number of incidentally detected cystic lesions of the pancreas is rapidly increasing in everyday radiological routines. Precise and rapid classification, including targeted therapeutic considerations, is of essential importance. The new European guideline should also support this. This review article provides information on the spectrum of cystic pancreatic lesions, their appearance, and a comparison of morphologic and histologic characteristics. This is done in the context of current literature and clinical value. The recommendations of the European guidelines include statements on conservative management as well as relative and absolute indications for surgery in cystic lesions of the pancreas. The guidelines suggest surgical resection for mucinous cystic neoplasm (MCN) ≥ 40 mm; furthermore, for symptomatic MCN or imaging signs of malignancy, this is recommended independent of its size (grade IB recommendation). For main duct IPMNs (intraductal papillary mucinous neoplasms), surgical therapy is always recommended; for branch duct IPMNs, a number of different risk criteria are applicable to evaluate absolute or relative indications for surgery. Based on imaging characteristics of the most common cystic pancreatic lesions, a precise diagnostic classification of the tumor, as well as guidance for further treatment, is possible through radiology.
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Affiliation(s)
- Christopher Kloth
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Benedikt Haggenmüller
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Annika Beck
- Institute of Pathology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Martin Wagner
- Department of Internal Medicine 1, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Marko Kornmann
- Department of General and Visceral Surgery, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Jochen P. Steinacker
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Nora Steinacker-Stanescu
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Daniel Vogele
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Markus S. Juchems
- Department of Diagnostic and Interventional Radiology, Konstanz Hospital, Mainaustraße 35, 78464 Konstanz, Germany
| | - Stefan A. Schmidt
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
- Correspondence: ; Tel.: +49-731-500-61004; Fax: +49-731-500-61005
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Singh S, Zhao Q, Sachs TE, Hartshorn K. Reporting a Case of Solid Pseudopapillary Neoplasm of the Pancreas in a 44-Year-Old Woman with Parallel Analysis of Literature. Case Rep Oncol Med 2023; 2023:1768926. [PMID: 37153719 PMCID: PMC10162882 DOI: 10.1155/2023/1768926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/31/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023] Open
Abstract
We present a distinctive case of solid pseudopapillary neoplasm as seen in a 44-year-old woman who presented with an abdominal mass but unremarkable labs with no elevation in any of the tumor markers. Her symptomatology ranged from typical symptoms suggestive of malignancy such as weight loss, lethargy, and anorexia to complaints like abdominal pain and jaundice. Prior to presenting at our center, she was given no hope or much in terms of treatment options. She was found to have a substantial mass over the body and tail of pancreas with characteristic and typical gross as well as histological features. Subsequently, she underwent a successful surgery and has found herself in remission since.
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Affiliation(s)
- Sargun Singh
- Division of Gastroenterology and Liver Disease, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Qing Zhao
- Department of Pathology, Boston University School of Medicine, Boston, MA, USA
| | - Teviah E. Sachs
- Section of Surgical Oncology, Department of Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Kevan Hartshorn
- Section of Hematology Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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6
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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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Dhali A, Ray S, Das S, Mandal TS, Khamrui S, Gupta A, Ansari Z, Ghosh R, Dhali GK. Clinical profile and outcome of solid pseudopapillary neoplasm of the pancreas: A retrospective study on 28 patients. Int J Surg 2022; 104:106708. [PMID: 35700958 DOI: 10.1016/j.ijsu.2022.106708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Solid pseudopapillary neoplasms (SPN) of the pancreas are rare tumors accounting for 0.9-2.7% of all exocrine pancreatic tumors. Very few studies comprising of more than 10 patients have been published. The aim of the present study is to report on our experience with SPNs over a period of 14 years from a tertiary center of Eastern India. METHODOLOGY Data of all patients whose histopathology reports of surgically resected specimen confirmed SPN were retrospectively reviewed in the present study. RESULTS Twenty-eight patients had a pathologically confirmed diagnosis of SPN. Twenty-five (89.3%) patients were females with a median age of 26 (15-45) years. Abdominal pain (89.2%) was the most common presenting symptom. Abdominal mass was palpable in 12 (42.8%) patients. The mean size of the tumor was 9.03 cm (range, 4-25 cm). The most common location of the tumor was in the body and tail of pancreas (35.7%). The most commonly performed operation was distal pancreaticosplenectomy (n = 17, 60.7%), followed by Whipple's procedure (n = 8, 28.5%). Thirty postoperative complications developed in 23 (82.1%) patients. The operative mortality was 3.5% (n = 1). The median hospital stay was 10 (5-25) days. Over a median follow-up period of 36 months (range), no patient developed recurrence. CONCLUSION Although the size of tumor was quite large at the time of initial presentation, complete surgical resection was possible in all the patients. In experienced hand, surgery can be performed with acceptable perioperative mortality and excellent long-term outcomes.
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Affiliation(s)
- Arkadeep Dhali
- Department of GI Surgery, IPGME&R, School of Digestive & Liver Diseases, Kolkata, India
| | - Sukanta Ray
- Department of GI Surgery, IPGME&R, School of Digestive & Liver Diseases, Kolkata, India.
| | - Somak Das
- Department of GI Surgery, IPGME&R, School of Digestive & Liver Diseases, Kolkata, India
| | - Tuhin Subhra Mandal
- Department of GI Surgery, IPGME&R, School of Digestive & Liver Diseases, Kolkata, India
| | - Sujan Khamrui
- Department of GI Surgery, IPGME&R, School of Digestive & Liver Diseases, Kolkata, India
| | - Arunesh Gupta
- Department of GI Surgery, IPGME&R, School of Digestive & Liver Diseases, Kolkata, India
| | - Zuber Ansari
- Department of GI Surgery, IPGME&R, School of Digestive & Liver Diseases, Kolkata, India
| | - Ranajoy Ghosh
- Department of GI Pathology, IPGME&R, School of Digestive & Liver Diseases, Kolkata, India
| | - Gopal Krishna Dhali
- Department of Gastroenterology, IPGME&R, School of Digestive & Liver Diseases, Kolkata, India
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Dinarvand P, Wang WL, Roy-Chowdhuri S. Utility of SOX11 for the diagnosis of solid pseudopapillary neoplasm of the pancreas on cytological preparations. Cytopathology 2022; 33:216-221. [PMID: 34816516 PMCID: PMC8813899 DOI: 10.1111/cyt.13080] [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: 08/17/2021] [Revised: 11/09/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The diagnosis of solid pseudopapillary neoplasm (SPN) on fine needle aspiration specimens can be challenging because of morphological overlap with other pancreatic neoplasms, including pancreatic neuroendocrine tumour (PanNET). SRY-related high-mobility group box 11 (SOX11) is a recently described sensitive and specific marker for SPN diagnosis. However, SOX11 immunocytochemistry on cytological smears has not been reported. We evaluated the utility of SOX11 for diagnosis of SPN on cytological preparations. METHODS SOX11 immunocytochemistry was performed on Papanicolaou-stained smears and/or corresponding cell blocks from aspirates of 7 SPN and 10 PanNET cases identified between 2005 and 2020. Findings were compared with those for beta-catenin, a frequently used diagnostic marker for SPN. RESULTS Six smears and 6 cell blocks from SPN cases and 8 smears and 10 cell blocks from PanNET cases were available for immunostaining. For SPN, nuclear staining for SOX11 was seen in 6 of 6 (100%) smears and 5 of 6 (83%) cell blocks, with equivocal staining in 1 cell block. In contrast, 7 of 8 (88%) smears and 9 of 10 (90%) cell blocks were negative for SOX11 for PanNet, with equivocal staining seen in 1 case. Beta-catenin immunocytochemistry showed nuclear staining in 6 of 7 (86%) SPN cases and no staining in all 10 (100%) PanNET cases. CONCLUSIONS SOX11 detected by immunocytochemistry can serve as a useful diagnostic marker for SPN, in addition to beta catenin, and can be performed on cytological smears in cases without a cell block preparation.
