Solid-pseudopapillary tumor of the pancreas

Solid pseudopapillary neoplasms of the pancreas (SPNs): diagnostic accuracy of CT and CT imaging features

PURPOSE

To summarize the abdominal computed tomography (CT) imaging and clinicopathological data of patients with SPNs of the pancreas and analyze the accuracy of preoperative CT diagnosis and features.

MATERIALS AND METHODS

Between June 2006 and June 2023, CT images of 120 histopathologically proven SPNs in the pancreas were retrospectively reviewed. Fifteen features, including age, sex, and CT-determined features, were included in a multiple stepwise regression analysis. The correlations between features and SPNs, including odds ratios (ORs) and 95% confidence intervals (CIs), were evaluated.

RESULTS

Among the 120 patients, the diagnostic accuracy of CT was 43.3%. The baseline CT results of patients with a correct diagnosis and misdiagnosis revealed significant differences in sex (P = 0.043), age (P = 0.004), boundary (P = 0.037) and encapsulation (P = 0.002) between the two groups. The preoperative imaging diagnostic accuracy was significantly greater in females than in males (47.9% vs. 25.0%, P = 0.043). The immunohistochemical indices did not significantly differ between the two groups. The results of univariate analysis revealed significant differences in sex (P = 0.048), age (P = 0.014), tumor length (P = 0.023), tumor boundaries (P = 0.039) and capsule type (P = 0.003). The results of multivariate analysis revealed that encapsulation was closely related to the diagnostic accuracy of CT (P = 0.04).

CONCLUSIONS

The accuracy of CT in the diagnosis of SPNs is low, but a length‒diameter ratio of the tumor approaching 1.0, encapsulation and clear boundaries are important CT-determined features. The capsule is an independent CT predictor in the diagnosis of SPNs.

Massive extrapancreatic solid pseudopapillary neoplasm misdiagnosed as hepatic tumor: a case report and literature review

Background

Solid pseudopapillary neoplasms (SPNs) of the pancreas are uncommon, low-malignancy neoplasms. Moreover, the occurrence of extrapancreatic SPNs is rarely encountered.

Case summary

A 45-year-old female presented with a right upper abdominal mass and abdominal pain for 3 and 1 months as chief complaints, respectively. Initially, the patient was misdiagnosed with hepatocellular carcinoma based on her symptoms and results of physical and imaging examinations. Following multidisciplinary discussion and ruling out surgical contraindications, a decision was taken to proceed with surgical intervention. Interestingly, the tumor was found to originate from the retroperitoneum and had invaded the right half of the liver and the right wall of the inferior vena cava. The operation was uneventful, and the pathological findings confirmed the tumor as an extrapancreatic SPN. The patient remained asymptomatic after 15 months of follow-up.

Conclusion

Surgical treatment remains the preferred option for extrapancreatic SPN. The preoperative misdiagnosis also highlights the importance of accurate diagnosis and the development of appropriate treatment strategies for liver masses.

Rare Solid Pancreatic Lesions on Cross-Sectional Imaging

Several solid lesions can be found within the pancreas mainly arising from the exocrine and endocrine pancreatic tissue. Among all pancreatic malignancies, the most common subtype is pancreatic ductal adenocarcinoma (PDAC), to a point that pancreatic cancer and PDAC are used interchangeably. But, in addition to PDAC, and to the other most common and well-known solid lesions, either related to benign conditions, such as pancreatitis, or not so benign, such as pancreatic neuroendocrine neoplasms (pNENs), there are solid pancreatic lesions considered rare due to their low incidence. These lesions may originate from a cell line with a differentiation other than exocrine/endocrine, such as from the nerve sheath as for pancreatic schwannoma or from mesenchymal cells as for solitary fibrous tumour. These rare solid pancreatic lesions may show a behaviour that ranges in a benign to highly aggressive malignant spectrum. This review includes cases of an intrapancreatic accessory spleen, pancreatic tuberculosis, solid serous cystadenoma, solid pseudopapillary tumour, pancreatic schwannoma, purely intraductal neuroendocrine tumour, pancreatic fibrous solitary tumour, acinar cell carcinoma, undifferentiated carcinoma with osteoclastic-like giant cells, adenosquamous carcinoma, colloid carcinoma of the pancreas, primary leiomyosarcoma of the pancreas, primary and secondary pancreatic lymphoma and metastases within the pancreas. Therefore, it is important to determine the correct diagnosis to ensure optimal patient management. Because of their rarity, their existence is less well known and, when depicted, in most cases incidentally, the correct diagnosis remains challenging. However, there are some typical imaging features present on cross-sectional imaging modalities that, taken into account with the clinical and biological context, contribute substantially to achieve the correct diagnosis.

Pancreatic Cystic Lesions: Imaging Techniques and Diagnostic Features

The detection of incidental pancreatic cystic lesions has increased over time. It is crucial to separate benign from potentially malignant or malignant lesions to guide management and reduce morbidity and mortality. The key imaging features used to fully characterize cystic lesions are optimally assessed by contrast-enhanced magnetic resonance imaging/magnetic resonance cholangiopancreatography, with pancreas protocol computed tomography offering a complementary role. While some imaging features have high specificity for a particular diagnosis, overlapping imaging features between diagnoses may require further investigation with follow-up diagnostic imaging or tissue sampling.

The Role of MRI in the Diagnosis of Solid Pseudopapillary Neoplasm of the Pancreas and Its Mimickers: A Case-Based Review with Emphasis on Differential Diagnosis

Solid pseudopapillary neoplasm (SPN) is rare pancreatic tumor occurring most commonly in young females. The typical imaging appearance of SPN is of well-defined, encapsulated, and large heterogeneous tumors, consisting of solid and cystic components due to various degrees of intralesional hemorrhage and necrosis. However, atypical imaging presentation in the form of small solid tumors or uniformly cystic lesions might also be seen, which can be explained by specific pathological characteristics. Other imaging features such as a round shape, the absence of main pancreatic duct dilatation, and slow growth, in combination with vague symptoms, favor the diagnosis of SPNs. Nevertheless, the radiological findings of SPN might overlap with other solid and cystic pancreatic neoplasms, such as neuroendocrine tumors, serous and mucinous neoplasms, and even small pancreatic adenocarcinomas. In addition, a few benign non-tumorous conditions including walled-of-necrosis, and intrapancreatic accessory spleen may also pose diagnostic dilemmas simulating SPNs on imaging studies. The aim of this manuscript is to provide a comprehensive overview of the typical and atypical imaging features of SPNs and to describe useful tips for differential diagnosis with its potential mimickers.

Can solid pseudopapillary neoplasm of the pancreas without degeneration be diagnosed with imaging? a comparison study of the solid component of solid pseudopapillary neoplasm, neuroendocrine neoplasm, and ductal adenocarcinoma

PURPOSE

To investigate the MR findings of the solid components within pancreatic solid pseudopapillary neoplasms (SPNs) to characterize solid SPN without degeneration.

METHODS

After case matching, 23 patients with SPNs, 23 with pancreatic neuroendocrine neoplasms (PNENs), and 46 pancreatic ductal adenocarcinomas (PDACs) were included in this retrospective comparative study. The MR findings of the solid components within the pancreatic tumors were assessed qualitatively and semi-quantitatively.

