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Radulovic MK, Brecelj J, Gruden A, Flezar MS. Role of endoscopic ultrasound-guided fine needle aspiration biopsies in diagnosing pancreatic neoplasms in the paediatric population: experience from a tertiary center and review of the literature. Radiol Oncol 2024; 58:78-86. [PMID: 38378032 PMCID: PMC10878772 DOI: 10.2478/raon-2024-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/07/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Endoscopic ultrasound-guided fine needle aspiration biopsy (EUS FNAB) is a well established diagnostic method in adult patients, but is rarely used in the paediatric population. The Clinical Department of Gastroenterology at the University Clinical Centre Ljubljana and the Department of Cytopathology at the Institute of Pathology, Faculty of Medicine, University of Ljubljana, Slovenia, have been closely collaborating on EUS FNAB since the introduction in 2010. The aim of the study was to review the cases of EUS FNAB of pancreatic neoplasms in children. PATIENTS AND METHODS In the digital archive of the Institute of Pathology (IP), Faculty of Medicine (FM), University of Ljubljana (UL), we found 6 cases of EUS FNAB in children, 3 had EUS FNAB of the pancreas, 2 of whom had a cytopathologic diagnosis of a tumour. In the first case, the lesion was ultrasonographically solid, and the cell sample contained branching papillary structures surrounded by aggregates of small cells with nuclear grooves. In the second case, the lesion was ultrasonographically cystic, and predominantly necrosis was seen, with only single preserved cells. Positive nuclear reaction for β-catenin was found in both cases by immunohistochemical staining. RESULTS In both cases, the cytopathological diagnosis of solid pseudopapillary neoplasm of the pancreas was made, the cases represent the totality of paediatric cases of pancreatic neoplasms from the Children's Hospital Ljubljana since 2010. There were no adverse events during and after EUS FNAB. A histopathological examination of the tumour resection specimens confirmed the cytopathological diagnosis. CONCLUSIONS Our experience indicates that EUS FNAB is a safe and effective method for diagnosing pancreatic neoplasms in the pediatric population, as supported by the findings in the literature.
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Affiliation(s)
- Maja Kebe Radulovic
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jernej Brecelj
- Department of Gastroenterology, Hepatology and Nutrition, University Children’s Hospital Ljubljana, and Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andrej Gruden
- University Medical Centre Ljubljana, Service of Internal Medicine, Department of Gastroenterology, Ljubljana, Slovenia
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Guo J, Zhao Q, Qin L, Xie S, Lu S, Li B, He M, Xie L, Yu S. Massive extrapancreatic solid pseudopapillary neoplasm misdiagnosed as hepatic tumor: a case report and literature review. Front Oncol 2024; 14:1342400. [PMID: 38380363 PMCID: PMC10877141 DOI: 10.3389/fonc.2024.1342400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/16/2024] [Indexed: 02/22/2024] Open
Abstract
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.
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Affiliation(s)
- Jixu Guo
- Division of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qingjuan Zhao
- The First Clinical Medical College, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Liting Qin
- Division of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shengjie Xie
- Division of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shiliu Lu
- Division of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Baibei Li
- Division of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Meilin He
- The First Clinical Medical College, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Linhong Xie
- Division of Hepatobiliary Surgery, The Second People’s Hospital of Qinzhou, Qinzhou, China
| | - Shuiping Yu
- Division of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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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.
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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
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Pawlak KM, Tehami N, Maher B, Asif S, Rawal KK, Balaban DV, Tag-Adeen M, Ghalim F, Abbas WA, Ghoneem E, Ragab K, El-Ansary M, Kadir S, Amin S, Siau K, Wiechowska-Kozlowska A, Mönkemüller K, Abdelfatah D, Abdellatef A, Lakhtakia S, Okasha HH. Role of endoscopic ultrasound in the characterization of solid pseudopapillary neoplasm of the pancreas. World J Gastrointest Endosc 2023; 15:273-284. [PMID: 37138939 PMCID: PMC10150282 DOI: 10.4253/wjge.v15.i4.273] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/17/2023] [Accepted: 03/29/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Solid pseudopapillary neoplasm (SPN) is an uncommon pathology of the pancreas with unpredictable malignant potential. Endoscopic ultrasound (EUS) assessment plays a vital role in lesion characterization and confirmation of the tissue diagnosis. However, there is a paucity of data regarding the imaging assessment of these lesions.
AIM To determine the characteristic EUS features of SPN and define its role in preoperative assessment.