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Affiliation(s)
- Peyman Dinarvand
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei-Lien Wang
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sinchita Roy-Chowdhuri
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Fogliati A, Garancini M, Uggeri F, Braga M, Gianotti L. Pancreatic Cystic Neoplasms and Pregnancy: A Systematic Review of Surgical Cases and a Case Report of a Fully Laparoscopic Distal Pancreatectomy. Surg Laparosc Endosc Percutan Tech 2021; 32:133-139. [PMID: 34882616 PMCID: PMC9907686 DOI: 10.1097/sle.0000000000001023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/28/2021] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
| | - Mattia Garancini
- Department of Surgery, San Gerardo University Hospital, Monza, Italy
| | - Fabio Uggeri
- School of Medicine and Surgery, Milano-Bicocca University, Milan
- Department of Surgery, San Gerardo University Hospital, Monza, Italy
| | - Marco Braga
- School of Medicine and Surgery, Milano-Bicocca University, Milan
- Department of Surgery, San Gerardo University Hospital, Monza, Italy
| | - Luca Gianotti
- School of Medicine and Surgery, Milano-Bicocca University, Milan
- Department of Surgery, San Gerardo University Hospital, Monza, Italy
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Guimaraes N, Vila Nova C, Oliveira Dias R, Fonseca Pinho J, Valente Cecílio J. Distal Pancreatectomy for Solid Pseudopapillary Tumor of the Pancreas: A Case Report. Cureus 2021; 13:e19880. [PMID: 34858768 PMCID: PMC8614182 DOI: 10.7759/cureus.19880] [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: 11/24/2021] [Indexed: 11/05/2022] Open
Abstract
Solid pseudopapillary tumor (SPT) of the pancreas is a rare tumor, sometimes asymptomatic, mainly affecting young females. It has a low malignant potential, and its complete surgical resection with free margins is the treatment of choice, offering an excellent prognosis. We present the case of a 43-year-old healthy female who was referred to the surgery department for a large abdominal mass found in the abdominal ultrasound. In the course of the study of this mass, an abdominal CT with fine needle aspiration (FNA) was performed, revealing a solid pseudopapillary tumor of the tail of the pancreas. A laparotomic distal pancreatectomy with total splenectomy was performed. A grade B pancreatic fistula occurred on the third postoperative day, and she was released on postoperative day 11. Histopathology study revealed a 10 cm solid pseudopapillary tumor of the pancreas, with cavities filled with hematic content and limited by a partially calcified capsule. SPT is a rare and indolent tumor. Prognosis is highly favorable after an adequate surgical resection, hence the importance of a precise preoperative diagnosis. Therefore, it is important to choose the most appropriate surgical strategy for each patient.
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Affiliation(s)
- Narcisa Guimaraes
- General Surgery, Hospital Distrital da Figueira da Foz, Figueira da Foz, PRT
| | - Carlos Vila Nova
- General Surgery, Hospital Distrital da Figueira da Foz, Figueira da Foz, PRT
| | | | - Joao Fonseca Pinho
- General Surgery, Hospital Distrital da Figueira da Foz, Figueira da Foz, PRT
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Lymphoid Enhancer Binding Factor 1 (LEF1) and Paired Box Gene 8 (PAX8): A Limited Immunohistochemistry Panel to Distinguish Solid Pseudopapillary Neoplasms and Pancreatic Neuroendocrine Tumors. Appl Immunohistochem Mol Morphol 2021; 28:776-780. [PMID: 32723981 DOI: 10.1097/pai.0000000000000830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Solid pseudopapillary neoplasms (SPNs) and pancreatic neuroendocrine tumors (PanNETs) are distinctive entities. However, due to overlapping morphologies, distinguishing them remains a diagnostic challenge. Our study investigates the utility of immunohistochemistry for nuclear lymphoid enhancer binding factor 1 (LEF1) and paired box gene 8 (PAX8) in differentiating these 2 entities. LEF1 and PAX8 immunohistochemistry were performed on fine-needle aspiration cell blocks and surgical resection specimens diagnosed as SPN or PanNET at our institution from January 2007 to August 2016. Eight SPN and 25 PanNET cell blocks and 17 SPN and 34 PanNET surgical resection specimens were examined. On cell blocks, positive staining for LEF1 had high frequency, sensitivity, and specificity for SPN (88%, 88%, and 88%) as did positive staining for PAX8 for PanNET (76%, 76%, and 75%). The findings on surgical resection specimens were consistent with those from cell blocks (LEF1+ in SPN: 100%, 100%, and 97%; PAX8+ in PanNET: 59%, 59%, and 100%). A combined LEF1+/PAX8- phenotype showed high sensitivity and specificity for SPN (cell block: 63% and 100%; surgical specimen: 100% and 98%) as did a LEF1-/PAX8+ phenotype for PanNET (cell block: 64% and 100%; surgical specimen: 59% and 100%). SPN and PanNET exhibit opposite immunophenotypic profiles with LEF1+/PAX8- in SPN and LEF1-/PAX8+ in PanNET. The combination of these 2 stains provides an effective means of distinguishing these 2 entities.
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Vasudevan SA, Ha TAN, Zhu H, Heaton TE, LaQuaglia MP, Murphy JT, Barry WE, Goodhue C, Kim ES, Aldrink JH, Polites SF, Leraas HJ, Rice HE, Tracy ET, Lautz TB, Superina RA, Davidoff AM, Langham MR, Murphy AJ, Bütter A, Davidson J, Glick RD, Grijalva J, Gow KW, Ehrlich PF, Newman EA, Lal DR, Malek MM, Le-Nguyen A, Piché N, Rothstein DH, Short SS, Meyers R, Dasgupta R. Pancreaticoduodenectomy for the treatment of pancreatic neoplasms in children: A Pediatric Surgical Oncology Research Collaborative study. Pediatr Blood Cancer 2020; 67:e28425. [PMID: 32658372 PMCID: PMC7674210 DOI: 10.1002/pbc.28425] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/23/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND To better characterize short-term and long-term outcomes in children with pancreatic tumors treated with pancreaticoduodenectomy (PD). METHODS Patients 21 years of age or younger who underwent PD at Pediatric Surgical Oncology Collaborative (PSORC) hospitals between 1990 and 2017 were identified. Demographic, clinical information, and outcomes (operative complications, long-term pancreatic function, recurrence, and survival) were collected. RESULTS Sixty-five patients from 18 institutions with a median age of 13 years (4 months-22 years) and a median (IQR) follow-up of 2.8 (4.3) years were analyzed. Solid pseudopapillary tumor of the pancreas (SPN) was the most common histology. Postoperative complications included pancreatic leak in 14% (n = 9), delayed gastric emptying in 9% (n = 6), marginal ulcer in one patient, and perioperative (30-day) death due to hepatic failure in one patient. Pancreatic insufficiency was observed in 32% (n = 21) of patients, with 23%, 3%, and 6% with exocrine, or endocrine insufficiencies, or both, respectively. Children with SPN and benign neoplasms all survived. Overall, there were 14 (22%) recurrences and 11 deaths (17%). Univariate analysis revealed non-SPN malignant tumor diagnosis, preoperative vascular involvement, intraoperative transfusion requirement, pathologic vascular invasion, positive margins, and need for neoadjuvant chemotherapy as risk factors for recurrence and poor survival. Multivariate analysis only revealed pathologic vascular invasion as a risk factor for recurrence and poor survival. CONCLUSION This is the largest series of pediatric PD patients. PD is curative for SPN and benign neoplasms. Pancreatic insufficiency is the most common postoperative complication. Outcome is primarily associated with histology.