RESULTS

In the qualitative assessment, significant differences were noted in T2-weighted imaging and MR cholangiopancreatography (MRCP). SPNs with a score of 4-5 (iso- to hyper-intense compared with the renal cortex) were observed in 18/19 (94.7%) by reader 1 and 15/19 (78.9%) by reader 2 (score 5, 52.6% and 47.4%) on fast spin-echo (FSE) T2-weighted imaging. On MRCP, the two readers identified 12 (63.2%) and 8 (42.1%) SPNs, respectively. The semi-quantitative signal-intensity ratio (SIR, signal intensity of tumor/signal intensity of the pancreatic parenchyma) of SPNs on FSE T2-weighted imaging was significantly higher (mean, 1.99-2.01) than that of PNENs (1.30-1.31) or PDACs (1.26-1.28). The sensitivity/specificity of 'hyper' on T2-weighted imaging (qualitative score of 4-5, or SIR of ≥ 1.5) were 78.9-100.0%/63.8-79.7%. The sensitivity/specificity of 'remarkably hyper' (score of 5, SIR of ≥ 2.0, or visible on MRCP) or salt-and-pepper pattern were 36.8-68.4%/85.5-98.6%.

CONCLUSION

T2-weighted imaging may be the key sequence for solid SPN. Solid tumors with hyper-intensity on T2-weighted imaging (especially, more hyper-intense than the renal cortex, more than twice the signal of the pancreatic parenchyma, depicted on MRCP, or salt-and-pepper appearance) may be suspected to be SPNs.

PANCREATIC SOLID-PSEUDOPAPILLARY NEOPLASM IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS

BACKGROUND

Solid pseudopapillary neoplasm of the pancreas is an uncommon pancreatic tumor, which is more frequent in young adult women. Familial adenomatous polyposis is a genetic condition associated with colorectal cancer that also increases the risk of developing other tumors as well.

AIM

The aim of this study was to discuss the association of familial adenomatous polyposis with solid pseudopapillary neoplasm of the pancreas, which is very rare.

METHODS

We report two cases of patients with familial adenomatous polyposis who developed solid pseudopapillary neoplasm of the pancreas of the pancreas and were submitted to laparoscopic pancreatic resections with splenic preservation (one male and one female).

RESULTS

ß-catenin and Wnt signaling pathways have been found to play an important role in the tumorigenesis of solid pseudopapillary neoplasm of the pancreas, and their constitutive activation due to adenomatous polyposis coli gene inactivation in familial adenomatous polyposis may explain the relationship between familial adenomatous polyposis and solid pseudopapillary neoplasm of the pancreas.

CONCLUSION

Colonic resection must be prioritized, and a minimally invasive approach is preferred to minimize the risk of developing desmoid tumor. Pancreatic resection usually does not require extensive lymphadenectomy for solid pseudopapillary neoplasm of the pancreas, and splenic preservation is feasible.

Solid Pseudopapillary Neoplasm of the Pancreas: A Case Report of a Rare Tumor Detected by Sonography

This case presentation describes a solid pseudopapillary neoplasm found in a young 41-year-old female. This mass was initially detected with sonography and later confirmed with an ultrasound-guided biopsy. The neoplasm was scheduled to be surgically resected, as a cure, which has a favorable long-term prognosis. This case provides information on the imaging characteristics and natural history of this benign neoplasm.

Role of endoscopic ultrasonography in the diagnosis of solid pseudo-papillary neoplasm: Egyptian multi-centric case series and systematic review

Solid pseudo-papillary neoplasm (SPPN) is a rare type of pancreatic tumor accounting for less than 2% of all pancreatic neoplasms. Accurate diagnosis of these tumors is very important for proper management. In this study, observations were documented from 18 consecutive cases diagnosed with SPPN using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The data of 18 consecutive cases were prospectively collected and reviewed. The collected data included age, gender, symptoms, size and site of the lesion, and type of surgery performed, in addition to mortality and recurrence rates.

The mean age of the included cases was 33 years, and most of them were females (94.44%). Abdominal pain was the common symptom, and the pancreatic body was the most affected site. EUS-FNA confirmed the diagnosis in all cases when compared to the surgical specimen obtained. Cases were treated either with pancreatico-duodenectomy or distal pancreatectomy. One case (1/18) had early postoperative mortality due to sepsis. The remaining cases developed no recurrence or metastasis during the follow-up period of 18 months.

SPPN is not a common pancreatic tumor. Confirming the diagnosis plays a crucial role prior to surgery as it facilitates intraoperative planning; therefore, EUS-FNA is a golden standard method used to diagnose. Postoperative survival has improved if the tumor is completely removed. EUS-FNA technique is a minimally invasive technique that can provide high yielding in providing detailed diagnostic analysis of SPPN.

Differentiation Between Solid Pseudopapillary Neoplasm of the Pancreas and Nonfunctional Pancreatic Neuroendocrine Neoplasm Using Endoscopic Ultrasound

OBJECTIVES

We investigated the utility of endoscopic ultrasound (EUS) for differentiating between solid pseudopapillary neoplasm of the pancreas (SPN) and pancreatic neuroendocrine neoplasm (PanNEN).

METHODS

A retrospective analysis was performed on 29 and 77 consecutive patients with pathologically proven SPN and nonfunctional PanNEN. In patients who underwent contrast-enhanced harmonic EUS (CH-EUS), lesions were classified into 3 vascular patterns (hypoechoic/isoechoic/hyperechoic), and the presence of "the alveolus nest sign," which we previously reported as a characteristic feature of SPN on CH-EUS, was also assessed.

RESULTS

Conventional EUS findings showed that calcification echoes were significantly more frequent in SPN lesions than in PanNEN lesions (19/29 [66%] vs 21/77 [27%], P = 0.001) as was internal isoechogenicity or hyperechogenicity (10/29 [34%] vs 11/77 [14%], P = 0.029). Contrast-enhanced harmonic EUS findings showed that SPN lesions more frequently had the isoechoic or hypoechoic vascular pattern, and significantly more frequently had the alveolus nest sign (18/25 [72%] vs 4/60 [7%], P < 0.001). In a multivariate analysis, the presence of the alveolus nest sign contributed the most to the SPN diagnosis (odds ratio, 70; 95% confidence interval, 6.2-786).

CONCLUSIONS

Endoscopic ultrasound, particularly the presence of the alveolus nest sign on CH-EUS, is useful for differentiating SPN from PanNEN.

Solid pseudopapillary tumor of the pancreas: E-cadherin, β-catenin, CD99 new useful markers with characteristic expression (about two case reports)

Solid pseudopapillary neoplasm of the pancreas is a rare tumor that has favorable prognosis. It poses frequently diagnostic challenges. We describe two cases of solid pseudopapillary tumor of the pancreas managed in our department between 2007 and 2011. Two females have mean age of 36.5 years. Clinical presentation include: abdominal pain, bloating and palpable abdominal mass. Tumor is localized in the head of the pancreas in one case and in the tail in the other case. The mean size of the mass was 6 cm (range: 5 to 7 cm). Surgical treatment was performed in two cases. Histological examination confirms the diagnosis of solid pseudopapillary tumor of the pancreas. Immunohistochemical analysis was concordant to the literature data especially concerning CD99 which positivity was in dot, loss of positivity of E-cadherin and nuclear staining of β-catenin. CD10 and α-1-antitrypsin were also positive. One patient was dead 3 days postoperative and neither cancer recurrence nor distant metastases were detected on the follow up of the other. However, solid pseudo-papillary tumor of the pancreas has a distinctive histological appearance; some cases are problematic requiring the use of immunohistochemistry to distinguish it from other pancreatic neoplasm which prognosis is different.

