1
|
Ricardo VD, Marchetti G, de Almeida AF, Lopes CV, Reis JDS, Bonin EA, de Araújo WC, Machado MA, Romanini SG, Ardengh JC. Multicenter Study on the Performance of Imaging Tests Compared to Endosonography-Guided Fine-Needle Aspiration in the Diagnosis of Solid Pseudopapillary Neoplasms of the Pancreas. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:375-383. [PMID: 37868635 PMCID: PMC10586220 DOI: 10.1159/000525994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/07/2022] [Indexed: 10/24/2023]
Abstract
Introduction Imaging diagnosis of pancreatic solid-pseudopapillary neoplasms (SPNs) is difficult. Preoperative diagnosis by endosonography-guided fine-needle aspiration (EUS-FNA) is possible and has been reported in the literature in pancreatic tumors. However, its usefulness is still controversial. The aim of this study was to determine the accuracy of the EUS-FNA in the diagnosis of patients with SPN and describe the findings in computerized tomography (CT), magnetic resonance cholangiopancreatography imaging (MRI/MRCP), and EUS therefore comparing the imaging methods alone to the findings of microhistology (McH) obtained by EUS-FNA. Materials and Methods We retrospectively reviewed the medical records of patients undergoing EUS-FNA with suspected SPN in imaging studies in 5 Brazilian high-volume hospitals (two university hospitals and three private hospitals). The demographic data; findings in CT, MRI/MRCP, and EUS; and McH results obtained by EUS-FNA were noted prospectively. The final diagnosis was obtained after the anatomopathological examination of the surgical specimen in all patients (gold standard), and we compared the results of CT, MRI/MRCP, EUS, and the McH with the gold standard. Results Fifty-four patients were included in the study, of which 49 (90.7%) were women with an average age of 33.4 (range 11-78) years. The most common symptom presented was abdominal pain, present in 35.2% patients. SPN was detected incidentally in 32 (59%) patients. The average size of the tumors was 3.8 cm (SD: 2.26). The most common finding at EUS was a solid, solid/cystic, and cystic lesion in 52.9%, 41.1%, and 7.8% patients, respectively. The final diagnosis was 51 patients with SPN and 3 with nonfunctioning pancreatic neuroendocrine tumors (NF-NET). The correct diagnosis was made by CT, MRI/MRCP, EUS isolated, and EUS-FNA in 21.9%, 28.88%, 64.71%, and 88.24%, respectively. EUS-FNA associated with CT and MRI increased diagnostic performance from 22.72% to 94.11% and from 29.16% to 94.11%, respectively. Conclusions SPN are rare, incidentally identified in most cases, and affect young women. Differential diagnosis between SPN, NF-NET, and other types of tumors with imaging tests can be difficult. EUS-FNA increases preoperative diagnosis in case of diagnostic doubt and should be used whenever necessary to rule out NF-NET or other type of solid/cystic nodular lesion of the pancreas.