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Affiliation(s)
- Sanjeev A. Vasudevan
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children’s Surgical Oncology Program, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, US
| | - Tu-Anh N. Ha
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children’s Surgical Oncology Program, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, US
| | - Huirong Zhu
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children’s Surgical Oncology Program, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, US
| | - Todd E. Heaton
- Division of Pediatric Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, US
| | - Michael P. LaQuaglia
- Division of Pediatric Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, US
| | - Joseph T. Murphy
- Division of Pediatric Surgery, UT Southwestern Medical School, Children’s Medical Center, Dallas, TX, US
| | - Wesley E. Barry
- Division of Pediatric Surgery, Department of Surgery, Children’s Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, US
| | - Catherine Goodhue
- Division of Pediatric Surgery, Department of Surgery, Children’s Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, US
| | - Eugene S. Kim
- Division of Pediatric Surgery, Department of Surgery, Children’s Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, US
| | - Jennifer H. Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, US
| | - Stephanie F. Polites
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, US
| | - Harold J Leraas
- Division of Pediatric Surgery, Duke University Medical Center, Durham, NC, US
| | - Henry E Rice
- Division of Pediatric Surgery, Duke University Medical Center, Durham, NC, US
| | - Elisabeth T Tracy
- Division of Pediatric Surgery, Duke University Medical Center, Durham, NC, US
| | - Timothy B Lautz
- Division of Pediatric Surgery, Division of Transplant Surgery, Ann & Robert H Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, IL, US
| | - Riccardo A Superina
- Division of Pediatric Surgery, Division of Transplant Surgery, Ann & Robert H Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, IL, US
| | - Andrew M. Davidoff
- Department of Surgery, St. Jude Children’s Research Hospital, University of Tennessee Health Science Center, Memphis, TN, US
| | - Max R. Langham
- Department of Surgery, St. Jude Children’s Research Hospital, University of Tennessee Health Science Center, Memphis, TN, US
| | - Andrew J. Murphy
- Department of Surgery, St. Jude Children’s Research Hospital, University of Tennessee Health Science Center, Memphis, TN, US
| | - Andreana Bütter
- Division of Pediatric Surgery, Children’s Hospital, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jacob Davidson
- Division of Pediatric Surgery, Children’s Hospital, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Richard D. Glick
- Division of Pediatric Surgery, Cohen Children’s Medical Center, Zucker School of Medicine at Hofstra/Northwell, Queens, NY, US
| | - James Grijalva
- Division of Pediatric Surgery, Seattle Children’s Hospital, Seattle, WA, US
| | - Kenneth W. Gow
- Division of Pediatric Surgery, Seattle Children’s Hospital, Seattle, WA, US
| | - Peter F. Ehrlich
- Department of Surgery, C.S. Mott Children’s Hospital, The University of Michigan, Ann Arbor, MI, US
| | - Erika A. Newman
- Department of Surgery, C.S. Mott Children’s Hospital, The University of Michigan, Ann Arbor, MI, US
| | - Dave R. Lal
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, US
| | - Marcus M. Malek
- Division of Pediatric General and Thoracic Surgery, Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, US
| | - Annie Le-Nguyen
- Division of Pediatric Surgery, CHU Sainte-Justine, University of Montreal, Montreal, Qc, Canada
| | - Nelson Piché
- Division of Pediatric Surgery, CHU Sainte-Justine, University of Montreal, Montreal, Qc, Canada
| | - David H. Rothstein
- Department of Pediatric Surgery, John R. Oishei Children’s Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, US
| | - Scott S. Short
- Division of Pediatric Surgery, Primary Children’s Hospital, University of Utah School of Medicine, Salt Lake City, UT, US
| | - Rebecka Meyers
- Division of Pediatric Surgery, Primary Children’s Hospital, University of Utah School of Medicine, Salt Lake City, UT, US
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, US
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A Review of Clinicopathological Characteristics and Treatment of Solid Pseudopapillary Tumor of the Pancreas with 2450 Cases in Chinese Population. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2829647. [PMID: 32685461 PMCID: PMC7352122 DOI: 10.1155/2020/2829647] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/20/2020] [Indexed: 02/07/2023]
Abstract
Background Solid pseudopapillary tumor of the pancreas (SPTP) has been reported as a rare disease with low malignant potential. The aim of this study was to summarize experiences of the diagnosis and treatment for the patients reported in the Chinese population. Method 2450 SPTP cases reported in English and Chinese literature before Jan 2020 were for our review and analysis retrospectively. Result There are 389 male cases and 2061 female cases, and the ratio of male/female was 1 : 5.3. The average age was 29.3 years. The main clinical symptoms were upper abdominal pain and bloating discomfort in 51.6% of the cases and epigastric mass. 38.6% of the tumor was located at the head of the pancreas and 55.4% at the body and tail of the pancreas. The most frequent operative styles were tumor enucleation (38.4%). Pathology showed that the average diameter of the tumor was 8.2 cm and 12.3% of SPTP was malignant. 98.3% of cases had favorable survival. Conclusions SPTP is a rare indolent tumor occurring mainly in young women, and the main clinical performances are abdominal mass and abdominal pain; most tumors are distributed at the head and the tail of the pancreas; the prognosis after complete resection is excellent.
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Ma YY, Chen JB, Shi JJ, Niu LZ, Xu KC. Cryoablation for liver metastasis from solid pseudopapillary tumor of the pancreas: A case report. World J Clin Cases 2020; 8:398-403. [PMID: 32047791 PMCID: PMC7000946 DOI: 10.12998/wjcc.v8.i2.398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/16/2019] [Accepted: 12/22/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Solid pseudopapillary tumor (SPT) of the pancreas is a rare pancreatic tumor and 10% to 15% of cases are associated with metastasis. Cryoablation is a new method that can induce tumor necrosis, and treatment of tumors by cryoablation can cause anti-tumor immune responses.
CASE SUMMARY A 16-year-old woman with SPT of the pancreas developed liver metastases 5.3 years after complete resection of the primary pancreatic tumor. She was admitted with chief complaints of abdominal pain in the upper abdomen and a weight loss of approximately 5 kg over 4 mo. Carbohydrate antigen (CA) 125, carcinoembryonic antigen, and CA 199 were normal. An abdominal computed tomography scan found multiple nodules in the right lobe of the liver that measured approximately 13.5 cm × 10.8 cm × 21.4 cm. Immunohistochemical staining results showed that CD10 and CD56 were positive, and the patient was diagnosed with SPT of the pancreas with liver metastasis. The patient underwent percutaneous cryoablation and interventional embolization. During the 5-year follow-up, the patient remained disease-free after cryoablation, with relatively normal immune function.
CONCLUSION Herein, we for the first time report the treatment of liver metastasis from SPT of the pancreas using cryoablation plus interventional embolization, which could be a promising alternative therapy for pancreatic SPT liver metastasis.
