Tumeurs pseudopapillaires et solides du pancréas : à propos de cinq cas et revue de la littérature

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

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

Malignant Solid Pseudopapillary Neoplasm of the Pancreas: An Orthogonal Analysis

BACKGROUND

Pancreatic solid pseudopapillary neoplasms (SPN) are generally indolent; however, some patients present with "malignant" SPN. An orthogonal analysis of multiple datasets was performed to investigate the utility of complete surgical resection (CSR) for malignant SPN.

METHODS

A systematic review was performed for cases of malignant SPN, defined as T4, N1, and/or M1. Malignant SPN was analyzed within the National Cancer Database (NCDB) and compared with T1-3N0M0 SPN. Predictors of malignant SPN were assessed, and treatments were analyzed by using survival analysis.

RESULTS

The systematic review yielded 164 cases of malignant SPN. Of 31 children, only one died due to malignant SPN. Among adults, CSR was associated with improved disease-specific survival (DSS) (P = 0.0002). Chemotherapy did not improve malignant SPN DSS, whether resected (P = 0.8485) or not (P = 0.2219). Of 692 adults with SPN within the NCDB, 93 (13.4%) had malignant SPN. Pancreatic head location (odds ratio [OR] 2.174; 95% confidence interval [CI] 1.136-4.166; P = 0.0186) and tumor size (OR 1.154; 95% CI 1.079-1.235; P < 0.0001) associated with the malignant phenotype. Malignant SPN predicted decreased overall survival (OS) compared with T1-3N0M0 disease (P < 0.0001). Resected malignant SPN demonstrated improved OS (P < 0.0001), including resected stage IV malignant SPN (P = 0.0003). Chemotherapy did not improve OS for malignant SPN, whether resected (P = 0.8633) or not (P = 0.5734). Within a multivariable model, resection was associated with decreased hazard of death (hazard ratio 0.090; 95% CI 0.030-0.261; P < 0.0001).

CONCLUSIONS

Approximately 13% of patients with SPN present with a malignant phenotype. Pediatric cases may be less aggressive. Resection may improve survival for malignant SPN, which does not appear chemosensitive.

Solid pseudopapillary tumors of the pancreas in young women: Case report

INTRODUCTION AND IMPORTANCE

Solid pseudopapillary tumor of the pancreas (SPTP) is a rare tumor of the exocrine pancreas, with undetermined etiopathogeny, which most often affects young women. The clinical and physical signs are non-specific and despite the progress of complementary examinations, Confirmation is usually anatomopathological. Surgical resection is the only curative treatment.

CASE PRESENTATION

We report the case of a 17-year-old girl, consulted for a left hypochondrium mass which imaging concluded to be a corporal-caudal tumor mass of the pancreas for which a complete surgical excision was performed and whose anatomopathological study confirmed a pseudo-papillary and solid tumor of the pancreas. The positive diagnosis of SPTP remains difficult and is usually made on pathological analysis with immunohistochemical study.

DISCUSSION

Solid pseudopapillary tumor of the pancreas is a rare anatomic-clinical entity, first described by Frantz in 1959. The clinical manifestations of SPTP are not specific. Biologically, no signs are predictive of SPTP and imaging usually shows a well encapsulated mass with both solid and cystic components. The curative treatment of SPTP is exclusively surgical and consists of a complete removal of the tumor with its capsule because of its degenerative potential SPTP has a good prognosis with a recurrence rate of 10-15% and 95% survival at 5 years.

CONCLUSION

Solid pseudopapillary tumor of the pancreas is a rare tumor of the exocrine pancreas. Its evolution is slow. Preoperative diagnosis remains difficult despite the progress of complementary examinations. Surgical resection is the only curative treatment. Its prognosis remains excellent.

[Rare pancreatic tumor detected unexpectedly in a child in the Ivory Coast]

La tumeur pseudo-papillaire et solide du pancréas (TPPSP) est une tumeur rare. Elle touche le plus souvent la femme jeune. Décrite la première fois par Frantz en 1959, sa pathogénie demeure peu claire. C’est une tumeur de bon pronostic qui nécessite une chirurgie radicale. Les auteurs rapportent un cas de TPPSP chez une fillette de 11 ans. La symptomatologie était aiguë, faite de syndrome de compression et d’épigastralgies. L’examen trouvait une masse solide de l’hypochondre gauche. Le scanner montrait une masse de structure mixte de la queue du pancréas. Une splénopancréatectomie gauche était réalisée. Le diagnostic était confirmé par l’examen histologique avec immunohistochimie. Le suivi à long terme ne montrait pas de récidive. Le recul est de deux ans et demi. À travers cette observation et une revue de la littérature, les auteurs discutent la contribution de la radiologie dans le diagnostic et insistent sur une chirurgie radicale dans le traitement de ces tumeurs de faible degré de malignité.