Solid pseudopapillary neoplasm of the head of the pancreas: A case report

Introduction

and importance: Solid pseudopapillary tumor of the pancreas (SPN) or Frantz's tumor is a rare tumor of low malignant potential common in young women. The aim of this paper is to present and discuss a case of a solid pseudopapillary tumor of the pancreas occurring in a 19-year-old female.

Case presentation

A 19-year-old girl presented to our department with epigastric pain for two months, she had no clinical findings on physical examination. Abdominal Computed tomography scan (CT scan) showed the presence of a well-defined tumor arising from the pancreatic head measuring 9,1 × 8.1 × 8.5 cm, heterogeneous and with solid and necrosis components. The patient was subjected to surgery and histopathological examination confirmed the diagnosis of a pseudopapillary tumor of the pancreas.

Clinical discussion

This is an interesting case report of a rare tumor, in so far as without any adjuvant chemotherapy Prognosis of the tumor is better than other pancreatic tumors. surgical resection seems to be the best strategy in the management of SPT.

Conclusion

Close follow up is necessary for early detection of the recurrence and metastasis.

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Solid pseudopapillary tumor of the pancreas is a rare tumor of low malignant potential.

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The prognosis is favorable even in the presence of distant metastasis.

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Surgical resection is the treatment of choice.

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Close follow up is necessary to early detection of the recurrence and metastasis.

Cystic pancreatic lesions: MR imaging findings and management

Cystic pancreatic lesions (CPLs) are frequently casual findings in radiological examinations performed for other reasons in patients with unrelated symptoms. As they require different management according to their histological nature, differential diagnosis is essential. Radiologist plays a key role in the diagnosis and management of these lesions as imaging is able to correctly characterize most of them and thus address to a correct management. The first step for a correct characterization is to look for a communication between the CPLs and the main pancreatic duct, and then, it is essential to evaluate the morphology of the lesions. Age, sex and a history of previous pancreatic pathologies are important information to be used in the differential diagnosis. As some CPLs with different pathologic backgrounds can show the same morphological findings, differential diagnosis can be difficult, and thus, the final diagnosis can require other techniques, such as endoscopic ultrasound, endoscopic ultrasound-fine needle aspiration and endoscopic ultrasound-through the needle biopsy, and multidisciplinary management is important for a correct management.

Solid bifocal pseudopapillary neoplasm of the pancreas: A case report

INTRODUCTION

This neoplasm of the pancreas is an uncommon entity, with a frequency of 0.3-2.7% of all pancreatic tumors and even more so the finding of a synchronous lesion of the same histological lineage. For this reason, we report the atypical presentation of a SPNPs through a clinical case, review of the literature and a classification proposal, from the quantitative point of view.

CASE PRESENTATION

21-year-old patient, with incidental finding of two pancreatic tumors. Surgery included a pyloric preserving pancreatoduodenectomy with pancreatojejunostomy, distal pancreatectomy and central pancreas was preserved. The patient presents low output pancreatic fistula and nosocomial infection, treated with antibiotic therapy, being discharged 29 days after the intervention. Pathological and immunohistochemical analysis consistent with two SPNP.

DISCUSSION

Its diagnosis is confirmed with the histological study and two synchronic SPNP are a rare entity and for this, or multiple lesions, an attempt should be made of a conservative resection of the parenchyma to minimize pancreatic insufficiency in a frequently young population, and always look for R0 resection, due to its uncertain behavior.

CONCLUSION

Bifocal SPNP is rare and for this it is utility classify this entity -from the quantitative point of view- into unifocal, bifocal and multifocal for future medical research.

Case report: Ballotable abdominal mass in a child - Definitely renal in origin?

Introduction and importance

The differential diagnosis of a paediatric abdominal mass can be extensive, as it potentially involves multiple organs including gastrointestinal, genitourinary, endocrine, and gynaecological systems. Hence, a systematic approach to history taking and physical examination is needed to clinch the diagnosis. Specifically, the approach for assessing, investigating, and managing a ballotable left hypochondrial mass in a child can be challenging.

Case presentation

We report a 10-year-old Dusun girl presenting with left hypochondrial pain and noted a left hypochondrial mass on examination. This report highlights the role of clinical imaging during the pre-operative and post-operative phases.

Clinical discussion

Ultrasound and CT imaging was useful in determining that the tumor originated from the tail of the pancreas. The presence of a definite capsule with internal solid-cystic components helped narrowed the differential diagnosis to solid pseudopapillary neoplasm (SPN) of the pancreas. MR liver was useful to rule out liver metastasis in this child.

Intervention and outcome

The patient was scheduled for laparotomy and tumour excision at a regional paediatric centre. Successful excision of the tumor en-mass was performed and the child's subsequent recovery was uneventful.

Conclusion

Clinical imaging plays a critical role in the diagnosis and management of paediatric solid organ tumours. Other than renal origin, suspicion of pancreatic tail origin should be considered by clinicians when encountering a ballotable left abdominal mass.

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A mass arising from the pancreatic tail can present as a ballotable mass.

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Imaging findings for solid pseudopapillary neoplasm and differentials are presented.

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The role of imaging in the management of solid pseudopapillary neoplasm is discussed.

Solid pseudo-papillary tumor of the pancreas: Diagnosis by endoscopic ultrasound-guided fine needle aspiration cytology and immunocytochemistry

Pseudopapillary tumor (SPT) is a rare primary pancreatic neoplasm of uncertain origin and low malignant potential that typically affects young females, mostly in their third decade of life. There are only a few reports on fine needle aspiration (FNA) cytology diagnosis of this neoplasm. We report one such case which was diagnosed based on cytomorphologic and immunocytochemical features on endoscopic ultrasound (EUS) guided FNA smears. A 24-year-old woman presented to the gastroenterology clinic with 3-month history of epigastric pain, anorexia, and weight loss (10 kg over same time period). Abdominal CT revealed a large (13X11 cm) heterogeneous cystic lesion occupying most of the pancreatic body. EUS examination confirmed the presence of a large mixed cystic-solid lesion occupying most of the pancreatic body and neck. EUS-guided FNA smears showed tumor cells in sheets with papillary/pseudo-papillary and acinar formation. The tumor cells had abundant clear and vacuolated cytoplasm and round to oval nuclei with bland chromatin. PAS staining revealed positively stained capillary networks at the core of the papillary/pseudo-papillary structures. In addition, there were PAS positive intra-cytoplasmic and extra-cellular globules which were diastase resistant. Immuno-cytochemical staining on direct smears revealed positive reaction for cyclinD1, vimentin, CD56, beta-catenin, CD10 and progesterone receptor. Thus, this is the example of an extremely rare neoplasm which had a typical clinical and imaging setting, and could be conclusively diagnosed because of characteristic cytomorphological and immunocytochemical features.