METHODS This was an international, multicenter, retrospective, observational study of prospective cohorts from 7 large hepatopancreaticobiliary centers. All cases with postoperative histology of SPN were included in the study. Data collected included clinical, biochemical, histological and EUS characteristics.
RESULTS One hundred and six patients with the diagnosis of SPN were included. The mean age was 26 years (range 9 to 70 years), with female predominance (89.6%). The most frequent clinical presentation was abdominal pain (80/106; 75.5%). The mean diameter of the lesion was 53.7 mm (range 15 to 130 mm), with the slight predominant location in the head of the pancreas (44/106; 41.5%). The majority of lesions presented with solid imaging features (59/106; 55.7%) although 33.0% (35/106) had mixed solid/cystic characteristics and 11.3% (12/106) had cystic morphology. Calcification was observed in only 4 (3.8%) cases. Main pancreatic duct dilation was uncommon, evident in only 2 cases (1.9%), whilst common bile duct dilation was observed in 5 (11.3%) cases. One patient demonstrated a double duct sign at presentation. Elastography and Doppler evaluation demonstrated inconsistent appearances with no emergence of a predictable pattern. EUS guided biopsy was performed using three different types of needles: Fine needle aspiration (67/106; 63.2%), fine needle biopsy (37/106; 34.9%), and Sonar Trucut (2/106; 1.9%). The diagnosis was conclusive in 103 (97.2%) cases. Ninety-seven patients were treated surgically (91.5%) and the post-surgical SPN diagnosis was confirmed in all cases. During the 2-year follow-up period, no recurrence was observed.
CONCLUSION SPN presented primarily as a solid lesion on endosonographic assessment. The lesion tended to be located in the head or body of the pancreas. There was no consistent characteristic pattern apparent on either elastography or Doppler assessment. Similarly SPN did not frequently cause stricture of the pancreatic duct or common bile duct. Importantly, we confirmed that EUS-guided biopsy was an efficient and safe diagnostic tool. The needle type used does not appear to have a significant impact on the diagnostic yield. Overall SPN remains a challenging diagnosis based on EUS imaging with no pathognomonic features. EUS guided biopsy remains the gold standard in establishing the diagnosis.
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Affiliation(s)
- Katarzyna M Pawlak
- Endoscopy Unit, Department of Gastroenterology, Hospital of The Ministry of Interior and Administration, Szczecin 01-218, Poland
| | - Nadeem Tehami
- Interventional Endoscopy Unit, University Hospital Southampton NHS Foundation Trust, 3AX PO, United Kingdom
| | - Ben Maher
- Interventional Endoscopy Unit, University Hospital Southampton NHS Foundation Trust, 3AX PO, United Kingdom
| | - Shujaath Asif
- Consultant Gastroenterologist, AIG Hospitals, Hyderabad 500032, India
| | - Krishn Kant Rawal
- Department of Gastroenterology, Prime Institute of Digestive Sciences, Rajkot 360001, India
| | - Daniel Vasile Balaban
- Department of Gastroenterology, Central Military Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest 010011, Romania
| | - Mohammed Tag-Adeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Qena Faculty of Medicine, South Valley University, Qena 83511, Egypt
- Department of Endoscopy, Shefa Al-Orman Hospital, Luxor 85951, Egypt
| | - Fahd Ghalim
- Interventional Endoscopy Unit, Sainte Marie Hospital, OSNY 95520, France
| | - Wael A Abbas
- Department of Internal Medicine, Gastroenterology Unit, Faculty of Medicine, Assuit University, Assuit 71511, Egypt
| | - Elsayed Ghoneem
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt
| | - Khaled Ragab
- Department of Hepatology and Gastroenterology, Theodor Bilharz Research Institute, Giza 12511, Egypt
| | - Mahmoud El-Ansary
- Department of Hepatology & Gastroenterology, Theodor Bilharz Research Institute, Giza 12511, Egypt
| | - Shanil Kadir
- Department of Gastroenterology, Liaquat National Hospital & Medical College, Karachi 75900, Pakistan
| | - Sunil Amin
- Division of Digestive and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 32118, United States
| | - Keith Siau
- Department of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, United Kingdom
| | | | - Klaus Mönkemüller
- Department of Gastroenterology, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, AL 35294, United States
| | - Dalia Abdelfatah
- Department of Cancer Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo 11511, Egypt
| | - Abeer Abdellatef
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Faculty of Medicine, Cairo University, Cairo 11511, Egypt
| | - Sundeep Lakhtakia
- Consultant Gastroenterologist, AIG Hospitals, Hyderabad 500032, India
| | - Hussein Hassan Okasha
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Faculty of Medicine, Cairo University, Cairo 11451, Egypt
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Muacevic A, Adler JR. Solid Pseudopapillary Epithelial Neoplasm of the Pancreas in the Paediatric Population: A Report of Two Cases. Cureus 2022; 14:e29805. [PMID: 36337824 PMCID: PMC9620738 DOI: 10.7759/cureus.29805] [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] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
A rare pathology, the solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas accounts for approximately 1% of pancreatic neoplasms. Initially called ‘Frantz’s tumour’, it has now been renamed to SPEN by the World Health Organization (WHO). This tumour has a predilection for females and a good prognosis with surgical excision being the treatment of choice. Palpable abdominal masses in children are of significant clinical importance. Identifying cystic lesions in the pancreas from CT or MRI scans always warrant further investigations. Primary pancreatic neoplasms account for 0.1% of pancreatic tumours in the paediatric population; an extremely rare circumstance constituting a diagnostic and therapeutic challenge to surgeons. This article comprises two paediatric cases of SPEN in 14- and 11-year-old females, respectively, and a literature review on current management.