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Affiliation(s)
- Yang-Yang Ma
- Central Laboratory, Fuda Cancer Hospital, Jinan University, Guangzhou 510665, Guangdong Province, China
| | - Ji-Bing Chen
- Central Laboratory, Fuda Cancer Hospital, Jinan University, Guangzhou 510665, Guangdong Province, China
| | - Juan-Juan Shi
- Department of Oncology, Fuda Cancer Hospital, Jinan University, Guangzhou 510665, Guangdong Province, China
| | - Li-Zhi Niu
- Department of Oncology, Fuda Cancer Hospital, Jinan University, Guangzhou 510665, Guangdong Province, China
| | - Ke-Chen Xu
- Department of Oncology, Fuda Cancer Hospital, Jinan University, Guangzhou 510665, Guangdong Province, China
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Lin X, Lin R, Lu F, Chen Y, Huang H. Surgical Management of Solid Pseudopapillary Neoplasms of Pancreas: A Single-Center Experience of 60 Patients. Dig Surg 2020; 37:348-354. [PMID: 31958791 DOI: 10.1159/000505062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/22/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare neoplasms, and the selection of surgical approaches is still under debate. The aim of this study was to analyze the clinicopathological characteristics and surgical outcomes of SPN patients and to compare the short-term and long-term outcomes between conventional operations and parenchyma-preserving operations. METHODS Patients who underwent pancreatic resection for SPNs between February 2010 and May 2019 in Fujian Medical University Union Hospital were identified. Clinicopathological details, perioperative data, and long-term follow-up results were retrospectively analyzed. RESULTS Sixty patients underwent surgical resection for SPNs during the study period: 48 females and 12 males. The mean age was 32.2 years. All patients underwent margin-negative surgical resection. The median follow-up period was 47 months (range: 3~118 months). One patient developed liver metastases 14 months after the operation and received local ablation therapy. All patients were alive during the follow-up. The incidence of postoperative pancreatic fistula was higher in the parenchyma-preserving surgery group than in the conventional surgery group (40.0 vs. 11.1%, p = 0.034). There was no significant difference in the tumor recurrence rate between the 2 groups. Eight (17.7%) and 6 patients (13.3%) in the conventional surgery group demonstrated endocrine and exocrine pancreatic insufficiency, respectively; furthermore, no patients in the parenchyma-preserving surgery group had endocrine or exocrine pancreatic insufficiency, but the incidences were not significantly different between the 2 groups. CONCLUSIONS Margin-negative surgical resection of SPNs yields a very low rate of tumor recurrence and excellent long-term survival.
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Affiliation(s)
- Xianchao Lin
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ronggui Lin
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Fengchun Lu
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yanchang Chen
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Heguang Huang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China,
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Outcome and prognosis after pancreatectomy in patients with solid pseudopapillary neoplasms. Pancreatology 2019; 19:699-709. [PMID: 31227367 DOI: 10.1016/j.pan.2019.06.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/30/2019] [Accepted: 06/12/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Solid pseudopapillary neoplasms (SPN) are rare and represent approximately 4% of all cystic pancreatic tumors. The prognosis is excellent, although 10-15% of SPN patients show metastasis at the time of surgery or tumor recurrence during follow-up after pancreatectomy. Aim of the study was to analyze surgical management, risk factors for malignancy as well as long-term outcome and prognosis of this distinct tumor entity. METHOD All patients with pancreatic resection for SPN between 10/2001 and 07/2018 in the authors' institution were identified from a prospective database. Clinicopathologic details, perioperative data and long-term follow-up results were retrospectively analyzed. RESULTS Fifty-two patients were identified, 44 (85%) of them were female and the median age was 29 years (IQR 9-71). Seven (13%) patients showed a malignant behaviour of SPN with N1 (n = 2) or M1 (n = 1) disease at resection; 5 patients developed tumor recurrence, after a median of 21 months. During follow-up time (median 54 months) all patients were alive, the 5- and 10-year rates for disease-free survival were 89.0% and 81.6%, respectively. Significant risk factors for recurrence were age <18 years (p = 0.0087) and parenchyma-preserving surgical approaches (p = 0.0006). The postoperative long-term outcome showed ECOG = 0-1 in all patients, with resection related exocrine insufficiency in 20 (41%) and diabetes mellitus in 2 (4%) patients. CONCLUSIONS Age < 18 years is a significant risk factor for malignancy in SPN, and parenchyma preserving resections harbor a significant risk for tumor recurrence. As recurrence may occur late, a systematic life-long follow-up should be performed.
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Yalçın B, Yağcı‐Küpeli B, Ekinci S, Orhan D, Oğuz B, Varan A, Kutluk T, Akyüz C. Solid pseudopapillary neoplasm of the pancreas in children: Hacettepe experience. ANZ J Surg 2019; 89:E236-E240. [DOI: 10.1111/ans.15111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/15/2018] [Accepted: 01/25/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Bilgehan Yalçın
- Department of Pediatric OncologyHacettepe University Faculty of Medicine Ankara Turkey
| | - Begül Yağcı‐Küpeli
- Department of Pediatric OncologyHacettepe University Faculty of Medicine Ankara Turkey
- Department of Pediatric Hematology/OncologyAdana City Education and Research Hospital, Sağlık Bilimleri University Adana Turkey
| | - Saniye Ekinci
- Department of Pediatric SurgeryHacettepe University Faculty of Medicine Ankara Turkey
| | - Diclehan Orhan
- Department of PathologyHacettepe University Faculty of Medicine Ankara Turkey
| | - Berna Oğuz
- Department of RadiologyHacettepe University Faculty of Medicine Ankara Turkey
| | - Ali Varan
- Department of Pediatric OncologyHacettepe University Faculty of Medicine Ankara Turkey
| | - Tezer Kutluk
- Department of Pediatric OncologyHacettepe University Faculty of Medicine Ankara Turkey
| | - Canan Akyüz
- Department of Pediatric OncologyHacettepe University Faculty of Medicine Ankara Turkey
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Coelho JCU, da Costa MAR, Ramos EJB, Torres AR, Savio MC, Claus CMP. Surgical Management of Solid Pseudopapillary Tumor of the Pancreas. JSLS 2019; 22:JSLS.2018.00032. [PMID: 30740012 PMCID: PMC6365096 DOI: 10.4293/jsls.2018.00032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and Objectives: Although solid pseudopapillary tumor (SPT) of the pancreas is rare, its diagnosis has increased severalfold in the past decades. We present our experience in the management of SPT, including a patient who experienced tumor rupture during laparoscopy pancreatic resection. Methods: Data on all patients with SPT who were subjected to surgical treatment were retrospectively obtained. Results: Of 20 patients evaluated, 17 (85%) were females. The mean age was 31 years. Tumor size varied from 2.7 × 1.5 to 13.5 × 10.0 cm, with a mean of 6.4 × 7.6 cm. The most common location was the tail and/or body of the pancreas (14 patients [70%]). Pancreatic tumor resection was performed in 19 patients (50%). The type of resection depended on tumor location and size: distal pancreatectomy (n = 13), pancreatoduodenectomy (n = 5), and central pancreatectomy (n = 1) Pancreatic resection was performed via laparoscopy in 7 patients who underwent distal pancreatectomy. Tumor resection was not performed in only 1 patient (5%), due to invasion of mesenteric vessels and presence of liver metastases. One patient had tumor rupture during laparoscopic resection, with no apparent macroscopic dissemination of the tumor. All 19 patients who underwent SPT resection had no tumor recurrence, including a patient with capsule invasion and another patient with tumor rupture during surgical dissection. The mean follow-up time was 38 months (range, 6–72 months). Conclusion: Complete SPT resection is possible in most patients, with a low recurrence rate. Because of its large size, laparoscopic resection of SPT's should be performed only by experienced surgeons to avoid tumor rupture.