Solid pseudopapillary Tumor of the Pancreas: Radiological and surgical review

Solid Pseudopapillary Neoplasms of the pancreas are rare pancreatic tumors with low-grade malignant potential, typically affecting young females. In this review, we discuss the surgical anatomy; the imaging characteristics, and image reporting essentials for proper surgical planning along with the atypical features which should caution the physician regarding the risk of malignancy. We also discuss the common surgical procedures and organ preservation surgeries along with a comprehensive review of the literature.

Obstructed ileocaecal tuberculosis with splenic tuberculosis and solid pseudopapillary tumour of tail of pancreas in an immunocompetent woman

A 22-year-old young woman presented with fever, lower abdominal pain and vomiting for 20 days. She had persistent fever and abdominal pain. Fever panel was negative. Clinical features were suggestive of subacute small bowel obstruction. Contrast-enhanced CT abdomen showed thickening of distal ileum, ileocaecal junction and caecum with conglomerate necrotic nodal mass in the ileocolic mesentry along with a lesion in the tail of pancreas. Patient was discussed with multidisciplinary team and decided to undergo a single-stage procedure after adequate nutritional optimisation. During optimisation, she underwent acute obstruction and hence taken up for emergency laparotomy proceeded to right haemicolectomy with distal pancreatectomy and splenectomy 4 weeks after the time of admission. Histopathology showed ileocaecal tuberculosis and solid pseudopapillary tumour with margins free of tumour. Approach of obstructed ileocaecal tuberculosis in the setting of incidental diagnosis of solid pseudopapillary tumour of pancreas in a moribund patient was challenging.

Spontaneous rupture of solid pseudopapillary tumor of pancreas: A case report and review of literature

INTRODUCTION

Solid pseudopapillary tumors (SPT) account for 1% to 3% of all pancreatic tumors. They have low malignant potential with a favorable prognosis, and predominantly occur in young women. The pathogenesis and clinical behavior of SPT are still uncertain. In addition, most ruptures of SPT were associated with blunt abdominal trauma, while spontaneous ruptures seemed to be quite rare. Up to now, there have been only 3 spontaneous ruptured SPT cases reported worldwide.

PATIENT CONCERNS

Here, we reported a 22-year-old female patient with left lower abdominal pain. Computed tomography (CT) showed that a hemorrhagic complex solid cystic mass located in the lesser omentum sac.

DIAGNOSIS

According to pathological findings of tumor specimen, the diagnosis of solid pseudopapillary tumor (SPT) of the pancreas was made.

INTERVENTIONS

Distal pancreatectomy and splenectomy was carried out.

OUTCOMES

The patient recovered to normal status within 10 days after surgery.

CONCLUSION

Besides, we reviewed about 50 cases in literatures to find out the clinical characteristics and differential diagnostic strategies of SPT.

Synchronous Pancreatic Solid Pseudopapillary Neoplasm Masquerading as Extralymphatic Involvement on 18F-Fluoro-2-deoxy-D-glucose Positron Emission Tomography/Computed Tomography in a Case of Hodgkin's Lymphoma

Solid pseudopapillary neoplasm (SPN) is a rare histopathologic variant of pancreatic tumors. Franz first described this tumor as a “papillary tumor of the pancreas, benign or malignant.” In 1996, the World Health Organization named this tumor as SPN of the pancreas. It has a female preponderance with a male-to-female ratio of 1:9. A 30-year-old female who is a known case of lymphocyte-rich classic Hodgkin's lymphoma underwent ¹⁸F-fluoro-2-deoxy-D-glucose (FDG) positron-emission tomography/computed tomography (PET/CT) for initial staging which showed intense metabolic activity in bilateral enlarged cervical and splenic hilar lymph nodes. Furthermore, intense metabolic activity was noted in hypodense lesion in the tail of the pancreas, and she was reported to be having Stage IIIE disease. Post chemotherapy, ¹⁸F-FDG PET/CT showed disappearance of all previously metabolically active lymph nodes but persisting metabolically active lesion in tail of the pancreas. Hence, we reported as complete metabolic response of Hodgkin's lymphoma as per the Lugano criteria with suspected synchronous primary in the tail of the pancreas. Post distal pancreatectomy, histopathological examination and immunohistochemistry revealed the pancreatic lesion as SPN. SPN of the pancreas itself is a rare tumor and the presence of SPN in a patient with Hodgkin's lymphoma as synchronous primary is very rare. Due to the high density of mitochondria and the hypervascular nature of the tumor, there is an accumulation of ¹⁸F-FDG in SPN tumor cells. Patients with SPN usually have a very good prognosis after surgery. The five-year survival rate is as high as 95%–97%.

Surgical approach to solid pseudopapillary neoplasms of the proximal pancreas: minimally invasive vs. open

Background

Solid pseudopapillary neoplasms (SPN) of the pancreas are rare pancreatic neoplasms where complete resection is the cornerstone in management. It has been demonstrated in previous studies that minimally invasive surgical approaches are effective management options in treating SPNs of the distal pancreas. The purpose of this study is to evaluate the feasibility of minimally invasive surgery in treating SPNs of the uncinate, head, and neck of the pancreas.

Methods

Data from 2005 to 2017 at Severance Hospital of the Yonsei University Health systems in Seoul, South Korea, were retrospectively collected for 25 patients who were diagnosed with SPN of the uncinate, head, and neck of the pancreas and who underwent curative resection. Three groups of patients were considered, depending on the year of surgery, in order to determine trends in the surgical management of SPN. The patients were also divided into two groups corresponding to the type of operation done (minimally invasive surgery vs. open surgery). Perioperative patient data, including age, gender, body mass index (BMI), tumor size, and operation done, were compared and analyzed statistically. Long-term nutritional effects were measured using the Controlling Nutritional Status (CONUT) scoring system.

Results

There were no statistically significant differences in age, gender, BMI, symptomatic presentation, operation type, tumor size, and tumor stage between the three time periods. In comparing between minimally invasive and open surgery, there were no statistically significant differences in age, gender, symptomatic presentation, BMI, tumor size, preoperative stage, type of operation, operation time, pancreatic duct size, post-operative pancreatic fistula (POPF) grade, death associated with disease, recurrence, pathological parameters, and change in CONUT score. There was a significant difference in tumor size (4.5 ± 1.8 vs. 2.6 ± 1.0 cm, p = 0.004), blood loss (664.2 ± 512.4 vs. 277.7 ± 250.8 mL, p = 0.024), need to transfuse (33% vs. 0%, p = 0.023), hospital length of stay (27.4 ± 15.3 vs. 11.5 ± 5.3 days, p = 0.002), and complication rate (75% vs. 30.8%, p = 0.027) between the two groups.

Conclusions

In appropriately selected patients with SPNs of the uncinate, head, and neck of the pancreas, a minimally invasive surgical approach offers at least equal oncologic and nutritional outcomes, while demonstrating decreased complications and decreased hospital length of stay compared with that of an open surgical approach.

Preoperative contrast-enhanced computed tomographic characterisation of pancreatic cystic lesions: A prospective study

Background

Characterisation of pancreatic cystic lesions has a direct role in their management and computed tomography is the mainstay of investigation for diagnosing and characterising them.

Objectives

The aim of this study was to prospectively assess the diagnostic accuracy of contrast-enhanced computed tomography (CECT) in preoperative characterisation of pancreatic cystic lesions with histopathology as the reference standard.