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Okasha H, Abbas W, Altonbary A, Hakim H, Ameen MG, El-Nady M. Role of endoscopic ultrasonography in the diagnosis of solid pseudo-papillary neoplasm: Egyptian multi-centric case series and systematic review. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.1186/s43162-022-00105-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractSolid 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.
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7
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Iqbal B, Kambale T, Gore C, Vishwanathan V, Dharwadkar A. Frantz's Tumor an Unusual Pancreatic Neoplasm with Rare Presentation. CLINICAL CANCER INVESTIGATION JOURNAL 2022. [DOI: 10.51847/nsr50zkrc5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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8
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AlQattan AS, Alshaqaq HM, Al Abdrabalnabi AA, Alnamlah M, Alanazi AA, Alqahtani MS. Huge solid pseudopapillary tumor of the pancreas 'Frantz tumor': a case report. J Gastrointest Oncol 2020; 11:1098-1104. [PMID: 33209501 DOI: 10.21037/jgo-20-180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Solid pseudopapillary neoplasms (SPN) of the pancreas are rare neoplasms accounting for 1-2% of all pancreatic tumors and have a general female predominance. We report a case and intraoperative videos of SPN involving the whole pancreatic tail. A 19-year-old female patient initially presented to another healthcare facility complaining of abdominal pain, which was started 6 years ago. A contrast-enhanced Computed Tomography (CT) scan of the abdomen showed a large mass measuring 15.6 cm × 11.6 cm × 11 cm, arising from the pancreas with an enhancing cystic component. The patient underwent exploratory laparotomy, which revealed a huge mass occupying most of the abdominal cavity. Thus, we proceeded with a distal pancreatectomy and splenectomy. Intraoperatively, the frozen section showed that the mass had features of a solid pseudopapillary tumor of the pancreas with negative resection margins. The SPN diagnosis was confirmed by histopathology and immunohistochemistry. The pathophysiology behind the development of SPN and its cellular origin is still a matter of debate with multiple proposed hypotheses. SPNs are asymptomatic in almost 70% of all cases and usually discovered incidentally. The pre-operative diagnosis of SPNs remains a clinical challenge despite all the current advances in the diagnostic modalities. Surgical management with negative resection margins is the mainstay of treatment, even with metastasis and vascular invasion, surgical excision should be performed whenever feasible. The recurrence rate after surgical resection has been reported to be 3-9%. The prognosis of SPN limited to the pancreas is generally excellent with over 95% cure rate following complete surgical resection. SPN is a rare entity of a controversial origin but is considered as a low-grade malignancy. Surgical resection to achieve complete excision constitutes the mainstay of treatment, which mostly results in an excellent prognosis.
