Solid pseudopapillary neoplasm of the pancreas: report of a case after a 10-year follow-up and review of the literature

Solid Pseudopapillary Neoplasm of the Pancreas: A Clinicopathological Study of 12 Cases With Emphasis on Diagnostic Pitfalls

INTRODUCTION

Solid pseudopapillary neoplasm of the pancreas (SPNP) is a rare primary neoplasm with distinct clinicopathological features. The tumor most commonly occurs in younger (premenopausal) women and is typified by low malignant potential and an excellent overall prognosis.

METHODS

A retrospective search over 20 years at two referral tertiary care institutions (King Faisal Hospital and Research Center and King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia) revealed 12 female patients diagnosed with SPNPs. The reslts of ancillary studies performed at the time of diagnosis were also reviewed and placed in the context of current recommendations.

RESULTS

The clinical and pathological findings were reviewed. All patients were females, aged 18 to 30 years. Eight patients presented with abdominal pain, of which two experienced significant weight loss, and four presented with abdominal mass/discomfort. The tumor size ranged from 1.5 and 15 cm. Two cases were initially diagnosed as neuroendocrine tumors (NETs). One of the cases presented as a multifocal disease. All patients were treated surgically with a follow-up period between one and 11 years. Only one patient presented with peritoneal metastasis after seven years of follow-up, but generally, all are doing well.

CONCLUSIONS

We have analyzed 12 SPNP cases in our population over 20 years (2001-2021) in this study. In brief, SPNP is a low-grade malignant potential tumor. Even though SPNP is a recognized entity, diagnostic challenges can arise particularly in the setting of limited sampling. Pathologists must be aware of the classic morphological features of SPNP and the characteristic profile of immunohistochemistry and be able to differentiate SPNP from other mimickers, especially well-differentiated NETs of the pancreas, and ultimately to avoid misdiagnosis and unnecessary oncologic treatment. Adequate surgical resection with negative margins is associated with an excellent outcome.

Laparoscopic Distal Pancreatectomy with or without Preservation of the Spleen for Solid Pseudopapillary Neoplasm

Solid pseudopapillary neoplasm (SPN) is a rare tumor of the pancreas. Laparoscopic distal pancreatectomy (DP) is a feasible and safe procedure, and successful spleen preservation rates are higher using a laparoscopic approach. We hypothesized that certain patients with SPN would be good candidates for laparoscopic surgery; however, few surgeons have reported laparoscopic DP for SPN. We discuss the preoperative assessment and surgical simulation for two SPN cases. A simulation was designed because we consider that a thorough preoperative understanding of the procedure based on three-dimensional image analysis is important for successful laparoscopic DP. We also discuss the details of the actual laparoscopic DP with or without splenic preservation that we performed for our two SPN cases. It is critical to use appropriate instruments at appropriate points in the procedure; surgical instruments are numerous and varied, and surgeons should maximize the use of each instrument. Finally, we discuss the key techniques and surgical pitfalls in laparoscopic DP with or without splenic preservation. We conclude that experience alone is inadequate for successful laparoscopic surgery.

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.

Pseudopapillary tumor in pediatric age: clinical and surgical management

BACKGROUND

Solid pseudopapillary tumors of the pancreas are rare exocrine pancreatic tumors. Through a review of pediatric cases in a single Institution, we present the clinical and surgical management of this neoplasm.

METHODS

We retrospectively reviewed the clinical charts of patients treated at our unit between 1995 and 2009 for SPT. Clinical and surgical management were analyzed and reported.

RESULTS

During the study period 11 patients underwent surgery for pseudopapillary tumor. Five patients were treated with duodenum-preserving pancreatic head resection and six patients with splenopancreasectomy with a Roux-en-Y pancreatic jejunostomy. Patients did not show recurrence and are currently disease free. Blood tests, Ultrasound, Computed tomography and Magnetic Resonance Imaging were not useful to preoperatively identify the nature of the pancreatic masses.

CONCLUSION

Solid pseudopapillary tumor is a rare condition that should be taken into account for the differential diagnosis of pancreatic masses in pediatric age. Due to its favourable prognosis, surgical removal should be planned and done following the intraoperative findings.

Solid pseudopapillary tumor of the pancreas: a rare and probably misdiagnosed neoplasm

Solid Pseudopapillary Tumor of the pancreas is a rare nonfunctioning tumor. It is considered a low-grade malignancy that is apparently curable with surgical complete excision in most instances. We present a case of solid pseudopapillary pancreatic tumor that represented a challenge to the radiologists. This case highlights its possible various appearances and the need to the radiologist to be familiar with them.