Collapse
Affiliation(s)
| | - Giulia Marchetti
- Santa Casa de São Paulo Medical School (FCMSCSP), São Paulo, Brazil
| | | | - César Vivian Lopes
- Endoscopy Service of Santa Casa do Rio Grande do Sul, Rio Grande, Brazil
| | - Jerusa dos Santos Reis
- Endoscopy Section of the Presidente Dutra Hospital, Federal University of Maranhão, São Luís, Brazil
| | | | | | | | | | - José Celso Ardengh
- Endoscopy Department of Hospital Moriah, São Paulo, Brazil
- Digestive Endoscopy Section of Hospital das Clínicas de Ribeirão Preto Medical School, University of São Paulo (HCFMRP-USP), São Paulo, Brazil
- Department of Diagnostic Imaging of the Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| |
Collapse
|
2
|
Kim MS, Park H, Lee S, Yoo SY, Cho SY, Lee SK, Jin DK. Clinical characteristics, treatment outcomes, and occurrence of diabetes mellitus after pancreatic resection of solid pseudopapillary tumor in children and adolescents: A single institution experience with 51 cases. Pancreatology 2021; 21:509-514. [PMID: 33509684 DOI: 10.1016/j.pan.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/25/2020] [Accepted: 01/15/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Solid pseudopapillary tumors (SPTs) are rare, but they comprise the majority of pediatric pancreatic neoplasms. However, studies on these conditions in pediatric patients are lacking. The aim of this study was to investigate the clinical characteristics and treatment outcomes in children and adolescents with SPTs. METHODS This retrospective study included 51 patients with SPTs who had undergone pancreatic tumor resection before the age of 19 years at Samsung Medical Center in Korea (from November 1994 to August 2020). We investigated the postoperative outcomes. RESULTS Of the 51 patients with SPTs (female, 88.2%), the median age at diagnosis was 14 years (range, 8-19). The most common symptom was abdominal pain (60.8%), and 14 patients (27.5%) were asymptomatic. The median maximal tumor diameter was 7 cm (range, 1.4-14), and the pancreatic body and/or tail were involved in 68.6% of patients. The short-term complication rate was 21.5%, and the recurrence rate was 5.9%. New-onset diabetes mellitus (NODM) occurred in four patients. CONCLUSIONS The ideal treatment for SPTs is complete resection of the tumor; however, long-term postoperative complications including NODM should be monitored carefully, particularly in children and adolescents.
Collapse
Affiliation(s)
- Min-Sun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyojung Park
- Department of Pediatrics, Seongnam Citizens Medical Center, Gyeonggi-do, Republic of Korea
| | - Sanghoon Lee
- Department of Pediatric Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - So Young Yoo
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Yoon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Suk-Koo Lee
- Department of Pediatric Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Kyu Jin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
3
|
Ardengh JC, Lopes CV, Venco FE, Machado MA. Diagnosis of pancreatic solid pseudopapillary neoplasms using cell‐blocks and immunohistochemical evaluation of endoscopic ultrasound‐guided fine needle aspiration biopsy specimens. Cytopathology 2020; 32:50-56. [DOI: 10.1111/cyt.12905] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/09/2020] [Accepted: 08/17/2020] [Indexed: 12/11/2022]
Affiliation(s)
- José Celso Ardengh
- Division of Surgery and Anatomy Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
- Endoscopy Unit Hospital 9 de Julho São Paulo Brazil
| | - César Vivian Lopes
- Department of Gastroenterology and Digestive Endoscopy Santa Casa Hospital Porto Alegre Brazil
| | | | | |
Collapse
|
4
|
McHugh KE, Stelow EB, Harrison GP, Policarpio‐Nicolas MLC. The usefulness of lymphoid enhancer‐binding factor 1 and androgen receptor in diagnosing solid pseudopapillary neoplasm of the pancreas on cytopathology. Cancer Cytopathol 2019; 127:700-707. [DOI: 10.1002/cncy.22186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Kelsey E. McHugh
- Department of Laboratory Medicine Cleveland Clinic Cleveland Ohio
| | - Edward B. Stelow
- Department of Pathology University of Virginia School of Medicine Charlottesville Virginia
| | - Grant P. Harrison
- Department of Pathology University of Virginia School of Medicine Charlottesville Virginia
| | | |
Collapse
|
5
|