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Affiliation(s)
- Julio C U Coelho
- Division of Gastrointestinal Surgery of the Hospital Nossa Senhora das Graças and Clinical Hospital of the Federal University of Parana, Curitiba, Brazil
| | - Marco A R da Costa
- Division of Gastrointestinal Surgery of the Hospital Nossa Senhora das Graças and Clinical Hospital of the Federal University of Parana, Curitiba, Brazil
| | - Eduardo J B Ramos
- Division of Gastrointestinal Surgery of the Hospital Nossa Senhora das Graças and Clinical Hospital of the Federal University of Parana, Curitiba, Brazil
| | - André Ritzmann Torres
- Division of Gastrointestinal Surgery of the Hospital Nossa Senhora das Graças and Clinical Hospital of the Federal University of Parana, Curitiba, Brazil
| | - Mariane Christina Savio
- Division of Gastrointestinal Surgery of the Hospital Nossa Senhora das Graças and Clinical Hospital of the Federal University of Parana, Curitiba, Brazil
| | - Christiano M P Claus
- Division of Gastrointestinal Surgery of the Hospital Nossa Senhora das Graças and Clinical Hospital of the Federal University of Parana, Curitiba, Brazil
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Tsujie M, Wakasa T, Mizuno S, Ishikawa H, Manabe H, Koyama T, Kitani K, Satoi S, Inoue K, Fukuda S, Kawasaki T, Yukawa M, Ohta Y, Inoue M. Solid pseudopapillary neoplasm of the pancreas showing marked distal atrophy: A case report. Int J Surg Case Rep 2019; 55:136-139. [PMID: 30731300 PMCID: PMC6365397 DOI: 10.1016/j.ijscr.2019.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/18/2019] [Accepted: 01/22/2019] [Indexed: 11/30/2022] Open
Abstract
Solid pseudopapillary neoplasm with marked parenchymal atrophy of the distal pancreas. No acinar cells were observed, indicating exocrine dysfunction of atrophic parenchyma. The vestige of main pancreatic duct was observed in the distal atrophic pancreas. Central pancreatectomy without anastomosis of distal side of pancreas was performed.
Introduction Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare neoplasm, affecting primarily young females. Because SPNs are of low-malignancy, they rarely obstruct the main pancreatic duct (MPD) and cause atrophy of the distal pancreas even if their tumor sizes are large. Presentation of case A 35-year-old female was referred to our hospital due to pancreatic tumor. Imaging findings showed the presence of well-defined round tumor in the body of the pancreas with 25-mm in diameter. The pancreas parenchyma distal to the tumor was markedly atrophic, and MPD dilatation was not observed. The lesion was diagnosed as SPN by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), and central pancreatectomy was performed. Intraoperative frozen section of the distal atrophic pancreas showed no evidence of acinar cells, indicating exocrine dysfunction. Therefore, we closed distal pancreas stump instead of reconstruction. In the distal atrophic parenchyma, scattered foci of islets of Langerhans and the vestige of dilated MPD were observed. She has shown neither endocrine nor exocrine insufficiency after surgery. Discussion SPNs are usually found without atrophic change of distal pancreas. To the best of our knowledge, this is the first report of SPN in which exocrine dysfunction of atrophic pancreas was demonstrated pathologically and central pancreatectomy without anastomosis of distal pancreas was chosen for the surgical treatment. Conclusion We reported a very rare case of SPN with marked distal parenchymal atrophy. We successfully performed central pancreatectomy without reconstruction.
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Affiliation(s)
- Masanori Tsujie
- Department of Surgery, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma 630-0293, Nara, Japan.
| | - Tomoko Wakasa
- Department of Pathology, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma 630-0293, Nara, Japan
| | - Shigeto Mizuno
- Department of Endoscopic Diagnosis and Treatment, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma 630-0293, Nara, Japan
| | - Hajime Ishikawa
- Department of Surgery, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma 630-0293, Nara, Japan
| | - Hironobu Manabe
- Department of Surgery, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma 630-0293, Nara, Japan
| | - Taichi Koyama
- Department of Surgery, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma 630-0293, Nara, Japan
| | - Kotaro Kitani
- Department of Surgery, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma 630-0293, Nara, Japan
| | - Shumpei Satoi
- Department of Surgery, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma 630-0293, Nara, Japan
| | - Keisuke Inoue
- Department of Surgery, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma 630-0293, Nara, Japan
| | - Shuichi Fukuda
- Department of Surgery, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma 630-0293, Nara, Japan
| | - Toshihiko Kawasaki
- Department of Gastroenterology, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma 630-0293, Nara, Japan
| | - Masao Yukawa
- Department of Surgery, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma 630-0293, Nara, Japan
| | - Yoshio Ohta
- Department of Pathology, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma 630-0293, Nara, Japan
| | - Masatoshi Inoue
- Department of Surgery, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma 630-0293, Nara, Japan
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Analysis of 50 cases of solid pseudopapillary tumor of pancreas: Aggressive surgical resection provides excellent outcomes. Eur J Surg Oncol 2018; 45:187-191. [PMID: 30228023 DOI: 10.1016/j.ejso.2018.08.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/29/2018] [Accepted: 08/01/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION This study reports the clinicopathological characteristics and the perioperative and long-term treatment outcomes after aggressive surgical resection in solid pseudopapillary tumor (SPT) of the pancreas performed at a high volume center for pancreatic surgery in India. MATERIALS AND METHODS We analyzed a prospectively maintained database of the patients operated for SPT at Tata Memorial Hospital, India over a period of 11 years from February 2007 to February 2018. RESULTS Fifty consecutive patients operated for SPT, during the study period were included. The median age at presentation was 24 years. Majority of the patients (43/50) were female (86%). Disease was predominantly localized in the head and uncinate process of pancreas (66%). Median tumor size was 7.7 cm (Range 1.6-15 cm). Tumor extent was radiologically defined as borderline resectable or locally advanced in 48% (n = 24) patients. Forty-six major pancreatic resections were performed, which included 10 (21%) vascular resections, 2 synchronous liver metastasectomies, 1 multi visceral resection and 5 total pancreaticosplenectomies. Five of these resections were reoperations in patients deemed inoperable on exploration at other centers. R0 resection was achieved in 47 patients (98%). Postoperative major morbidity was 19% and there was no mortality. At a median follow-up of 29 months (Range, 1-121 months), all patients were alive without any recurrence. CONCLUSION Aggressive complete surgical resection of SPT achieves excellent long-term survival. Surgery, especially for large and borderline resectable tumors, can be potentially complex and should be performed at high-volume centers to provide the best chance of cure.
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Abstract
OBJECTIVES Prognostic factors for solid pseudopapillary neoplasms (SPN) of the pancreas have been incompletely defined in the literature. We aimed to use the National Cancer Database to describe survival and characterize prognostic factors in patients with pancreatic pseudopapillary neoplasms. METHODS We identified 304 patients with pancreatic SPN diagnosed between 2004 and 2012 using the National Cancer Database. All patients were included in the survival analysis. Kaplan-Meier method, χ, and log-rank tests were used for statistical analysis. Cox proportional hazard regression model was used for multivariate analysis. RESULTS The median age at diagnosis was 36.5 years. Eighty-five percent of patients were female, 69% were white, and 25% were black. Metastases were observed in 5% of patients. Median tumor size was 5.1 cm. Ninety-two percent of patients underwent primary tumor resection. At 60 months, 98% of patients who underwent resection were alive, and 40% who did not undergo resection were alive. On multivariate analysis, female sex, resection of primary tumor, and absence of metastasis were correlated with improved survival. CONCLUSIONS Patients with SPN who undergo resection have an excellent survival at 5 years. Surgery should be considered in all patients with this diagnosis.