Solid pseudopapillary neoplasms of the pancreas: a multi-institutional study of 21 patients

BACKGROUND

Solid pseudopapillary neoplasms of the pancreas (SPN) account for less than 1% of all pancreatic tumors. The goal of this study was to better understand the nature of these rare tumors through analysis of patients' clinical presentations and outcomes following surgical resection.

METHODS

A multi-institutional retrospective review was conducted of all patients who underwent surgical resection from 1994 to 2008.

RESULTS

Twenty-one patients were identified with SPN. Twenty patients were female. Median age at presentation was 34 y. The most common presenting symptom was abdominal pain (67%). All patients underwent resection: distal pancreatectomy (9), pancreaticoduodenectomy (5), central pancreatectomy (6), and laparoscopic excision/enucleation (1). A R(0) resection was obtained in all patients. Median tumor size was 5.5 cm. AJCC stages were stage I (18), stage II (1), stage III (2), and stage IV (0). Postsurgical complications occurred in 52% of patients, with pancreatic fistulae being the most common (29%). The median follow-up time was 55 mo. All patients remain alive without evidence of recurrence.

CONCLUSION

Solid pseudopapillary neoplasms of the pancreas are atypical pancreatic tumors. SPN usually occur in young women who present with abdominal pain. Oncologic outcomes in patients who undergo surgical resection are excellent.

Previously unidentified complex cytogenetic changes found in a pediatric case of solid-pseudopapillary neoplasm of the pancreas

Solid pseudopapillary neoplasm of the pancreas (SPNP) is a rare tumor with low malignant potential found in adolescent girls and young women. The pathogenesis of SPNP remains uncertain and its management is controversial. Genetic changes associated with SPNP have seldom been reported. We describe here the cytogenetic investigation of a case of SPNP in a 13-year-old girl whose tumor cells revealed two unrelated clones: one clone characterized by complex karyotypic changes, including breakpoints in two common fragile sites at chromosome 2, band q33, and chromosome 4, band q31, and the second clone defined by partial monosomy for chromosome X. Loss of heterozygosity for HRAS was also identified by array comparative genomic hybridization (a-CGH). These cumulative changes seem insufficient for activation of cell transformation, but could possibly play a role in priming the cell for future mutagenic events.

Papillary cystic and solid tumour of the pancreas: report of a case and literature review

Background

The papillary cystic and solid tumour of the pancreas (PCSTP) is a rare primary neoplasm of unknown pathogenesis typically found in young women. PCSTP is a low-grade malignant tumour, which is often asymptomatic but it may present with abdominal pain.

Case presentation

A 38 year old female patient who presented with one day history of epigastric pain was diagnosed as PCSTP. The patient was successfully treated with distal pancreatectomy.

Conclusion

It is important to differentiate this tumour from other pancreatic tumours because, unlike malignant pancreatic tumours, this neoplasm does not usually metastasise and is amenable to cure after complete surgical resection. However, the cell origin and the aetiology of this tumour are not clear and further studies are warranted in its pathogenesis.

Tumeur pseudo-papillaire pancréatique révélée par la rupture de varices œso-gastriques secondaire à une cirrhose biliaire par une compression cholédocienne

Pseudo-papillary tumors of the pancreas are rare and usually occur in young women. We report a case with a very rare presentation (rupture of esogastric varices complicating biliary cirrhosis secondary to bile duct compression by a pancreatic tumor). After biological and radiological explorations, a duodenopancreatectomy was performed. Diagnosis was confirmed by conventional histology and immunohistochemistry. One year later, the patient remained asymptomatic.

Solid-Pseudopapillary Tumor of the Pancreas: Two Cases in Male Patients

Solid-pseudopapillary tumor (SPT) of the pancreas is a rare lesion with low malignant potential occurring predominantly in young women. This is a report of two cases in young male patients. Clinical data were retrieved retrospectively from a prospective database of patients with pancreatic tumors. The two patients were Caucasian males, ages 34 years (Pt1) and 41 years (Pt2) at the time of diagnosis. Pt1 presented with intermittent epigastric pain, nausea, and vomiting. Computed tomography (CT) scan showed a 9-cm mass involving the pancreatic head. He underwent pancreaticoduodenectomy, with en bloc segmental colectomy due to mesocolon involvement. Pt2 was asymptomatic, diagnosed with abdominal mass by screening ultrasound. He had an 11-cm tumor involving the pancreatic tail encasing the splenic vessels on CT. He underwent distal pancreatectomy with splenectomy en bloc. Pathology in both cases was reviewed by staff pathologists as well as outside consultants. SPT is a rare tumor of the pancreas that is diagnosed primarily in young women. The cases presented here demonstrate SPT of the pancreas in two men. In both cases, the clinical presentation was relatively unremarkable. Both have had benign late postoperative courses, consistent with the low malignant potential of this lesion.