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Printes TRM, de Castro GL, Rabelo DC, da Silva Neto RA, da Silva Junior RA. Frantz's tumor as incidental finding during Heller myotomy for achalasia: case report and review of literature. Ann Med Surg (Lond) 2024; 86:4861-4864. [PMID: 39118740 PMCID: PMC11305790 DOI: 10.1097/ms9.0000000000002273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/03/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction Solid pseudopapillary tumor is a low-grade malignancy of the pancreas and predominantly affects young women. This neoplasm is a rare pancreatic entity with vague clinical presentation. Diagnosis is often incidental through imaging or even during surgical approach for another condition. Case presentation A 22-year-old Brazilian female with gastrointestinal symptoms was diagnosed with achalasia and underwent Heller myotomy. Intraoperatory findings included an enlarging mass in the distal pancreas. During follow-up for the surgical approach of achalasia, a hypothesis of Frantz's tumor was stated, and spleen-preserving distal pancreatectomy was performed. Discussion The pathological pathways of Frantz's tumor is still unclear, and its connection with chromosomal abnormalities is under investigation. Although the tumor has been reclassified over the years to solid pseudopapillary tumor, surgical resection remains the standard treatment. Conclusion Despite a surgical challenge, surgery presents a great prognosis in these patients and long-term survival. High suspicion and proper investigation are fundamental to diagnosis and early treatment.
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Bansal LK, Kapur N, Gupta AK, Nagpal A, Chaudhary P. Solid Pseudopapillary Neoplasm - Case Series and Review of Literature. Indian J Surg Oncol 2022; 13:765-775. [PMID: 36687233 PMCID: PMC9845477 DOI: 10.1007/s13193-022-01560-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/24/2022] [Indexed: 01/25/2023] Open
Abstract
Solid-pseudopapillary neoplasm (SPN) is a variety of solid and cystic tumors of the pancreas. It was first described by Frantz in 1959. It is an unusual form of pancreatic carcinoma, with unknown etiopathogenesis, which accounts for about 0.17 to 2.7% of all pancreatic tumors. Here, we are describing 5 cases of pancreatic solid pseudopapillary neoplasm, out of 180 pancreatic tumors, operated in our institution in the 5-year period (2015-2020). Also, we have reviewed all available case series (from 2006 to 2020) in the literature, of pancreatic pseudopapillary neoplasm, for demographic information, etiopathogenesis, diagnosis, and extent of operation to establish the optimal management of this condition. Retrospective analysis of pancreatic tumors was carried out from February 2015 to January 2020. A total of 180 patients underwent pancreatic resection in this period for pancreatic tumor, out of which, the solid pseudopapillary neoplasm was confirmed in 5 cases (2.76%). Among these 5 cases, 4 cases (80%) were female and one (20%) male, with age group range from 14 to 45 years (mean age - 28 years). Abdominal pain was the most frequent presenting symptom (60%). Mean tumor diameter was 6.9 cm (range, 2-18 cm). Two patients were diagnosed preoperatively by CECT and MRI findings, and three patients were diagnosed preoperatively by percutaneous/USG-guided and CT-guided FNA cytology. Two patients underwent pancreatoduodenectomy; one patient underwent enucleation; and two patients underwent spleen preserving distal pancreatectomy. Four patients are alive and on regular follow-up, while one patient died on the 5th post-operative day due to post-operative sepsis.