Crocoli A, Grimaldi C, Virgone C, De Pasquale MD, Cecchetto G, Cesaro S, Bisogno G, Cecinati V, Narciso A, Alberti D, Ferrari A, Dall'Igna P, Spada M, Inserra A. Outcome after surgery for solid pseudopapillary pancreatic tumors in children: Report from the TREP project-Italian Rare Tumors Study Group. Pediatr Blood Cancer 2019; 66:e27519. [PMID: 30362240 DOI: 10.1002/pbc.27519] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/12/2018] [Accepted: 10/01/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Solid pseudopapillary pancreatic tumors (SPPT) are an extremely rare entity in pediatric patients. Even if the role of radical surgical resection as primary treatment is well established, data about follow-up after pancreatic resection in children are scant. METHODS A retrospective review of data from the Italian Pediatric Rare Tumor Registry (TREP) was performed. Short-term (<30 days) and long-term complications of different surgical resections, as well as long-term follow-up were evaluated. RESULTS From January 2000 to present, 43 patients (male:female = 8:35) were enrolled. The median age at diagnosis was 13.2 years (range, 7-18). Nine children had an incidental diagnosis, whereas 26 complained of abdominal pain and 4 of palpable mass. Tumors arose either from the head of pancreas (n = 14) or from body/tail (n = 29): only one patient presented with metastatic disease. Resection was complete in all patients (cephalic duodenopancreatectomy vs distal resection). At follow-up (median, 8.4 years; range, 0-17 years), one recurrence occurred in a patient with intraoperative rupture. All patients are alive. Three pancreatic fistulas occurred in the body/tail group, whereas four complications occurred in the head group (one ileal ischemia, two stenosis of the pancreatic duct, and one chylous fistula). CONCLUSION Surgery is the best therapeutic option for these tumors; hence, complete resection is mandatory. Extensive resections, including cephalic duodenopancreatectomy, are safe when performed in specialized centers. Long-term follow-up should be aimed to detect tumor recurrence and to evaluate residual pancreatic function.
Collapse
Affiliation(s)
- Alessandro Crocoli
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chiara Grimaldi
- Department of Pediatric Surgery and Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Calogero Virgone
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | | | - Giovanni Cecchetto
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Simone Cesaro
- Pediatric Hematology-Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Valerio Cecinati
- Pediatric Hematology and Oncology Unit, Department of Hematology, Transfusion Medicine and Biotechnology, Pescara, Italy
| | - Alessandra Narciso
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Daniele Alberti
- Pediatric Surgery Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Patrizia Dall'Igna
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Marco Spada
- Department of Pediatric Surgery and Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Inserra
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| |
Collapse
|
6
|
Misra S, Saran RK, Srivastava S, Barman S, Dahale A. Utility of cytomorphology in distinguishing solid pseudopapillary neoplasm of pancreas from pancreatic neuroendocrine tumor with emphasis on nuclear folds and nuclear grooves. Diagn Cytopathol 2019; 47:531-540. [DOI: 10.1002/dc.24145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/05/2018] [Accepted: 01/02/2019] [Indexed: 01/17/2023]
Affiliation(s)
- Sunayana Misra
- Department of PathologyGB Pant Institute of Post Graduate Medical Education and Research 1 Jawahar Lal Nehru Marg, New Delhi India
| | - RK Saran
- Department of PathologyGB Pant Institute of Post Graduate Medical Education and Research 1 Jawahar Lal Nehru Marg, New Delhi India
| | - Siddharth Srivastava
- Department of GastroenterologyGB Pant Institute of Post Graduate Medical Education and Research 1 Jawahar Lal Nehru Marg, New Delhi India
| | - Sandip Barman
- Department of PathologyGB Pant Institute of Post Graduate Medical Education and Research 1 Jawahar Lal Nehru Marg, New Delhi India
| | - Amol Dahale
- Department of GastroenterologyGB Pant Institute of Post Graduate Medical Education and Research 1 Jawahar Lal Nehru Marg, New Delhi India
| |
Collapse
|
7
|
Policarpio-Nicolas MLC, McHugh KE, Sae-Ow W, Brainard JA. Pleomorphic and atypical multinucleated giant cells in solid pseudopapillary neoplasm of pancreas: A diagnostic pitfall in cytology and a review of the literature. Diagn Cytopathol 2018; 47:488-493. [PMID: 30552752 DOI: 10.1002/dc.24129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/14/2018] [Accepted: 11/27/2018] [Indexed: 02/06/2023]
Abstract
Solid pseudopapillary neoplasm of the pancreas (SPN) is a rare low-grade malignancy typically occurring in young women. Occasionally, these neoplasms present with pleomorphic to atypical multinucleated giant tumor cells which may mimic high-grade malignancy. Our patient is a 25-year-old male who presented with one year of intermittent epigastric pain. Magnetic resonance imaging showed a 3.1 × 2.5 cm mass in the pancreas body. Endoscopic ultrasound-guided fine needle aspiration of the mass showed large pleomorphic cells and atypical multinucleated giant cells in a background of singly scattered polygonal cells. Focally, these cells surrounded delicate hyalinized to fibrovascular cores forming pseudopapillae. Immunohistochemical stains show tumor cells are positive for beta-catenin, CD10, vimentin, and CD56. Although rare surgical pathology publications have described the presence of pleomorphic to atypical multinucleated giant cells occurring in SPN, to our knowledge, this is the first case reported example focused on cytomorphologic illustration and description.