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Ercelep O, Ozdemir N, Turan N, Topcu TO, Uysal M, Tanriverdi O, Demirci U, Taskoylu BY, Urakcı Z, Duran AO, Aksoy A, Menekse S, Ozcelik M, Gumus M. Retrospective evaluation of patients diagnosed solid pseudopapillary neoplasms of the pancreas. Curr Probl Cancer 2018; 43:27-32. [PMID: 30104029 DOI: 10.1016/j.currproblcancer.2018.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/30/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE Solid pseudopapillary neoplasm (SPN) is a rare, low-grade neoplasm with excellent prognosis. In this study, we evaluated clinicopathological characteristics of patients diagnosed with SPN retrospectively. METHODS This is a retrospective study intended to characterize patients with the diagnosis of SPN between 2005 and 2015. Clinicopathological features, recurrence rate, and overall survival of 28 patients were recorded. Malignant SPN criteria were defined as the presence of distant metastasis (developed at diagnosis or during follow up) or lymph node involvement. RESULTS The mean age at diagnosis was 42 (range: 17-41). Among patients, 82% (n = 23) were female and 17.9% (n = 5) were male. The mean size of tumor was 5.81 cm (range: 2-15). The mean follow up period was 55.6 months, 1-year survival was 96.5% and 5-year survival rate was 88%. A total of 25 patients were alive at the end of follow-up period and 3 of the patients became exitus due to disease. Two patients had a metastatic presentation in livers at the diagnosis and metastasis developed in 3 patients during follow-up (liver of 1 patient, peritoneum in 1 patient and liver and peritoneum in 1 patient). The reason of admission was headache in 68% patients. The type of operation was frequently subtotal pancreatectomy (n = 11, 39.3%) and distal pancreatectomy (n = 10, 35.7%). Tumors were located frequently in body and tail regions (n = 18, 64.3%) and the number of patients with malignant criteria was 6 (21.4%). Although the mean age of malignant patients was significantly higher than benign patients (P = 0.046), there was no significant difference between 2 groups in terms of gender, tumor size, capsule invasion, perineural invasion, vascular invasion, and margin status. CONCLUSION SPN is a rarely seen tumor with low malignity potential. Surgical resection provides long-term survival rate even in local invasion or metastasis conditions.
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Affiliation(s)
- Ozlem Ercelep
- Department of Medical Oncology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey.
| | - Nuriye Ozdemir
- Department of Medical Oncology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Nedim Turan
- Department of Medical Oncology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Turkan Ozturk Topcu
- Department of Medical Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Mukremin Uysal
- Department of Medical Oncology, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey
| | - Ozgur Tanriverdi
- Department of Medical Oncology, Faculty of Medicine, Mugla Sıtkı Kocaman University, Mugla, Turkey
| | - Umut Demirci
- Department of Medical Oncology, Ankara Yurtaslan Oncology Hospital, Ankara, Turkey
| | - Burcu Yapar Taskoylu
- Department of Medical Oncology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Zuhat Urakcı
- Department of Medical Oncology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Ayse Ocak Duran
- Department of Medical Oncology, Faculty of Medicine, Kayseri Erciyes University, Kayseri, Turkey
| | - Asude Aksoy
- Department of Medical Oncology, Faculty of Medicine, Malatya Inonu University, Malatya, Turkey
| | - Serkan Menekse
- Department of Medical Oncology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Melike Ozcelik
- Department of Medical Oncology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Mahmut Gumus
- Department of Medical Oncology, Faculty of Medicine, Bezmi Alem Vakif University, Istanbul, Turkey
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Tumor Location Correlates with Clinicopathological Features and Prognosis of the Solid Pseudopapillary Neoplasm. Gastroenterol Res Pract 2018; 2018:9023947. [PMID: 30057602 PMCID: PMC6051102 DOI: 10.1155/2018/9023947] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/24/2018] [Accepted: 06/10/2018] [Indexed: 12/18/2022] Open
Abstract
Background Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare neoplasms with low malignant behavior. These neoplasms can be aggressive and cause bad ending of SPN patients. The purpose of this article is to identify certain prognostic factors. Method We retrospectively evaluated 196 patients from our hospital and SEER database. We identified that tumor location was an independent prognostic indicator of SPN patients. Results DSS and OS of pancreatic head SPNs (HOP) were significantly shorter than those of other locations (OOP). Operation methods and age were different between HOP and OOP groups. Compared to OOP group, patients in HOP group were younger. Operation time was longer, and hospital stays were longer. Conclusion This work suggests that pancreatic head SPNs have distinct clinicopathological features and clinical outcome. It is urgent to optimize the treatment of SPN patients and identify effective prognostic indicators of SPN.
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Wang X, Liu X. Comments on "Laparoscopic management of solid pseudo papillary neoplasm of pancreas in tertiary care centre from south India". Pancreatology 2018; 18:463. [PMID: 29501405 DOI: 10.1016/j.pan.2018.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/21/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Xing Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xubao Liu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
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Abstract
Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy. It replaces the 2013 European consensus statement guidelines on PCN. European and non-European experts performed systematic reviews and used GRADE methodology to answer relevant clinical questions on nine topics (biomarkers, radiology, endoscopy, intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystic neoplasm, rare cysts, (neo)adjuvant treatment, and pathology). Recommendations include conservative management, relative and absolute indications for surgery. A conservative approach is recommended for asymptomatic MCN and IPMN measuring <40 mm without an enhancing nodule. Relative indications for surgery in IPMN include a main pancreatic duct (MPD) diameter between 5 and 9.9 mm or a cyst diameter ≥40 mm. Absolute indications for surgery in IPMN, due to the high-risk of malignant transformation, include jaundice, an enhancing mural nodule >5 mm, and MPD diameter >10 mm. Lifelong follow-up of IPMN is recommended in patients who are fit for surgery. The European evidence-based guidelines on PCN aim to improve the diagnosis and management of PCN.
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26
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Zeng J, Deng R. Few comments on "Laparoscopic management of solid pseudo papillary neoplasm of pancreas in tertiary care center from south India". Pancreatology 2018; 18:230. [PMID: 29305087 DOI: 10.1016/j.pan.2017.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/07/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Jing Zeng
- Center of Infectious Diseases, West China Hospital of Sichuan University, China
| | - Rong Deng
- Center of Infectious Diseases, West China Hospital of Sichuan University, China.
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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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Lubezky N, Klausner JM. Reply letter to: Comments on "Solid pseudopapillary neoplasm of the pancreas: Management and long-term outcome". Eur J Surg Oncol 2017; 44:270. [PMID: 29269108 DOI: 10.1016/j.ejso.2017.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Nir Lubezky
- Surgical Department, Tel-Aviv Medical Center, Tel-Aviv, Israel.