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Affiliation(s)
- Lalit Kumar Bansal
- Department of Surgery, ABVIMS and Dr. Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Neeti Kapur
- Department of Surgery, ABVIMS and Dr. Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Arun Kumar Gupta
- Department of Surgery, ABVIMS and Dr. Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Ashutosh Nagpal
- Department of Surgery, ABVIMS and Dr. Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Poras Chaudhary
- Department of Surgery, ABVIMS and Dr. Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
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Clinical Course, Genetic, and Immunohistochemical Characterization of Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumors) in a Brazilian Cohort. Genes (Basel) 2022; 13:genes13101809. [PMID: 36292694 PMCID: PMC9601385 DOI: 10.3390/genes13101809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 11/17/2022] Open
Abstract
Frantz tumors or solid pseudopapillary pancreatic neoplasm (SPN) are rare exocrine neoplasms that carry a favorable prognosis; they represent up to 3% of all tumors located in the region of the pancreas and have specific age and gender predispositions. In recent years, the rising curve of diagnosis is entitled to the evolution and access of diagnostic imaging. In this paper, we have retrospectively reviewed and described the clinical course of 40 patients with SPN from three institutions in Brazil, who had their diagnosis between 2005 and 2020, and analyzed the clinicopathological, genetic, and surgical aspects of these individuals. In accordance with the literature, most patients were women, 60% with unspecified symptoms at diagnosis, with tumors mainly located in the body and tail of the pancreas, of whom 70% underwent a distal pancreatectomy with sparing splenectomy as a standard procedure, and none of the cases have experienced recurrence to date. Surgery still remains the mainstay of treatment given the low metastatic potential, but more conservative approaches as observed in this cohort are evolving to become the standard of care. Herein, we present an in-depth analysis of cases focusing on the latest literature and report some of the smallest tumor cases in the literature. To our knowledge, this is the first report evaluating germline genetic testing and presenting a case of detected Li-Fraumeni syndrome.
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Perez A, Arcilla C, Fontanilla MRK, Berberabe AE. Resection of a recurrent solid pseudopapillary neoplasm of the pancreas after duodenal sparing pancreaticoduodenectomy: A case report. Int J Surg Case Rep 2021; 88:106526. [PMID: 34710773 PMCID: PMC8577456 DOI: 10.1016/j.ijscr.2021.106526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 01/19/2023] Open
Abstract
Introduction Solid Pseudopapillary Neoplasm (SPN) is a rare pancreatic neoplasm with low malignant potential and a relative indolent course. Complete resection of the SPN is curative for most cases and has a high survival rate. Recurrences, though rare, can still occur despite adequate resection. Pancreaticoduodenectomy is commonly performed to treat pancreatic head SPNs. In recent years, duodenum-preserving pancreatic head resection (DPPHR) has been reported as a less radical and acceptable alternative. Case presentation We are reporting a case of 26-year old female who presented with a 7 month history of epigastric pain and increasing abdominal girth. She was diagnosed by MRI to have a huge but resectable pancreatic head mass and subsequently underwent duodenum-preserving pancreatic head resection (DPPHR) with pancreaticojejunostomy. Histopathologic examination revealed a solid pseudopapillary tumor (SPN) with lymphovascular invasion and negative margins of resection. The patient underwent hepaticojejunostomy 5 months after resection for biliary stricture. Surveillance imaging revealed tumor recurrence warranting re-exploration for recurrence 3 years after the initial surgery. Intraoperative findings revealed the mass at the distal pancreatic remnant, requiring distal pancreatectomy and splenectomy. Discussion Solid pseudopapillary neoplasms are rare pancreatic neoplasms. Surgical resection of SPNs affords long term cure with good 5-year survival rates for localized tumors Despite the low malignant potential of SPNs, relapse after resection can still occur. Conclusion Complete local resection of the tumor is the treatment of choice in SPNs. DPPHR should be considered as an alternative in young patients with a localized SPN in the pancreatic head. Solid pseudopapillary neoplasm (SPN) is a rare pancreatic neoplasm. Complete local resection of the tumor is the treatment of choice. Duodenum preserving pancreatic head resection should be considered as an alternative to pancreatoduodenectomy for SPN. Despite the low malignant potential, recurrences occur and complete resection of tumor recurrence is the ideal management. Large tumor size and lymphovascular invasion are notable risk factors for SPN recurrence.