Method

A total of 38 patients with cystic pancreatic lesions diagnosed after clinical, laboratory and sonographic evaluation, irrespective of age, were preoperatively evaluated with CECT. Images were reviewed for the general characteristics of the lesions on pre-contrast and portal venous phase images and overall diagnostic accuracy calculated. Imaging findings were compared with histopathology, or cytology and/or intra-operative findings.

Results

Serous cystadenoma (SCA) was the most common cystic pancreatic lesion found in 31.6% of patients followed by mucinous cystadenoma (MCA) (26.3%), solid pseudo-papillary tumour (SPT) (21.1%) and intra-ductal papillary mucinous neoplasm (IPMN) (10.5%). Three patients (7.9%) had simple cysts and one patient (2.6%) had a lymphangioma. The diagnostic accuracy of CECT for pancreatic cystic lesions was found to be 72.5.

Conclusion

The diagnostic accuracy of computed tomography (CT) was high for SCA, IPMN and pancreatic cysts, and low for MCA and SPT. Combination of a multiloculated cystic lesion with locule size of less than 20 mm, septal enhancement with relative lack of wall enhancement, central scar and lobulated outline are highly specific for SCA. Unilocular or macro-cystic pattern with locule size of more than 20 mm, female gender and wall enhancement with smooth external contour are pointers towards MCA. Solid cystic pancreatic head lesions in young females may be suggestive of SPT. A dilated main pancreatic duct in a cystic lesion with internal septations may point towards IPMN. Fluid attenuation lesions with imperceptible non-enhancing wall indicate pancreatic cysts. Lastly, pseudocysts and neuroendocrine tumours with cystic components are great mimickers of pancreatic cystic lesions, and a history of pancreatitis and hormonal profile of patients should always be sought.

Clinicopathological Features and Treatment Outcomes of Solid Pseudopapillary Neoplasms of the Pancreas: A 10-Year Case Series from a Single Center

Background: Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare pancreatic tumors. This study summarizes the clinicopathological characteristics and treatment outcomes of SPN patients through a 10-year single-center case series. Materials and Methods: Medical records of patients diagnosed with SPNs and who underwent surgery between August 2007 and July 2017 at Qilu Hospital, Shandong University, were retrospectively analyzed. Results: This study included 91 patients: 13 males/78 females, mean age 28.8 ± 11.5 years. Among the cases, 38.5% were incidentally confirmed without specific symptoms, while the others displayed various abdominal symptoms. All patients had single pancreatic lesions, and 1 patient presented with liver metastasis. Abdominal enhanced computed tomography, magnetic resonance imaging, and endoscopic ultrasound were the diagnostic imaging techniques used to identify SPNs. All patients had successful surgical removal of their tumors; 28 patients underwent laparoscopy. During the 2-121-month follow-up period, 1 patient died of lung metastasis and multiple organ failure at 35 months postoperatively, but no other tumor recurrence or metastasis was found. Conclusions: SPN usually occurs in the young female population and presents with various clinical characteristics. Mixed solid-cystic masses with calcification or hemorrhage are typical morphological tumor features. Minimally invasive organ-/function-preserving operations are advocated for benign cases, while aggressive radical resection should be performed in patients with local invasion or distant metastasis.

Solid Pseudopapillary Neoplasm of the Pancreas Clinicopathological Characteristics and Long-Term Outcome: a Single-Center Experience

Solid pseudopapillary neoplasm is a rare tumor of the pancreas. These tumors are considered to have low malignant potential with good prognosis. Due to its rarity, details about clinical presentation and management of the disease are not very clear. This study aims to share our experience and to describe management of the disease. We retrospectively evaluated patients 13 patients diagnosed with SPT on histopathological examination of resected specimen. Data on their clinicopathological, management-related factors, and follow-up was collected. All the patients were females, with a median age of 20 years. Abdominal pain was the most common presentation. The mean tumor size was 6.5 cm and majority of tumors were located in the head region. R0 resection was obtained in all the patients. All patients were disease-free with a median follow-up of 68 months. Excellent prognosis can be achieved with a margin-negative resection in these tumors. Adjacent organ or vascular involvement is not a contraindication for surgical resection.

Radiological Workup of Cystic Neoplasms of the Pancreas

Pancreatic cystic lesions are being detected with increasing frequency because of increased use and improved quality of cross-sectional imaging techniques. Pancreatic cystic lesions encompass non-neoplastic lesions (such as pancreatitis-related collections) and neoplastic tumors. Common cystic pancreatic neoplasms include serous cystadenomas, mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, and solid pseudopapillary tumors. These cystic pancreatic neoplasms may have typical morphology, but at times show overlapping imaging features on cross-sectional examinations. This article reviews the classical and atypical imaging features of commonly encountered cystic pancreatic neoplasms and presents the limitations of current cross-sectional imaging techniques in accurately classifying pancreatic cystic lesions.

Solid Pseudopapillary Tumor of the Pancreas: A Single-center Experience and Review of the Literature

BACKGROUND

Solid pseudopapillary tumors (SPTs) of the pancreas are a rare occurrence, not exceeding 1-2% of all exocrine pancreatic tumors. SPT was first described in 1959 as "papillary tumor of the pancreas, benign or malignant" and affects mainly young women, in their second or third decade of age. These tumors are of low malignant potential, unclear pathogenesis, grow gradually and become considerably large before causing symptoms. A typical clinical presentation is often described by affected patients and, in some cases, an SPT is an incidental finding during the time the patient undergoes medical imaging studies for other health issues. SPT is frequently located at the head or tail of the pancreas. Metastases are rare but, when present, affect predominantly the liver.

PATIENTS AND METHODS

We report a series of five SPT cases in female patients 13-47 years old, presenting with almost identical symptoms of upper abdominal discomfort and non-tender palpable mass. Two out of five patients also reported vomiting, nausea and poor appetite as co-existing non-diagnostic symptoms. Only one patient presented without any symptoms. Tumor location and dimensions varied. One patient underwent a pancreatoduodenectomy (Whipple's procedure), while the remaining patients underwent distal pancreatectomy with concomitant splenectomy.

RESULTS

Perioperative morbidity and mortality was zero. All five patients are disease-free at a follow-up from 3 months to 13 years. Histopathology reports supported the diagnosis of SPT and no metastatic disease was present in any of the patients.

CONCLUSION

The overall prognosis of SPT of the pancreas is excellent due to its favorable biological features, even in the presence of distal metastasis. Although surgical resection is often curative, a close follow-up is advised in order to diagnose a possible local recurrence or distal metastasis and choose the proper therapeutic option for the patients.

Rare pancreatic tumors

In this review, we will focus on rare pancreatic tumors. Most of these tumors do not have distinct characteristic appearances so the key to diagnosis requires a combination of imaging appearance, laboratory data, patient demographics, and associated medical syndromes in order to narrow the differential diagnosis. Nonetheless, imaging plays a vital role in narrowing the differential and guiding management. While there are many variant pathologic entities that cannot be encompassed by a single review, we aim to illustrate the imaging appearance of less common pancreatic tumors highlighting key distinctive diagnostic characteristics and discuss the implications for management. While there is overlap in the imaging appearances of many of these entities, for educational purposes, lesions will be categorized into solid (hypoenhancing and hyperenhancing), cystic lesions, mesenchymal neoplasms, and neoplasms seen in younger patients (< 40 years).