[Solid pseudopapillary tumour of the pancreas: about a case and review of the literature]

Solid pseudopapillary tumours of the pancreas are rare tumours of uncertain etiology which mostly affects young women. Their prognosis is good especially after complete resection. We report a new case of a young woman; abdominal pain revealed solid pseudopapillary tumour. The diagnosis is based on histological examination associated with immunohistochemistry of the piece of resection removed with caudal splenopancreatectomy.

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

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

[Frantz tumor: 2 new cases]

A travers cet article, nous détaillons les caractéristiques clinico-pathologiques et discutons l'histogenèse de la tumeur de Frantz. Deux patients opérés pour tumeur de Frantz. Ils ont eu un traitement chirurgical seul. L'étude morphologique était couplée à un examen immuno-histochimique (IHC) utilisant les anticorps anti CD10, anti- vimentine, anti-énolase neuronale spécifique (NSE), anti-synaptophysine, anti-chromogranine A et anti-cytokératine. Un immuno-marquage à l'anti-oestrogène et l'anti-progestérone a été réalisé dans un cas. Il s'agissait d'une femme âgée de 45ans et d'un garçon de 12 ans. Les aspects échographiques et scannographiques étaient non spécifiques. Une exérèse chirurgicale complète a été réalisée dans les deux cas. L'analyse histologique évoquait une tumeur de Frantz. Le diagnostic a été retenu après étude immuno-histohimique. L'évolution était favorable sans récidive avec respectivement un recul de 18 et 16 mois. La tumeur de Frantz est une entité rare. Son diagnostic repose sur l'examen anatomopathologique complété par l'étude immuno-histochimique. Son pronostic est excellent après résection chirurgicale.

Management of a malignant case of solid pseudopapillary tumor of pancreas: a case report and literature review

Solid pseudopapillary tumor of the pancreas is a rare neoplasm with low malignant potential, which affects predominantly young females. Only approximately 10% to 15% cases of solid pseudopapillary tumors (SPTs) are malignant. We present the case of a 57-year-old woman who developed malignant SPT of the pancreas. Meanwhile, a literature review was carried out. Some clinicopathological features and strategies of management of malignant SPT are presented. In general, surgical removal of the tumor even in case of metastases or recurrence offers an excellent prognosis. Chemotherapy and radiotherapy should be taken into consideration in patients with unresectable tumor.

[The pseudopapillary tumor of the pancreas (or Frantz's tumor)]

The pseudopapillary tumor of the pancreas (or Frantz's tumor) is a rare exocrine pancreatic tumor with a low degree of malignancy. It occurs more frequently among women between 20 and 40 years of age and in the Asian population. This tumor is rarer in the pediatric population. The symptoms are subtle, the most striking being pain and an abdominal mass. Pathologically, the tumor is usually well circumscribed with regions of necrosis, hemorrhage and cystic degeneration. A thick, fibrous capsule is often present. The low grade of malignancy of this tumor with a fibrous capsule led to perform a surgical resection. The localization and local invasion determine the surgical technique. Despite its potential for local infiltration and metastatic disease (up to 15% confined often to the liver), the prognosis is favorable after a surgical resection with correct margins. Long follow-up is necessary to detect a possible recurrence, even late.

Frantz's tumor: is mutilating surgery always justified in young patients?

BACKGROUND

Solid pseudopapillary tumor (Frantz's tumor) of the pancreas is a rare lesion. It is of low-grade malignancy but can cause extensive local invasion. The aim of this study was to assess the outcome of Frantz's tumors after incomplete resection.

METHODS

We contacted all authors who published case reports describing incomplete resection of Frantz's tumor between 1985 and 2008 to request follow-up information.

RESULTS

Follow-up information was obtained for 11 out 18 patients who underwent incomplete resection. Estimated median survival rate was 5.7 years (69.5 months).

CONCLUSION

Since Frantz's tumor typically develops mainly in children and young women, a 5.7 year survival rate is unacceptable. Thus complete resection of locally invasive solid-pseudopapillary tumor of the pancreas is always justified, even at the price of difficult, mutilating surgery.