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Affiliation(s)
- Anthony Perez
- University of the Philippines Manila College of Medicine, Department of Surgery, Philippines; Manila Doctors Hospital, Philippines.
| | - Crisostomo Arcilla
- University of the Philippines Manila College of Medicine, Department of Surgery, Philippines; Manila Doctors Hospital, Philippines
| | | | - Apolinario Ericson Berberabe
- University of the Philippines Manila College of Medicine, Department of Surgery, Philippines; Manila Doctors Hospital, Philippines
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Eric D, Milosavljevic V, Gonzalez-Urquijo M, Tadic B, Veselinovic M, Grubor N, Jelic D, Bjelovic M. Laparoscopic enucleation of Frantz's tumor of the pancreas: Case report and literature review. Ann Med Surg (Lond) 2021; 64:102221. [PMID: 33796288 PMCID: PMC7995482 DOI: 10.1016/j.amsu.2021.102221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction Frantz's tumor of the pancreas is a rare phenomenon, and it accounts for 1-3% of all neoplasms of the pancreas. Its percentage is much higher in younger persons, especially in younger women, as compared to the rest of the population. Presentation of case The present study describes a 32-year-old female patient in whom a preoperative imaging diagnosis confirmed a mass in the junction of the pancreas' body and tail. Based on the anamnesis, the preoperative diagnosis, and the patient's general status, the decision was made to performed laparoscopic enucleation of the pancreatic tumor. The operation and postoperative recovery passed without complications. Definitive histopathological and immunohistochemical findings confirmed a solid pseudopapillary neoplasm of the pancreas. Discussion Depending on the localization and the size of the tumor, surgical options range from typical and atypical resections of the pancreas to minimally invasive surgical procedures, such as local excision and enucleation. Laparoscopic procedures have a comparative advantage in cases of enucleation and resection of the pancreas. The low frequency of recidivation and a favorable prognosis, even after repeated surgery, are additional reasons for favoring the laparoscopic approach over the classical surgical approach. Conclusion A minimally invasive surgical approach should be applied whenever the dimensions and the localization of the tumor permit it, bearing in mind all the benefits and advantages that this surgical technique offers.
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Affiliation(s)
| | | | - Mauricio Gonzalez-Urquijo
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Ignacio Morones Prieto O 3000, Monterrey, 64710, Mexico
- Corresponding author. Dr. Ignacio Morones Prieto O 3000, Monterrey, 64710, Mexico.
| | - Boris Tadic
- Clinical Center of Serbia, University Hospital for Digestive Surgery, Department for Minimally Invasive Upper Digestive Surgery, Belgrade, Serbia
| | - Milan Veselinovic
- Clinical Center of Serbia, University Hospital for Digestive Surgery, Department for Minimally Invasive Upper Digestive Surgery, Belgrade, Serbia
| | - Nikola Grubor
- Clinical Center of Serbia, University Hospital for Digestive Surgery, Department for Minimally Invasive Upper Digestive Surgery, Belgrade, Serbia
| | - Djordje Jelic
- University of Kragujevac, Faculty of Medicine, Kragujevac, Serbia
| | - Miloš Bjelovic
- Clinical Center of Serbia, University Hospital for Digestive Surgery, Department for Minimally Invasive Upper Digestive Surgery, Belgrade, Serbia
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Hepatic metastasis in Frantz's tumor: A case report. Int J Surg Case Rep 2020; 71:66-69. [PMID: 32473553 PMCID: PMC7260607 DOI: 10.1016/j.ijscr.2020.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/01/2020] [Accepted: 04/20/2020] [Indexed: 11/25/2022] Open
Abstract
This is a borderline tumor with indolent biological behavior. There are still multiple poorly understood factors that can dictate its malignant transformation and prognosis. Here, a rare tumor whose age and survival are tangent the literature reports describe. There is a need for a long and rigorous segment to identify possible long-term metastases.