Solid pseudopapillary neoplasm of the pancreas: CT imaging features and radiologic-pathologic correlation

PURPOSE

We aimed to evaluate the imaging features of solid pseudopapillary neoplasm (SPN) of the pancreas with an emphasis on radiologic-pathologic correlation.

METHODS

Ten patients (all female; mean age, 32 years) with histologic or cytologic diagnosis of SPN encountered between January 2007 and December 2013 were included in this study. Preoperative computed tomography (CT) images were reviewed for location, attenuation, enhancement pattern, margin, shape, size, morphology, presence of capsule and calcification. CT appearances were correlated with histopathologic findings.

RESULTS

Tumors in the distal pancreatic body and tail had a tendency to be larger (mean size 12.6 cm vs. 4.0 cm). Six of the nine tumors that were resected had a fibrous pseudocapsule at histology, five of which could be identified on CT scan. Eight lesions had mixed hypoenhancing solid components and cystic areas corresponding to tumor necrosis and hemorrhage. The two smallest lesions were purely solid and nonencapsulated. Varied patterns of calcification were seen in four tumors. Three of the four pancreatic tail tumors invaded the spleen. At a median follow-up of 53 months, there was no evidence of recurrence in the nine patients who underwent surgical resection of the tumor.

CONCLUSION

A mixed solid and cystic pancreatic mass in a young woman is suggestive of SPN. However, smaller lesions may be completely solid. Splenic invasion can occur in pancreatic tail SPNs; however, in this series it did not adversely affect the long-term outcome.

Image Findings of Solid Pseudopapillary Neoplasms of the Pancreas on Multiphasic Multidetector CT Scan-A Single Institute Experience from Southern India

Introduction

Solid Pseudopapillary Neoplasms (SPN) are uncommon pancreatic tumours and are slow growing with uncertain malignant potential, showing female preponderance. Postoperative prognosis is good and metastasis is rare.

Aim

To summarise the imaging and pathological features of seven cases of SPN in three years period, from January 2013 to January 2016.

Materials and Methods

In this retrospective study the imaging features of seven cases on triphasic multidetector Computed Tomogram (CT), a 16-slice scanner, were reviewed along with CT-guided Fine Needle Aspiration Cytology (FNAC) and histopathological examination. Statistics were expressed in terms of percentiles.

Results

All cases were female patients with an age range of 13-35 years (mean: 23.3 years). On CT assessment, the size of the tumours varied from 2.5-14 cm (mean: 5.3 cm). All these tumours were well capsulated and round to oval in shape. In four out of seven cases, the tumour was located in the tail of pancreas. All the solid enhancing portions showed moderate enhancement of at least 20-30 HU compared to unenhanced scan, on the other hand the cystic parts remained unenhanced with <5 HU variation in comparison to the plain scan. Histopathological examination exhibited characteristic poorly cohesive cuboidal cells arranged in papillaroid pattern having fine nuclear chromatin with nuclear grooves.

Conclusion

Solid pseudopapillary neoplasm is a high diagnostic possibility in case of a young female having pancreatic mass and needs to be evaluated with triphasic contrast enhanced CT scan, followed by FNAC and or histopathological examination.

Silent Presentation of a Solid Pseudopapillary Neoplasm of the Pancreas

BACKGROUND Solid pseudopapillary neoplasm (SPN) is a rare tumor frequently found in the head or tail of the pancreas. It mainly presents in young women between the 2nd and 3rd decades of life. A predilection for African Americans and Asians has been observed and is rarely reported in children. Most patients are symptomatic, with abdominal pain as the most common presenting symptom. Clinical laboratory test results are usually normal and pancreatic markers are not typically elevated. Metastatic disease is very uncommon, but most often metastasizes to the liver and regional lymph nodes. Prognosis is usually excellent after surgical resection. CASE REPORT We present the case of a 14-year-old Hispanic female who presented to the emergency department after a high-speed motor vehicle accident. She suffered multiple body traumas. Specifically, the patient referred severe epigastric pain. No significant past medical or surgical history was obtained. Laboratory workup was non-contributory. Further evaluation with abdomen and pelvis contrast-enhanced computed tomography and magnetic resonance imaging revealed a pancreatic tail mass. Distal pancreatectomy followed. Pathologic diagnosis of SPN was established. CONCLUSIONS SPN is a rare exocrine tumor with excellent prognosis following resection. Imaging findings are suggestive, but a pathology evaluation is necessary to make the final diagnosis. Differential diagnosis includes entities such as mucinous cystic pancreatic tumor, pancreatic ductal carcinoma, and pancreatic serous cystadenoma. Radiologists play a vital role in the diagnosis, since many times, as in our case, it presents as an incidental finding. A small percentage of SPN neoplasms are associated with metastasis or local recurrence. Therefore, the aim of our case presentation is to review key imaging findings to guide early management and surgical planning.

Solid Pseudopapillary Tumour of Extrapancreatic Origin Presenting as Mesenteric Cystic Mass: A Diagnostic Dilemma

Solid Pseudopapillary Tumour (SPT) is a rare and distinctive pancreatic exocrine neoplasm. Even Rarely, such primary SPT may originate from ectopic pancreatic tissues. We are hereby presenting one such unique case, where a 50-year-old female presented with pain and a mid-abdominal lump. Radiology revealed a well-defined outline located adjacent to the tail of pancreas. The excised mass was 19×14×7cm in dimension having zones of haemorrhage, necrosis and cystic spaces filled with necrotic debris. Microscopic examination confirmed the diagnosis of SPT. SPT originating in extrapancreatic location may mimic an ovarian cystic tumours or mesenteric cysts, its proper identification is crucial.

Solid Pseudopapillary Neoplasm of Pancreas; A Case Series and Review Literature

BACKGROUND

Information regarding solid pseudopapillary neoplasm (SPN) of the pancreas is limited in Iran. We aimed to review the clinicocytopathological features and follow-up of patients with SPN of pancreas who were diagnosed in a single center in Iran.

METHODS

Seven patients with SPN of the pancreas were diagnosed during January 2010 to March 2015 at the Digestive Disease Research Institute of Tehran University of Medical Sciences. The patients were reviewed prospectively.

RESULTS

Six out of the 7 patients were female and the mean age of all the patients was 29.4 years ranging from 15 to 61 years. The most common clinical presentation was nonspecific abdominal pain (N=6). The tumors were located mostly in head and neck of the pancreas. SPN was diagnosed in all patients by fine needle aspiration through endosonography (EUS-FNA). All patients underwent surgery. Histological findings of surgical tissues were consistent with EUS-FNA. The postoperative follow-up period of about 14 months was uneventful.

CONCLUSION

SPN of the pancreas is a rare pancreatic tumor which affects primarily young women. EUS-guided FNA could play an important role in preoperative diagnosis of SPN of the pancreas.