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29
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Wang X, Liu X. Comments on "Solid pseudopapillary neoplasm of the pancreas: Management and long-term outcome". EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2017; 44:268-269. [PMID: 29246641 DOI: 10.1016/j.ejso.2017.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 08/17/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Xing Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xubao Liu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
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30
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Xu Y, Zhao G, Pu N, Nuerxiati A, Ji Y, Zhang L, Rong Y, Lou W, Wang D, Kuang T, Xu X, Wu W. One Hundred Twenty-One Resected Solid Pseudopapillary Tumors of the Pancreas: An 8-Year Single-Institution Experience at Zhongshan Hospital, Shanghai, China. Pancreas 2017; 46:1023-1028. [PMID: 28742543 DOI: 10.1097/mpa.0000000000000885] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aims of this study were to introduce our experience with treating patients with pancreatic solid pseudopapillary tumors (SPTs) and to investigate the clinical risk factors for recurrence of SPTs because no consensus has been established to date. METHODS One hundred twenty-one patients underwent surgical resection from January 2008 to December 2015 in our institution. Clinical data were collected from the standardized reports. RESULTS Of the 121 patients, 93 (76.9%) were women, 28 (23.1%) were men, and the mean age at diagnosis was 33.7 years (range, 11-68 years). Sixty patients were subjected to short-term complications, and 8 patients experienced long-term complications, some of whom may require surgery. The tumor located in the distal pancreas (P = 0.02), and a Ki-67 index value > 1.5 (P = 0.01) indicated malignancy according to the World Health Organization 2000 classification. One hundred three patients responded to follow-up, and 3 cases (2.9%) were subject to liver metastases. Recurrence was more frequently observed in tumors classified as high-grade malignancies according to the World Health Organization 2010 classification (P = 0.013), synchronous metastases (P < 0.001), peripancreatic fat infiltration (P = 0.018), and lymphovascular invasion (P < 0.001). CONCLUSIONS Evaluating the risk of the recurrence of SPTs still requires systematic and multicenter trials in the future, even some pathological features showed statistical differences.
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Affiliation(s)
- Yadong Xu
- From the Departments of *General Surgery, and †Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
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Jutric Z, Rozenfeld Y, Grendar J, Hammill CW, Cassera MA, Newell PH, Hansen PD, Wolf RF. Analysis of 340 Patients with Solid Pseudopapillary Tumors of the Pancreas: A Closer Look at Patients with Metastatic Disease. Ann Surg Oncol 2017; 24:2015-2022. [PMID: 28299507 DOI: 10.1245/s10434-017-5772-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Current literature addressing the treatment of solid pseudopapillary neoplasms (SPNs) of the pancreas is limited, particularly for patients with distant metastases. We aimed to define predictive indicators of survival in a large series of patients and assess the outcome of patients with distant metastases. METHODS The National Cancer Database was queried for patients diagnosed with SPNs of the pancreas between 1998 and 2011. Single predictor univariate analyses were performed on variables including demographics, tumor characteristics, and surgery outcomes, and multivariate Cox proportional hazards survival analysis was then completed with backward elimination. RESULTS Overall, 340 patients were identified: 82% were female, median age was 39 years, and 84% had no comorbidities. Patients undergoing any type of surgical resection experienced long-term survival (85% 8-year survival). Patients undergoing surgical resection (n = 296) had superior survival (hazard ratio [HR] 21 for no surgery, p < 0.0001), as did patients treated at academic centers and those with private insurance (HR 3.9, p = 0.009; HR 4.9, p = 0.007). Sex, age, tumor size, presence of lymph node metastases, positive surgical margins, and presence of distant metastases were not significant predictors of survival in multivariate analysis. Of 24 patients with distant metastases, seven were treated surgically and experienced long-term survival similar to that of patients without metastases treated surgically (HR 2, p = 0.48). CONCLUSION SPNs of the pancreas are rare neoplasms with excellent overall survival; however, in a low number of patients they metastasize. Of the few patients with metastatic disease selected for resection, most experienced long-term survival.
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Affiliation(s)
- Zeljka Jutric
- Liver and Pancreas Surgery, Portland Providence Cancer Institute, Portland, OR, USA
| | | | - Jan Grendar
- Liver and Pancreas Surgery, Portland Providence Cancer Institute, Portland, OR, USA
| | - Chet W Hammill
- Division of Liver and Pancreas Surgery, The Oregon Clinic, Portland, OR, USA
| | - Maria A Cassera
- Liver and Pancreas Surgery, Portland Providence Cancer Institute, Portland, OR, USA
| | - Pippa H Newell
- Liver and Pancreas Surgery, Portland Providence Cancer Institute, Portland, OR, USA.,Division of Liver and Pancreas Surgery, The Oregon Clinic, Portland, OR, USA
| | - Paul D Hansen
- Liver and Pancreas Surgery, Portland Providence Cancer Institute, Portland, OR, USA.,Division of Liver and Pancreas Surgery, The Oregon Clinic, Portland, OR, USA
| | - Ronald F Wolf
- Liver and Pancreas Surgery, Portland Providence Cancer Institute, Portland, OR, USA. .,Division of Liver and Pancreas Surgery, The Oregon Clinic, Portland, OR, USA.
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Namur GN, Ribeiro TC, Souto MM, Figueira ERR, Bacchella T, Jureidini R. MINIMALLY INVASIVE SURGERY FOR PSEUDOPAPILLARY NEOPLASM OF THE PANCREAS. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 29:97-101. [PMID: 27438035 PMCID: PMC4944744 DOI: 10.1590/0102-6720201600020008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/08/2016] [Indexed: 01/04/2023]
Abstract
Background: Solid pseudopapillary pancreatic neoplasia is usually a large well-circumscribed
pancreatic mass, with cystic and solid areas more frequently found in young women.
It is a benign pancreatic neoplasia in most cases, therefore minimally invasive
surgery could be an interesting approach. Aim: Evaluate the results of minimally invasive surgery for this neoplasia. Methods: Patients with this tumor who underwent minimally invasive pancreatectomies
between 2009 and 2015 in a single institution, were analyzed regarding
demographic, clinical-pathological futures, post-operative morbidity and
disease-free survival. Results: All were women, and their median age was 39 (18-54) years. Two patients with
tumor in the head of the pancreas underwent laparoscopic pancreaticoduodenectomy,
and another one underwent laparoscopic enucleation. Two patients with tumor in the
neck underwent central pancreatectomy. Distal pancreatectomies were performed in
the other five, one with splenic preservation. None required blood transfusion or
conversion to open surgery. Two (20%) developed clinical relevant pancreatic
fistulas, requiring readmission. Median length of postoperative hospital stay was
five days (2-8). All resection margins were negative. Patients were followed for a
median of 38 months (14-71), and there was no recurrence. Conclusions: Minimally invasive surgery for solid pseudopapillary pancreatic neoplasia is
feasible for tumors in different locations in the pancreas. It was associated with
acceptable morbidity and respected the oncologic principles for treatment.