Introduction Frantz’s Tumor or Solid Pseudopapillary Neoplasm (SPN) is rare with a solid-cystic pattern, and most common in young women. Presentation of case This study based on guidelines for case reports (SCARE) reports a case of SPN in a teenager aged 13 years at the diagnosis time, attended at a teaching public hospital in Brazil, which evolved into liver metastases. Clinical, laboratory, therapeutic and imaging data were collected from the physical chart and analyzed in light of current publications on the topic. The first consultation occurred in January 2012, where weight loss, fever, vomiting, left-sided hypochondrium and epigastric pain were reported. Imaging exams evidenced an expansive heterogeneous process in the pancreatic tail; however, laboratory exams and tumor markers did not present alteration in relation to reference values. In March of 2012, she underwent caudal body pancreatectomy, splenectomy, segmental colectomy and colo-coloanastomosis as a function of the intraoperative findings. After 63 months, right-sided hepatectomy was performed to resect metastases. Currently, she is undergoing outpatient monitoring, without complaint or alterations in imaging and laboratory exams, totaling 100 months of global survival. Discussion This is an interesting case report of a rare tumor, in so far as without any adjuvant chemotherapies, an 8-year long survival time could be achieved in this particular type of tumor despite initially large tumor expansion and later liver metastases. Conclusion Additional epidemiological studies, molecular and clinical trials are required to increase knowledge on SPN.
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Hajjar R, Plasse M, Vandenbroucke-Menu F, Schwenter F, Sebajang H. Giant splenic cyst and solid pseudopapillary tumour of the pancreas managed with distal pancreatectomy and splenectomy. Ann R Coll Surg Engl 2020; 102:e1-e3. [PMID: 32003571 DOI: 10.1308/rcsann.2020.0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Solid pseudopapillary tumours of the pancreas and giant splenic cysts are very rare entities, and their coexistence in a young female patient has not been previously reported in the literature. We present the case of a 27-year-old woman who presented with abdominal pain and two masses on abdominal imaging. A mass located in the right upper quadrant was biopsied, and histological and immunohistochemical analysis showed a solid pseudopapillary tumour of the pancreas. A giant cystic splenic lesion was also noted. The patient underwent a distal pancreatectomy and splenectomy in our referral centre. Margins were negative on histopathological examination. Negative surgical margins were achieved with distal pancreatectomy and splenectomy despite the large size of the pancreatic tumour. The management of solid pseudopapillary tumours of the pancreas is often challenging and the concomitant presence of a giant splenic cyst poses additional challenges to the surgical management of such tumours.
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Affiliation(s)
- R Hajjar
- Centre hospitalier de l'Université de Montréal, Canada
| | - M Plasse
- Centre hospitalier de l'Université de Montréal, Canada
| | | | - F Schwenter
- Centre hospitalier de l'Université de Montréal, Canada
| | - H Sebajang
- Centre hospitalier de l'Université de Montréal, Canada
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Song TL, Chen H, Wang FR, Li YM. Combined treatment for solid pseudopapillary tumor of the pancreas with liver metastasis. Hepatobiliary Pancreat Dis Int 2019; 18:495-497. [PMID: 30987898 DOI: 10.1016/j.hbpd.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/29/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Tian-Liang Song
- Department of Oncology Surgery, Lanzhou University Second Hospital, Lanzhou 730000, China; Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou 730000, China
| | - Hao Chen
- Department of Oncology Surgery, Lanzhou University Second Hospital, Lanzhou 730000, China; Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou 730000, China
| | - Fu-Rong Wang
- Department of Pathology, Lanzhou University Second Hospital, Lanzhou 730000, China
| | - Yu-Min Li
- Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou 730000, China; Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730000, China.