Collapse
Affiliation(s)
| | - Kelsey E McHugh
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Wichit Sae-Ow
- Department of Pathology, The Queen's Medical Center, Honolulu, Hawaii
| | | |
Collapse
|
8
|
Basar O, Brugge WR. My Treatment Approach: Pancreatic Cysts. Mayo Clin Proc 2017; 92:1519-1531. [PMID: 28890216 DOI: 10.1016/j.mayocp.2017.06.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/21/2017] [Accepted: 06/06/2017] [Indexed: 12/12/2022]
Abstract
Our treatment approach for either symptomatic or incidentally found pancreatic cysts continues to improve. The true incidence of pancreatic cysts is not known, and pancreatic cystic neoplasms, especially intraductal papillary mucinous neoplasms, are currently most commonly diagnosed and resected. This is a result of increasing awareness, widespread availability of imaging, and better understanding of the nature of pancreatic cysts as well. Recent studies on molecular analysis and devices such as microbiopsy forceps help us better define and select the treatment approach to alleviate symptoms and to prevent malignant tumors while avoiding unnecessary surgery.
Collapse
Affiliation(s)
- Omer Basar
- Pancreas Biliary Center, Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA.
| | - William R Brugge
- Pancreas Biliary Center, Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| |
Collapse
|
9
|
Koo EJ, Lee H, Jung E, Choi SO. Laparoscopic distal pancreatectomy of a solid pseudopapillary tumour in a teenager after size reduction: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
10
|
Mirapoğlu SL, Aydogdu I, Gucin Z, Yilmaz TF, Umutoglu T, Kilincaslan H. Traumatic rupture of solid pseudopapillary tumors of the pancreas in children: A case report. Mol Clin Oncol 2016; 5:587-589. [PMID: 27900090 DOI: 10.3892/mco.2016.997] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/13/2016] [Indexed: 12/18/2022] Open
Abstract
Solid pseudopapillary tumor (SPT) of the pancreas is a pathological entity rarely encountered in children. Despite its malignant characteristics, SPT has a favorable clinical prognosis. This tumor is more frequently observed in females and is commonly localized in the tail and body of the pancreas. This is the case report of a 9-year-old female patient who presented with severe abdominal pain of sudden onset and vomiting following blunt abdominal trauma. Upon physical examination, abdominal distension, tenderness and abdominal guarding were detected. Abdominal magnetic resonance imaging revealed a mass sized 8×9×12 cm in the pancreas, with hemorrhagic-necrotic areas, and abundant intra-abdominal fluid. Intra-abdominal exploration confirmed the presence of an abundant amount of intraperitoneal hemorrhagic fluid. A mass was identified, originating from the body and the tail of the pancreas, adherent to the mesentery of the colon and the hilum of the spleen, which had ruptured in its inferolateral side. The tumor was extirpated together with the spleen and the involved parts of the pancreas. Histopathological examination demonstrated a solid pseudopapillary tumor of pancreatic origin. The patient's postoperative course was uneventful, clinically as well as metabolically.