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Affiliation(s)
| | - Thiago Costa Ribeiro
- Hospital de Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Marcelo M Souto
- Hospital de Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - Telesforo Bacchella
- Hospital de Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Ricardo Jureidini
- Hospital de Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Carrara S, Di Leo M, Zerbi A. The Golden Compass to the Depths. Gastroenterology 2016; 151:e7-e8. [PMID: 27713050 DOI: 10.1053/j.gastro.2016.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/13/2016] [Accepted: 07/06/2016] [Indexed: 12/02/2022]
Affiliation(s)
- Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano Milan, Italy
| | - Milena Di Leo
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano Milan, Italy
| | - Alessandro Zerbi
- Pancreatic Surgery Unit, Humanitas Research Hospital, Rozzano Milan, Italy
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Zhang C, Liu F, Chang H, Li H, Zhou X, Lu J, Qin C, Sun Y, Sun H, Lin J. Less Aggressive Surgical Procedure for Treatment of Solid Pseudopapillary Tumor: Limited Experience from a Single Institute. PLoS One 2015; 10:e0143452. [PMID: 26599966 PMCID: PMC4658154 DOI: 10.1371/journal.pone.0143452] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/04/2015] [Indexed: 01/17/2023] Open
Abstract
Objectives To evaluate the clinical characteristics and radiological features of solid pseudopapillary tumor (SPT) and assess surgical therapy strategy. Methods A retrospective review was performed in 62 patients pathologically confirmed of SPT treated between 2003 and 2014. The clinical features, radiological examinations and surgical strategies were analyzed. Results 56 females and 6 males were included in this study, mean age was 26 years old (range: 8–66 years old) with mean size of the tumor was 7.2 cm (range: 3–15 cm), and most tumor were commonly located in the head of pancreas (n = 29). Among all the cases, 3 patients had liver metastasis and underwent resection of SPT and liver metastasis. Furthermore, we performed 29 cases of local tumor excision; other patients underwent pancreaticoduodenectomy, middle pancreatectomy, middle pancreatectomy with splenectomy, distal pancreatectomy with spleen preservation, distal pancreatectomy with splenectomy and duodenum-preserving pancreatic head resection. No patient suffered from lymph node metastases. After median follow-up of 46 months (range: 2–135 months), no mortality or local recurrence or distant metastasis was found. Conclusions Solid pseudopapillary tumor is a latent malignant tumor with excellent prognosis. If feasible, less aggressive resection without regular lymphadenectomy is recommended for treatment of patients with SPT.
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Affiliation(s)
- Chi Zhang
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Fangfeng Liu
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Hong Chang
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
- * E-mail:
| | - Hongguang Li
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Xu Zhou
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Jun Lu
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Chengkun Qin
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Yongjie Sun
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Huidong Sun
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Jianbo Lin
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
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Li P, Hu Y, Yi J, Li J, Yang J, Wang J. Identification of potential biomarkers to differentially diagnose solid pseudopapillary tumors and pancreatic malignancies via a gene regulatory network. J Transl Med 2015; 13:361. [PMID: 26578390 PMCID: PMC4650856 DOI: 10.1186/s12967-015-0718-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/31/2015] [Indexed: 01/18/2023] Open
Abstract
Background Solid pseudopapillary neoplasms (SPN) are pancreatic tumors with low malignant potential and good prognosis. However, differential
diagnosis between SPN and pancreatic malignancies including pancreatic neuroendocrine tumor (PanNET) and ductal adenocarcinoma (PDAC) is difficult. This study tried to identify candidate biomarkers for the distinction between SPN and the two malignant pancreatic tumors by examining the gene regulatory network of SPN. Methods The gene regulatory network for SPN was constructed by a co-expression model. Genes that have been reported to be correlated with SPN were used as the clues to hunt more SPN-related genes in the network according to a shortest path approach. By means of the K-nearest neighbor algorithm (KNN) classifier evaluated by the jackknife test, sets of genes to distinguish SPN and malignant pancreatic tumors were determined. Results We took a new strategy to identify candidate biomarkers for differentiating SPN from the two malignant pancreatic tumors PanNET and PDAC by analyzing shortest paths among SPN-related genes in the gene regulatory network. 43 new SPN-relevant genes were discovered, among which, we found hsa-miR-194 and hsa-miR-7 along with 7 transcription factors (TFs) such as SOX11, SMAD3 and SOX4 etc. could correctly differentiate SPN from PanNET, while hsa-miR-204 and 4 TFs such as SOX9, TCF7 and PPARD etc. were demonstrated as the potential markers for SPN versus PDAC. 14 genes were demonstrated to serve as the candidate biomarkers for distinguishing SPN from PanNET and PDAC when considering them as malignant pancreatic tumors together. Conclusion This study provides new candidate genes related to SPN and the potential biomarkers to differentiate SPN from PanNET and PDAC, which may help to diagnose patients with SPN in clinical setting. Furthermore, candidate biomarkers such as SOX11 and hsa-miR-204 which could cause cell proliferation but inhibit invasion or metastasis may be of importance in understanding the molecular mechanism of pancreatic oncogenesis and could be possible therapeutic targets for malignant pancreatic tumors. Electronic supplementary material The online version of this article (doi:10.1186/s12967-015-0718-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pengping Li
- State Key Laboratory of Pharmaceutical Biotechnology, Collaborative Innovation Center of Chemistry for Life Sciences, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, NJU Advanced Institute for Life Sciences (NAILS), School of life sciences, Nanjing University, 163 Xianlin Road, Nanjing, 210023, China.
| | - Yuebing Hu
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China.
| | - Jiao Yi
- State Key Laboratory of Pharmaceutical Biotechnology, Collaborative Innovation Center of Chemistry for Life Sciences, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, NJU Advanced Institute for Life Sciences (NAILS), School of life sciences, Nanjing University, 163 Xianlin Road, Nanjing, 210023, China.
| | - Jie Li
- State Key Laboratory of Pharmaceutical Biotechnology, Collaborative Innovation Center of Chemistry for Life Sciences, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, NJU Advanced Institute for Life Sciences (NAILS), School of life sciences, Nanjing University, 163 Xianlin Road, Nanjing, 210023, China.
| | - Jie Yang
- State Key Laboratory of Pharmaceutical Biotechnology, Collaborative Innovation Center of Chemistry for Life Sciences, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, NJU Advanced Institute for Life Sciences (NAILS), School of life sciences, Nanjing University, 163 Xianlin Road, Nanjing, 210023, China.
| | - Jin Wang
- State Key Laboratory of Pharmaceutical Biotechnology, Collaborative Innovation Center of Chemistry for Life Sciences, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, NJU Advanced Institute for Life Sciences (NAILS), School of life sciences, Nanjing University, 163 Xianlin Road, Nanjing, 210023, China.
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Yu P, Cheng X, Du Y, Yang L, Xu Z, Yin W, Zhong Z, Wang X, Xu H, Hu C. Solid Pseudopapillary Neoplasms of the Pancreas: a 19-Year Multicenter Experience in China. J Gastrointest Surg 2015; 19:1433-40. [PMID: 26001371 DOI: 10.1007/s11605-015-2862-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/12/2015] [Indexed: 01/31/2023]
Abstract
AIM The aim of this study was to determine the clinicopathological features, surgical management, and prognosis of solid pseudopapillary neoplasms (SPNs) of the pancreas. METHODS This study conducted a retrospective analysis of 97 patients who underwent surgery for a pathologically confirmed SPN in five hospitals between January 1996 and December 2014. RESULTS The 97 cases included 93 female and 4 male patients, and the average age was 31.2 years. The tumor was located in the body or tail (70.1%), the head (20.6%), and the neck (9.3%). All patients underwent surgical exploration, including distal pancreatectomy (63.9%), pancreaticoduodenectomy (20.6%) (partial portal vein or superior mesenteric vein resection and artificial vascular graft reconstruction performed in 4.1% of the patients), central pancreatectomy (10.3%), enucleation (5.2%), and liver resection (1.0%). 16.5% of the patients had malignant tumors. The positive rate of Ki-67 was 66.7% in patients diagnosed with a malignant neoplasm and was comparable to 8.4% of the patients diagnosed to have a benign neoplasm (p < 0.001). After a median follow-up of 70.1 months, three patients had recurrence and one patient died of liver metastasis. CONCLUSIONS SPN is a rare neoplasm with low malignant potential. Surgical resection is warranted even in the presence of local invasion or metastases as patients demonstrate excellent long-term survival. Positive immunoreactivity for Ki-67 may predict the malignant potential and poor outcome of SPNs.
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Affiliation(s)
- Pengfei Yu
- Department of Abdominal Surgery, Zhejiang Cancer Hospital, 38# Guangji Road, Hangzhou, 310022, China,
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