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Pseudopapillary tumours of the pancreas. Eur Surg 2018. [DOI: 10.1007/s10353-018-0520-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Solid Pseudopapillary Neoplasm of the Pancreas in Children and Adults: A National Study of 369 Patients. J Pediatr Hematol Oncol 2018; 40:e233-e236. [PMID: 29240036 DOI: 10.1097/mph.0000000000001049] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor in children, with current evidence limited to single-center studies. We examined treatment and clinical outcomes for pediatric and adult SPN with a national data set. METHODS The 2004 to 2013 National Cancer Data Base was queried to identify all patients diagnosed with SPN. The cohort was stratified by age (pediatric and adult) defined as below 18 years and 18 years and above, respectively. Baseline characteristics and unadjusted outcomes were compared. RESULTS We identified 21 pediatric and 348 adult patients with SPN. Both groups displayed similar demographic composition. Patients were commonly female (90.5% [pediatric] vs. 85.9% [adult], P=0.56) and white (66.7% vs. 68.3%, P=0.74). Tumor location was similar between adults and children. Median tumor size was similar between children and adults (5.9 vs. 4.9 cm, P=0.41). Treatment strategies did not vary between groups. Partial pancreatectomy was the most common resection strategy (71.4% vs. 53.1%, P=0.80). Both groups experienced low mortality (0.0% vs. 0.7% at 5 y, P=0.31). CONCLUSIONS This study provides the largest comparison of pediatric and adult SPN to date. Children with SPN have similar disease severity at presentation, receive similar treatments, and demonstrate equivalent postoperative outcomes compared with their adult counterparts.
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De Moura DTH, Coronel M, Ribeiro IB, Farias GFA, Choez MA, Rocha R, Toscano MP, De Moura EGH. The importance of endoscopic ultrasound fine-needle aspiration in the diagnosis of solid pseudopapillary tumor of the pancreas: two case reports. J Med Case Rep 2018; 12:107. [PMID: 29695287 PMCID: PMC5918898 DOI: 10.1186/s13256-018-1585-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 01/27/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Solid pseudopapillary tumor of the pancreas, otherwise known as solid and cystic tumor or Frantz tumor, is an unusual form of pancreatic carcinoma, with unknown etiopathogenesis, that accounts for 0.2 to 2.7% of all pancreatic tumors. It is defined as an exocrine pancreatic neoplasia that mainly affects women between the second and third decade of life, and its management is not well defined. Endoscopic ultrasound offers a key anatomical advantage in accessing the pancreas and endoscopic ultrasound fine-needle aspiration has become the gold standard method for the diagnosis of pancreatic lesions. CASE PRESENTATION Case 1: A 31-year-old white Hispanic woman presented with epigastric pain for 5 months. An abdominal ultrasound revealed a single 2 cm nodule in the uncinate process of her pancreas. Endoscopic ultrasound showed a regular, well-defined solid lesion with alternating cystic areas at the uncinate process of her pancreas, measuring 1.7 × 1.4 cm; endoscopic ultrasound fine-needle aspiration was then performed with cytopathological analysis compatible with solid pseudopapillary tumor. Body computed tomography confirmed the absence of metastases and she underwent conventional duodenopancreatectomy. However, she died 4 days after surgery due to postoperative surgical complications. Case 2: A 35-year-old Hispanic woman presented with left upper quadrant abdominal pain for 3 months, associated with a palpable mass at this region. A computed tomography scan showed a solitary nodule in the pancreatic body. Endoscopic ultrasound showed a regular, well-defined, homogeneous lesion with small anechoic (cystic) areas, measuring 2 × 2 cm, in between the pancreatic body and neck. Endoscopic ultrasound fine-needle aspiration was performed and cytopathological analysis was suggestive of a pseudopapillary solid tumor. She underwent a body-tail laparoscopic pancreatectomy with splenectomy. Nine months after the diagnosis, she remains asymptomatic, continuing regular follow-up in the oncology out-patient clinic. CONCLUSIONS Solid pseudopapillary tumor is a rare pancreatic malignancy. Endoscopic ultrasound fine-needle aspiration is the gold standard method to characterize and diagnose this type of pancreatic lesion, making this an invaluable tool to help guide clinical management and improve the preoperative diagnostic yield.