Two-photon excited fluorescence imaging of the pancreatic solid pseudopapillary tumor without hematoxylin and eosin stains

Solid pseudopapillary tumor (SPT) of the pancreas is an epithelial tumor with low-grade malignant potential and present more common in females. At present, the gold standard for accurate diagnosis of pancreatic tumor was mostly depending on the pathological and/or cytological evaluation. In this work, TPEF microscopy was applied to obtain the images of human normal pancreas and SPT of the pancreas without hematoxylin and eosin (H&E) staining, for the purpose of identifying the organization structural, cell morphological, and cytoplasm changing, which were then compared to their corresponding H&E stained histopathological results. Our results showed that high-resolution TPEF imaging of the pancreatic SPT can clearly distinguish the pathological features from normal pancreas in unstained histological sections, and the results are consistent with the histological results. Moreover, we measured the nuclear-cytoplasmic ratios of the pancreatic SPT and normal pancreas to characterize their difference in the cytomorphological feature. It indicated that this technique can achieve the consistent information of pathological diagnosis, and has the potential to substantially improve the optical diagnosis and treatment of the pancreatic SPT without H&E staining in the future. SCANNING 38:245-250, 2016. © 2015 Wiley Periodicals, Inc.

Ultrasonographic features and differential diagnosis of solid pseudopapillary tumors of the pancreas

AIM: To explore the ultrasonographic features of solid pseudopapillary tumors of the pancreas (SPTP) and their differential diagnosis from pancreatic neuroendocrine tumors (PNET) and pancreatic cancer (PC).

METHODS: Clinical data including conventional ultrasonographic characteristics for 52 patients with pathologically confirmed SPTP, 63 patients with PNET, and 68 patients with PC and the patterns of contrast enhanced ultrasonography (CEUS) in 6 cases of SPTP, 10 cases of PNET and 21 cases of PC were retrospectively analyzed.

RESULTS: There were significant differences between the SPTP group and the PNET group in age, sex, jaundice, tumor size, shape, calcification, liquefaction, separation, blood flow, arterial phase and late phase enhancement mode and non-enhancement area in the lesions (P < 0.05), while presence of abdominal pain, elevated CA-199, number of tumors, location, expansion of the main pancreatic duct and recurrence or metastasis had no statistical significance (P > 0.05). There were significant differences between the SPTP group and the PC group in age, sex, abdominal pain, jaundice, elevated CA-199, tumor size, location, shape, calcification, liquefaction, expansion of the main pancreatic duct, recurrence or metastasis, arterial phase enhancement mode and non-enhancement area in the lesions (P < 0.05), while number of tumors, separation, blood flow and late phase enhancement mode had no statistical significance (P > 0.05).

CONCLUSION: A solid or cystic-solid pancreatic tumor which shows peripheral ring enhancement in the arterial phase, hypo-enhancement in the late phase and central non-enhancement area could be considered as an SPTP in young female patients without jaundice, elevated CA-199 or main pancreatic duct dilation. It should be differentiated from PNET and PC.

Solid Pseudopapillary Tumor in a Pregnant Woman: Imaging Findings and Literature Review

A solid pseudopapillary neoplasm is a rare pancreatic tumor accounting for 1-2% of exocrine pancreatic neoplasms. It is usually asymptomatic and discovered incidentally. It is mainly seen in young women between the second and third decades of life. Although it usually has a large size at the time of diagnosis, it is considered to have low malignant potential. Solid pseudopapillary tumors (SPTs) have characteristic magnetic resonance imaging (MRI) features that enable it to be differentiated from other more common pancreatic tumors. Here, we report the case of a 34-year-old pregnant woman who was admitted to The Royal Hospital, Oman, with a large mass in her pancreas, which was incidentally discovered during abdominal ultrasonography. The mass was investigated further with MRI. The MRI revealed a well-defined mass related to the tail and body of the pancreas with solid and cystic components. It had a heterogeneous texture with fluid levels of different signal intensities due to the presence of blood of different ages. The cystic-solid appearance of an encapsulated lesion with characteristic signal intensity on MRI suggested the possibility of a SPT. Postoperative histopathology results confirmed the diagnosis of a SPT. In this case report, we highlight the MRI features of a SPT and discuss how to differentiate it from other cystic pancreatic tumors to increase the awareness of clinicians to this rare pancreatic tumor.

Identification of potential biomarkers to differentially diagnose solid pseudopapillary tumors and pancreatic malignancies via a gene regulatory network

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.

A Persistent Solid Pseudopapillary Tumor of the Pancreas: Case Report and Brief Literature Review

Background: Solid pseudopapillary tumors (SPTs) of the pancreas are uncommon neoplasms, first reported in 1934, well described by Frantz in 1959, and later further characterized by Hamoudi in 1970. Ninety percent of these tumors occur in young females in their second to third decade of life. An interesting case of a persistent solid pseudopapillary neoplasm is described in this report. Case presentation: A 24-year-old woman from a Middle Eastern country presented with an 8.2 × 7.6 cm heterogeneous-enhancing lesion growing within the uncinate process of the pancreas. She had first experienced symptoms at the age of 12 years. Imaging studies showed that the mass closely abutted the superior mesenteric vein as well as the superior mesenteric artery (SMA). The patient underwent an open cholecystectomy and a classic pancreaticoduodenectomy. During the resection, the SMA was transected due to tumor adherence. The vessel was subsequently reapproximated in an end-to-end manner. On the first postoperative day, thrombosis of the SMA occurred and a bile leak developed. The patient returned to the operating room for SMA embolectomy and for repair of a hepaticojejunostomy leak, with redo of the biliary-enteric anastomosis. Histopathological examination showed solid pseudopapillary-arranged cells and cystic areas, showing strong cellular immunoreactivity for CD56, CD10, vimentin, and β-catenin, and weak diffuse staining for synaptophysin. The tumor stained negative for chromogranin A, trypsin, AE1/AE3, and E-cadherin. Molecular genetic analysis was negative for the MYB gene deletion. At nearly 1 year of follow-up, the patient is well with no evidence of tumor recurrence. Conclusion: SPTs of the pancreas should be included in the differential diagnosis of pancreatic tumors, especially in young women.

Incidental detection of a small solid pseudopapillary neoplasm of the pancreas after a traffic accident in a 12-year-old girl: a case report

Solid pseudopapillary neoplasm (SPN) is a rare tumor of the pancreas that tends to grow silently in patients at a young age, to a large size and mass. We report here a case of a small-sized SPN detected incidentally in a 12-year-old girl following a traffic accident. The tumor was 3.5 cm in maximal diameter and was found to have hemorrhagic necrosis without a solid component. Laparoscopic spleen-preserving distal pancreatectomy was performed which cured the patient. SPN is generally accepted to be a low grade malignant tumor, but its clinical behavior is sometimes unpredictable. Tumor size and the proportion of solid portion of the tumor have both recently been identified as predictors of malignancy. Although the initial presentation in this case was that of the traffic accident, the subsequent detection of a small, totally cystic SPN, and then the complete eradication of the lesion, led to a favorable outcome for the patient. Long-term monitoring should prevent any chance of recurrence.

Pancreatic tumours in children: diagnosis, treatment and outcome

PURPOSE

Pancreatic tumours in children are exceedingly rare and as a result constitute a diagnostic and therapeutic challenge to paediatric surgeons. We reviewed our experience with these rare entities.

METHODS

Retrospective single institution study on all paediatric pancreatic tumours over a period of 38 years (1973-2011) and literature review. We recorded data relating to the clinical features at presentation, diagnostic evaluation, treatment and outcome.