Collapse
Affiliation(s)
- Semih Lütfi Mirapoğlu
- Department of Pediatric Surgery, Bezmialem Vakif University Faculty of Medicine, Istanbul 34093, Turkey
| | - Ibrahim Aydogdu
- Department of Pediatric Surgery, Bezmialem Vakif University Faculty of Medicine, Istanbul 34093, Turkey
| | - Zuhal Gucin
- Department of Pathology, Bezmialem Vakif University Faculty of Medicine, Istanbul 34093, Turkey
| | - Temel Fatih Yilmaz
- Department of Radiology, Bezmialem Vakif University Faculty of Medicine, Istanbul 34093, Turkey
| | - Tarik Umutoglu
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University Faculty of Medicine, Istanbul 34093, Turkey
| | - Huseyin Kilincaslan
- Department of Pediatric Surgery, Bezmialem Vakif University Faculty of Medicine, Istanbul 34093, Turkey
| |
Collapse
|
11
|
Sacco Casamassima MG, Gause CD, Goldstein SD, Abdullah F, Meoded A, Lukish JR, Wolfgang CL, Cameron J, Hackam DJ, Hruban RH, Colombani PM. Pancreatic surgery for tumors in children and adolescents. Pediatr Surg Int 2016; 32:779-88. [PMID: 27364750 DOI: 10.1007/s00383-016-3925-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE Pancreatic neoplasms are uncommon in children. This study sought to analyze the clinical and pathological features of surgically resected pancreatic tumors in children and discuss management strategies. METHODS We conducted a retrospective review of patients ≤21 years with pancreatic neoplasms who underwent surgery at a single institution between 1995 and 2015. RESULTS Nineteen patients were identified with a median age at operation of 16.6 years (IQR 13.5-18.9). The most common histology was solid pseudopapillary neoplasm (SPN) (n = 13), followed by pancreatic neuroendocrine tumor (n = 3), serous cystadenoma (n = 2) and pancreatoblastoma (n = 1). Operative procedures included formal pancreatectomy (n = 17), enucleation (n = 1) and central pancreatectomy (n = 1). SPNs were noninvasive in all but one case with perineural, vascular and lymph node involvement. Seventeen patients (89.5 %) are currently alive and disease free at a median follow-up of 5.7 (IQR 3.7-10.9) years. Two patients died: one with metastatic insulinoma and another with SPN who developed peritoneal carcinomatosis secondary to a concurrent rectal adenocarcinoma. CONCLUSIONS Pediatric pancreatic tumors are a heterogeneous group of neoplastic lesions for which surgery can be curative. SPN is the most common histology, is characterized by low malignant potential and in selected cases can be safely and effectively treated with a tissue-sparing resection and minimally invasive approach.
Collapse
Affiliation(s)
| | - Colin D Gause
- Division of Pediatric Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Seth D Goldstein
- Division of Pediatric Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Avner Meoded
- Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
| | - Jeffrey R Lukish
- Division of Pediatric Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Christopher L Wolfgang
- Department of Surgery, The Sol Goldman Pancreatic Research Center, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - John Cameron
- Department of Surgery, The Sol Goldman Pancreatic Research Center, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - David J Hackam
- Division of Pediatric Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ralph H Hruban
- Department of Pathology, The Sol Goldman Pancreatic Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul M Colombani
- Department of Surgery, Johns Hopkins All Children's Hospital, 601 5th Street South, Suite 501, Saint Petersburg, FL, 33701, USA.