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Affiliation(s)
- Diogo Turiani Hourneaux De Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cezar, São Paulo, SP ZIP Code 05403-010 Brazil
| | - Martin Coronel
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cezar, São Paulo, SP ZIP Code 05403-010 Brazil
| | - Igor Braga Ribeiro
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cezar, São Paulo, SP ZIP Code 05403-010 Brazil
| | - Galileu Ferreira Ayala Farias
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cezar, São Paulo, SP ZIP Code 05403-010 Brazil
| | - Maria Auxiliadora Choez
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cezar, São Paulo, SP ZIP Code 05403-010 Brazil
| | - Rodrigo Rocha
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cezar, São Paulo, SP ZIP Code 05403-010 Brazil
| | - Marcello Pecoraro Toscano
- Pathology Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, Andar, bloco, Cerqueira Cezar, São Paulo, SP ZIP Code 05403-010 Brazil
| | - Eduardo Guimarães Hourneaux De Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cezar, São Paulo, SP ZIP Code 05403-010 Brazil
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Naar L, Spanomichou DA, Mastoraki A, Smyrniotis V, Arkadopoulos N. Solid Pseudopapillary Neoplasms of the Pancreas: A Surgical and Genetic Enigma. World J Surg 2018; 41:1871-1881. [PMID: 28251269 DOI: 10.1007/s00268-017-3921-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Solid pseudopapillary neoplasms of the pancreas are rare tumors accounting for 1-2% of pancreatic exocrine neoplasms. This entity was first described by Dr. Frantz in 1959 and was defined by the World Health Organization in 1996 as "solid pseudopapillary tumor." It is most often a benign neoplasm, but 10-15% of the cases are malignant. Over the past decades, the incidence of this tumor is increasing. However, many surgeons are still unfamiliar with this neoplasm and its unique characteristics, which can lead to pitfalls in the diagnosis and treatment. The correct diagnosis of SPNP is of utmost importance since it has a low malignant potential and with the appropriate treatment, patients have a long life expectancy. There are many genetic alterations, involving various signaling pathways that have been associated with SPNP and are very important in diagnosing the tumor. The cornerstone of SPNP treatment includes surgical excision of the tumor, preserving as much pancreatic tissue as possible. We review the information in the literature regarding more organ-preserving techniques and possible clinical features that might indicate a malignant potential, thus demanding a more radical intraoperative excision.
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Affiliation(s)
- Leon Naar
- 4th Department of Surgery, Athens University Medical School, ATTIKON University Hospital, 1 Rimini Street, Chaidari, 12462, Athens, Greece
| | - Despoina-Amalia Spanomichou
- 4th Department of Surgery, Athens University Medical School, ATTIKON University Hospital, 1 Rimini Street, Chaidari, 12462, Athens, Greece
| | - Aikaterini Mastoraki
- 4th Department of Surgery, Athens University Medical School, ATTIKON University Hospital, 1 Rimini Street, Chaidari, 12462, Athens, Greece.
| | - Vassilios Smyrniotis
- 4th Department of Surgery, Athens University Medical School, ATTIKON University Hospital, 1 Rimini Street, Chaidari, 12462, Athens, Greece
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, Athens University Medical School, ATTIKON University Hospital, 1 Rimini Street, Chaidari, 12462, Athens, Greece
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Chinnusamy P, Dey S, Chittawadagi B, Gurumurthy S, Sabnis S, Palanisamy S. First robotic pylorus preserving pancreaticoduodenectomy for Frantz's tumour in an adolescent girl. J Minim Access Surg 2018; 14:349-353. [PMID: 29737317 PMCID: PMC6130189 DOI: 10.4103/jmas.jmas_272_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Solid pseudopapillary tumour (SPT) is one of the uncommon benign cystic neoplasms of pancreas occurring predominantly in young females. Being benign in nature, surgical resection is the treatment of choice with excellent 5-year survival. A 14-year-old girl presented with pain abdomen for 1 week. On evaluation, she was found to have a large SPT involving head and uncinate process of Pancreas She underwent robotic pylorus preserving pancreaticoduodenectomy (R-PPPD) with da Vinci® Si Robotic System (Intuitive Surgical, Sunnyvale, CA, USA). The total operating time was 480 min. Her postoperative recovery was uneventful and she was discharged on postoperative day 6. In the era of minimally invasive surgery, robotic pancreatic resection and reconstruction are becoming more acceptable. Although the operating domain is small in younger age group, the precise movement of robotic arm and high quality magnified three-dimensional view allows the surgeons to perform PPPD on younger patients also. Young female patients suffering from SPTs can electively undergo R-PPPD with minimal morbidity and mortality. R-PPPD can become the treatment of choice for SPTs involving pancreatic head region even in paediatric and adolescent age group.