RESULTS

Fourteen patients were identified (eight male). The most common symptoms at presentation were abdominal pain, anorexia and vomiting. Two cases were discovered incidentally. There were 12 primary and 2 metastatic tumours. Tumour types were solid pseudopapillary neoplasm (n = 6), insulinoma (n = 3), pancreatoblastoma (n = 1), congenital pancreatic cyst (n = 1), Burkitt lymphoma of the pancreas (n = 1) and metastatic lesions of other primary tumours (n = 2). Twelve were treated with surgical resection including 2 laparoscopically. Post-surgical complications included acute pancreatitis (n = 2) and pancreatic pseudocyst (n = 2). There was one death from a metastatic tumour and treatment is ongoing in one patient. The remainder has survived.

CONCLUSION

Paediatric pancreatic tumours are rare entities and are usually benign. Clinical symptoms are often non-specific and presentation may be late due to tumour inactivity in case of endocrine neoplasms. For most tumours, surgical resection is the optimal treatment which may be successfully performed laparoscopically when the lesion is in the body or tail of the pancreas. Long-term outcome is generally good.

Solid Pseudopapillary Neoplasm of the Pancreas in a Pediatric Patient

Solid pseudopapillary neoplasm (SPN) is a rare epithelial neoplasm of the pancreas, with low malignant potential, that usually occurs in young women. With advancing diagnostic imaging techniques and technology, the number of documented SPN cases has increased. Due to a varying morphologic appearance, SPNs often fail to show typical imaging findings, making it difficult to establish a definitive diagnosis. A case is reported of a SPN discovered on a routine abdominal sonogram, further characterized with magnetic resonance imaging, and confirmed with surgical pathology analysis. Sonographers should be aware of this rare pathology and should consider SPN in the differential diagnosis when encountering an indeterminate pancreatic neoplasm, especially in a young female patient.

Solid pseudopapillary tumors of the pancreas: Findings from routine screening sonographic examination and the value of contrast-enhanced ultrasound

BACKGROUND

Solid pseudopapillary tumors (SPTs) are rare neoplasms of the pancreas. We describe the features of these small tumors identified on routine screening sonographic (US) examination and the potential value of using contrast-enhanced ultrasound (CEUS) scanning.

METHODS

We retrospectively reviewed records from 17 patients who had undergone screening via US examination at Peking University Third Hospital between January 2000 and June 2011. Each of these patients had been confirmed by a pathologist to have an SPT. Six patients had undergone CEUS prior to surgery. We recorded all features on both gray-scale US and CEUS.

RESULTS

All patients (4 men and 13 women; ages 23-35 years; mean age, 27.2 years) were initially screened by US. The largest mass identified was 5.0 cm in diameter (mean diameter, 4.2 cm), and most tumors showed homogeneous hypoechogenicity. A hyperechoic rim was detected in four masses. CEUS showed peripheral-rim hyperenhancement in the arterial phase of all six masses.

CONCLUSIONS

Routine screening US examinations are capable of identifying small (<5.0 cm) SPTs. These screening examinations allow diagnosis on the basis of typical imaging features, such as a homogeneously hypoechoic mass with a hyperechoic rim. CEUS shows greater detail of the rim and cystic areas in the tumor, which significantly improves the proper diagnosis.

Comparison of abdominal ultrasonographic findings with endoscopic ultrasonographic findings of solid pseudopapillary neoplasms of the pancreas

To compare abdominal ultrasonographic (AU) findings with endoscopic ultrasonographic (EUS) findings of solid pseudopapillary neoplasm (SPN) of the pancreas, 13 patients (male-to-female ratio, 3:10; mean age, 36 years) with surgically proven SPN who underwent both preoperative AU and EUS were included in the study. Ultrasonographic findings of the 2 modalities were compared according to internal echogenicity, calcification, demarcation, internal septum, and main pancreatic duct dilatation. Nine cases showed hypoechogenicity on both AU and EUS. The remaining 4 cases showed different echogenicity on both modalities as follows: hypoechogenicity (n = 2) and isoechogenicity (n = 2) on AU; and hyperechogenicity (n = 1), poor visualization of internal architecture due to dense rim calcification (n = 2), and isoechogenicity (n = 1) on EUS. In 2 cases with dense rim calcification, evaluation of the internal contents was more difficult on EUS compared with AU. In addition, central punctate calcifications of 2 cases were well visualized on both AU and EUS, but the 1 case of peripheral calcification was only seen on EUS. All cases showed good demarcation without main pancreatic ductal dilatation or internal septa. Endoscopic ultrasonography was superior to AU for the evaluation of internal echogenicity of pancreatic SPN; however, AU was superior at evaluating larger tumors and tumors with dense rim calcification.

Solid pseudopapillary tumor of the pancreatic: evaluation of clinical, radiological and surgical profiles

OBJECTIVE

To describe the clinical, radiological and surgical features of solid pseudopapillary tumor of the pancreas.

METHODS

We conducted a retrospective, observational study evaluating the multi-institutional clinical, radiological and surgical patients with a diagnosis of solid pseudopapillary tumor of the pancreas undergoing surgical treatment.

RESULTS

We identified eight patients in three hospitals in the state of Amazonas, seven females, six under the age of 30. The neoplasia predominated in the head of the pancreas. Five patients underwent pancreaticoduodenectomy, one enucleation, one distal pancreatectomy, and one was considered unresectable.

CONCLUSION

Solid pseudopapillary tumor of the pancreas predominated in young female patients, predominantly located in the pancreatic head.

Multiple liver metastases of pancreatic solid pseudopapillary tumor treated with resection following chemotherapy and transcatheter arterial embolization: A case report

A 33-year-old female was diagnosed with a solid pseudopapillary tumor (SPT) of the pancreas and multiple liver metastases at the Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital (Kanazawa, Japan). Distal pancreatectomy and postoperative systemic chemotherapy with gemcitabine (GEM) and S-1, an oral fluoropyrimidine derivative, was administered, however, liver metastases became enlarged and local recurrence occurred. Therefore, the patient was referred to the Department of Gastroenterologic Surgery at the Graduate School of Medicine (Kanazawa, Japan) for hepatic arterial infusion (HAI) chemotherapy. Oral S-1 (80 mg/m²) was administered as well as HAI chemotherapy with GEM (1,000 mg/standard liver volume). Following 18 cycles, tumor sizes were reduced and 18-fluorodeoxyglucose positron emission tomography (¹⁸FDG-PET) examination revealed obvious reduction of tumor FDG uptake. Transarterial tumor embolization (TAE) was performed for the previously unresectable right subphrenic liver tumor, and the other tumors were surgically resected. The resected tumors were diagnosed as liver metastases and a local recurrence of SPT in the postoperative pathological examination, which revealed that the resected tumors were composed of sheets of bland cells, which were positive for CD10, CD56, vimentin, neuron-specific enolase and α-antitrypsin. The postoperative course was uneventful, and the patient is currently under observation at an outpatient clinic; postoperative adjuvant chemotherapy with oral S-1 has continued, and additional TAE is planned. In the future, if the middle segment of the liver becomes enlarged, surgery for the residual right lobe tumor may be possible. This case demonstrates one method of SPT treatment: Preoperative HAI chemotherapy with GEM, plus oral S-1 and TAE. If complete resection can be achieved, the majority of patients with SPT have a favorable prognosis. In patients with unresectable metastases from SPT, it is crucial to conduct systematic multimodal treatment to maximize treatment success.