[The solid pseudopapillary tumor of pancreas: two cases and literature review]

Solid pseudopapillary tumor (SPT) of the pancreas is a rare exocrine pancreatic tumor behaving in a low-grade fashion, with limited local invasion risk and a rare metastatic evolution. We report SPT in two young females, revealed by abdominal pain and an epigastric mass. The diagnosis of a cystic tumor was based on abdominal ultrasound and CT data in the first case and on MRI in the second. A distal pancreatectomy and splenectomy were successfully performed in the first case and a central pancreatectomy in the second. Histological study confirmed the diagnosis of SPT of the pancreas.

Aggressive behaviour of solid-pseudopapillary tumor of the pancreas in adults: A case report and review of the literature

Solid-pseudopapillary tumor (SPT) is a rare neoplasm of the pancreas that usually occurs in young females. It is generally considered a low-grade malignant tumor that can remain asymptomatic for several years. The occurrence of infiltrating varieties of SPT is around 10%-15%. Between 1986 and 2006, 282 cystic tumors of the pancreas were observed. Among them a SPT was diagnosed in 8 patients (2.8%) with only one infiltrating variety. This was diagnosed in a 49-year-old female 13 years after the sonographic evidence of a small pancreatic cystic lesion interpreted as a pseudocyst. The tumor invaded a long segment of the portal-mesenteric vein confluence, and was removed with a total pancreatectomy, resection of the portal vein and reconstruction with the internal jugular vein. Histological examination confirmed the R-0 resection of the primary SPT, although a vascular invasion was demonstrated. The postoperative course was uneventful, but 32 mo after surgery the patient experienced diffuse liver metastases. Chemotherapy with different drugs was started. The patient is alive and symptom-free, with stable disease, 75 mo after surgery. Twenty-five patients with invasion of the portal vein and/or of mesenteric vessels were retrieved from the literature, 16 recent patients with tumor relapse after potentially curative resection were also retrieved. The best treatment remains a radical resection whenever possible, even in locally advanced or metastatic disease. The role of chemotherapy, and/or radiotherapy, is still to be defined.

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

OBJECTIVE

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

SUBJECTS AND METHODS

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

RESULTS

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

CONCLUSION

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

Metastatic Solid-pseudopapillary Tumour of the Pancreas: Clinico-biological Correlates and Management

Solid-pseudopapillary tumour of the pancreas is a rare neoplasm of young women, currently categorised in the World Health Organization classification under exocrine pancreatic tumours. Increased awareness of this condition correlated recently with an apparent rise in incidence as well as recognition of more aggressive clinical courses. We describe two patients with solid-pseudopapillary tumour of the pancreas. A smaller, localised tumour in an unusually young white man was surgically excised with no evidence of recurrence after 2 years. The other case also had an uncommon presentation, with an aggressive course resulting in vascular encasement of the superior mesenteric bundle and aorta, and local involvement of the mesenteric lymph nodes. A literature review was carried out, and the main clinico-pathological features and strategies of treatment of solid-pseudopapillary tumour of the pancreas are presented. Pathological, genetic and molecular features distinguish solid-pseudopapillary tumours from pancreatic ductal adenocarcinoma. Furthermore, neuroendocrine differentiation can be found focally in occasional cases of solid-pseudopapillary tumour. Patients with localised disease are usually cured by surgery. Prolonged survival can be seen in the presence of distant metastasis, if such lesions are resected surgically. Chemotherapy and radiation therapy are used in rare cases when resection is not possible. No current chemotherapy regimens are considered standard in the treatment of this tumour. A rational chemotherapy protocol for such a rare tumour needs to consider its origin and clinical behaviour. However, the indolent clinical progression of solid-pseudopapillary tumours is similar to that of pancreatic neuroendocrine tumour.

Successful treatment of solid-pseudopapillary tumor of the pancreas with multiple liver metastases

The solid-pseudopapillary tumor (SPT) is a very rare pancreatic neoplasm that predominantly affects young females. About 450 cases have been described in the world literature and approximately 20% of the reported patients were children. The occurrence of SPT with distant metastases in children is extremely rare with only two previously reported cases. We now report a 16-year-old Asian girl with a large SPT and synchronous multiple liver metastases who was successfully treated in a 2-step strategy, including initial pylorus-preserving partial duodenopancreatectomy, right hemicolectomy, resection and allografting of the portal vein and secondary resection of 12 liver metastases. The patient is disease free after a follow-up of 18 months after resection of the primary tumor, suggesting that an aggressive surgical treatment might also be justified for metastasized SPT.