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Affiliation(s)
- Palanivelu Chinnusamy
- Deapartment of HPB and Minimal Access Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - Sumanta Dey
- Deapartment of HPB and Minimal Access Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - Bhushan Chittawadagi
- Deapartment of HPB and Minimal Access Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - Srivatsan Gurumurthy
- Deapartment of HPB and Minimal Access Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - Sandeep Sabnis
- Deapartment of HPB and Minimal Access Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - Senthilnathan Palanisamy
- Deapartment of HPB and Minimal Access Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
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14
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Li DL, Li HS, Xu YK, Wang QS, Chen RY, Zhou F. Solid pseudopapillary tumor of the pancreas: clinical features and imaging findings. Clin Imaging 2017; 48:113-121. [PMID: 29073488 DOI: 10.1016/j.clinimag.2017.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 09/16/2017] [Accepted: 10/09/2017] [Indexed: 02/07/2023]
Abstract
This study aimed to report clinical features and CT, MRI, PET/CT findings of solid pseudopapillary tumor (SPT) of the pancreas. Thirty-four patients with pathologically proven SPT were retrospectively reviewed. Most patients were asymptomatic. SPTs in male patients mainly appeared as solid and near solid tumors. Mixed tumors and cystic tumors had larger size than solid and near solid tumors. Solid tumors and solid part of mixed tumors were T2 hyperintense and T1 hypointense and had progressive enhancement. Four tumors (80%) showed markedly even or uneven 18F-FDG uptake. These characteristic features can help differentiate SPT from other pancreatic neoplasms.
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Affiliation(s)
- Dong-Li Li
- Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Hong-Sheng Li
- PET Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Yi-Kai Xu
- Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China.
| | - Quan-Shi Wang
- PET Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Rui-Ying Chen
- Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Fang Zhou
- Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China
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15
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Solid pseudopapillary neoplasm-Case report of a rare pancreatic tumor. Int J Surg Case Rep 2017; 33:148-150. [PMID: 28327418 PMCID: PMC5358903 DOI: 10.1016/j.ijscr.2017.02.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 02/26/2017] [Accepted: 02/27/2017] [Indexed: 01/08/2023] Open
Abstract
Solid pseudopapillary neoplasm is a rare pancreatic tumor. Most patients are female and within the second or third decade of life. The radiologic features are crucial for an accurate diagnosis. Tumor size has not been shown to be a predictor of resectability. Surgical resection is the treatment of choice with an excellent long-term prognosis.
Introduction Solid pseudopapillary neoplasm (SPN) is a rare pancreatic tumor. Most patients are female within the second or third decade of life with only a small minority concerning children. Frequently described as low malignant potential tumors, surgical resection remains the main treatment. Presentation of case The authors present a case of a SPN diagnosed in a 17-year-old Caucasian girl with vomiting and abdominal pain localized to the right upper quadrant. CT scans and MRI scans showed the presence of a well-defined tumor arising from the pancreatic head with 14 cm of greater diameter. Pylorus-preserving pancreatoduodenectomy was performed and histopathology confirmed a SPN with complete resection and no evidence of malignancy. Discussion SPN are usually found incidentally hence the importance of an accurate radiologic diagnosis. Symptoms may be present such as abdominal pain or vomiting due to compression, namely in large tumors. A surgical approach is usually indicated aiming complete resection, with tumor size not predicting resectability. Conclusion Solid pseudopapillary tumors of the pancreas are extremely rare and usually have an excellent long-term prognosis after surgical resection.
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