| |
Collapse
|
12
|
Machado I, López-Soto MV, Pérez-López AS, Domínguez-Álvarez C, Llombart-Bosch A. Hyaline globules and papillary fragments in cytologic smears from two intra-abdominal tumors (ovarian and hepatic) in female patients: A diagnostic pitfall with histologic correlation. Diagn Cytopathol 2016; 44:935-943. [DOI: 10.1002/dc.23531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/11/2016] [Accepted: 06/24/2016] [Indexed: 12/28/2022]
Affiliation(s)
- Isidro Machado
- Pathology Department; Instituto Valenciano De Oncología; Valencia Spain
| | | | | | | | | |
Collapse
|
13
|
Guo X, Li N, Ren K, Wu L, Ma LI, Wu S, Xie F, Feng Z. Extrapancreatic solid pseudopapillary tumors: A clinicopathological analysis of two cases. Mol Clin Oncol 2016; 4:845-850. [PMID: 27123293 DOI: 10.3892/mco.2016.802] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 02/09/2016] [Indexed: 12/17/2022] Open
Abstract
Solid pseudopapillary tumors (SPTs) are unusual neoplasms that mostly occur in the pancreas, and predominantly affect young women. As a low-grade malignant neoplasm of the exocrine pancreas, they occasionally metastasize, usually to the liver or peritoneum. It has been reported that <1% of SPTs are primary extrapancreatic SPTs. In the present study, we present two rare, but conspicuous extrapancreatic SPTs. Both occurred in young women, and showed good prognoses following surgery. One was a recurrent SPT of the pancreas that metastasized to the ovary, and the other was a distinct primary neoplasm that arose in the retroperitoneal area. The pathological features of the two tumors, including solid and pseudopapillary growth patterns with pale or eosinophilic cytoplasm, were characteristic of SPTs of the pancreas. However, in the case of the metastatic ovarian tumor, focal necrosis and an increased nuclear-to-cytoplasmic ratio were observed. The presence of positive nuclear-cytoplasmic β-catenin, the loss of membranous E-cadherin expression, and a perinuclear punctate CD99 staining pattern on immunohistochemistical analysis, were essential features for diagnosis. The aim of the present study was to compare the morphological and immunohistochemical features of these tumors with those typical of pancreatic SPTs, and to raise awareness that SPTs are able to metastasize to unusual sites, and may also arise as primary tumors outside the pancreas, which may lead to diagnostic dilemmas.
Collapse
Affiliation(s)
- Xingmei Guo
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| | - Nan Li
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| | - Kai Ren
- Faculty of Pharmacy, Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
| | - Ligao Wu
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| | - L I Ma
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| | - Shiwu Wu
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| | - Fengmei Xie
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| | - Zhenzhong Feng
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| |
Collapse
|
14
|
Abstract
The incidence of pancreatic cystic neoplasms is rising, in part from detection through the increasing use of high-resolution cross-sectional imaging techniques. Initial diagnosis is generally based on imaging characteristics identified on computed tomography and/or MRI. Endoscopic ultrasound provides further imaging characterization and also enables fluid aspiration and analysis to additionally aid differentiation. The general approach to these lesions includes surgical intervention and/or surveillance imaging. Taking into account diverse presentations, varying malignant potential, and the uncertain natural history of some of these lesions, an evidence-based approach is limited. This article discusses recent updates in the diagnosis and management of cystic neoplasms of the pancreas.
Collapse
Affiliation(s)
| | - Koenraad J Mortele
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mandeep S Sawhney
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
15
|
Laparoscopic Distal Pancreatectomy with or without Preservation of the Spleen for Solid Pseudopapillary Neoplasm. Case Rep Surg 2015; 2015:487639. [PMID: 26587305 PMCID: PMC4637475 DOI: 10.1155/2015/487639] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
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.
Collapse
|
16
|
Ahmed A, VandenBussche CJ, Ali SZ, Olson MT. The dilemma of “indeterminate” interpretations of pancreatic neuroendocrine tumors on fine needle aspiration. Diagn Cytopathol 2015; 44:10-3. [DOI: 10.1002/dc.23333] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 06/23/2015] [Accepted: 08/05/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Aadil Ahmed
- Department of Pathology; the Johns Hopkins University School of Medicine; Baltimore Maryland
| | | | - Syed Z. Ali
- Department of Pathology; the Johns Hopkins University School of Medicine; Baltimore Maryland
- Department of Radiology; the Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Matthew T. Olson
- Department of Pathology; the Johns Hopkins University School of Medicine; Baltimore Maryland
| |
Collapse
|