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Affiliation(s)
- Abdullah Saleh AlQattan
- Hepatopancreaticobiliary Unit, Department of Surgery, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
| | - Hassan M Alshaqaq
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Alaa A Al Abdrabalnabi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Muna Alnamlah
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Ahmed Abdulmajeed Alanazi
- Hepatopancreaticobiliary Unit, Department of Surgery, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
| | - Mohammed Saad Alqahtani
- Hepatopancreaticobiliary Unit, Department of Surgery, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
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9
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Ozaki K, Ikeno H, Kaizaki Y, Maeda K, Higuchi S, Kosaka N, Kimura H, Gabata T. Pearls and pitfalls of imaging features of pancreatic cystic lesions: a case-based approach with imaging-pathologic correlation. Jpn J Radiol 2020; 39:118-142. [PMID: 32840742 DOI: 10.1007/s11604-020-01032-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022]
Abstract
A variety of neoplastic and non-neoplastic lesions of the pancreas can present with a predominantly cystic architecture. These lesions are increasingly being detected as incidental findings on routine cross-sectional imaging following technological advances in these techniques and their widespread use. The different histopathological behaviors show various common and uncommon imaging findings, and some cases show similar appearance in spite of different histopathology. Each lesion requires specific management because of the differing risk of progression to malignancy, and an accurate imaging diagnosis is crucial. The typical imaging characteristics that differentiate pancreatic cystic lesions have been well described and fully summarized. However, in addition to a small percentage of cases that shows uncommon imaging findings, a substantial percentage of cystic lesions shows overlapping imaging findings that can lead to radiological misdiagnosis. For appropriate diagnosis and optimal treatment strategy, it is important to know the uncommon and overlapping imaging findings of these lesions, in addition to familiarity with the typical aspects. In this article, we reconfirm the well-known characteristic imaging features of pancreatic cystic lesions and present several diagnostically challenging cases, focusing on the uncommon and overlapping imaging findings.
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Affiliation(s)
- Kumi Ozaki
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan.
| | - Hiroshi Ikeno
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Yasuharu Kaizaki
- Department of Diagnostic Pathology, Fukui Prefectural Hospital, Fukui, Japan
| | - Kazuya Maeda
- Department of Surgery, Fukui Prefectural Hospital, Fukui, Japan
| | - Shohei Higuchi
- Department of Pathology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Nobuyuki Kosaka
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
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10
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Farhat W, Ammar H, Amine Said M, Mizouni A, Bouazzi A, Abdessaied N, Ben Mabrouk M, Ben Ali A. Solid pseudopapillary neoplasm of the pancreas: a report of 10 cases and literature review. ANZ J Surg 2020; 90:1683-1688. [PMID: 31989788 DOI: 10.1111/ans.15701] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/07/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Solid pseudopapillary tumour of the pancreas (SPTP) is a rare pancreatic tumour characterized by a non-specific clinical presentations and vague radiologic features. The aim of this study is to identify these tumours from other pancreatic neoplasms because complete resection is curative in most cases and provides long-term survival. METHODS A retrospective analysis of patients operated for SPTP between January 2000 and December 2018 was conducted. The collected data included age, gender, clinical findings, laboratory tests, radiological findings, anatomopathological examination, immunohistochemistry results, surgical treatment, mortality, morbidity and recurrence. RESULTS Ten cases of SPTP have been diagnosed between January 2000 and December 2018 representing 5.1% of all pancreatic tumours operated during this period (male/female: 2/8; median age 41.2 years; range 19-78 years). The most common symptom was abdominal pain and physical examination was normal in four of 10 cases. The most common tumour localization was the tail of the pancreas. The main tumour size was 7.2 cm (range 2-15 cm). One patient had abdominal disseminated disease. Surgical interventions were distal pancreatectomy in five cases, enucleation in one case, cephalic duodeno-pancreatectomy in two cases, central pancreatectomy in one case and pancreatic biopsy in one case. Only one patient received adjuvant chemotherapy. During follow-up, one patient died after 12 months and another developed unique hepatic metastasis that was resected. CONCLUSION Although it is delayed in diagnosis, the overall prognosis of these tumours remains good even with local recurrence and metastasis. Complete surgical resection is the treatment of choice even in cases of recurrence.
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Affiliation(s)
- Waad Farhat
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Houssem Ammar
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Mohamed Amine Said
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Abdelkader Mizouni
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Amal Bouazzi
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Nihed Abdessaied
- Department of Pathology, Farhat Hached Hospital, University of Sousse, Sousse, Tunisia
| | | | - Ali Ben Ali
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
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11
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Erráez-Jaramillo PJ, Ortiz-Hidalgo C. [The histological and immunohistochemical diagnosis of solid pseudopapillary neoplasm of the pancreas and its differential diagnosis]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2019; 52:178-189. [PMID: 31213259 DOI: 10.1016/j.patol.2019.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 02/23/2019] [Accepted: 03/03/2019] [Indexed: 01/12/2023]
Abstract
Solid pseudopapillary neoplasm of the pancreas is a rare tumor of uncertain histogenesis, described separately by Gruber and Frantz, that accounts for between approximately 1% and 3% of pancreatic neoplasms. It is characterized by a cystic and solid pattern of growth patterns with formation of pseudopapillae. It occurs primarily in young women, although cases in children and older patients and men have been reported. The tumor is of low-grade malignant potential, as the majority of the cases are cured by simple but complete surgical resection. Knowledge of the unique morphologic characteristics of this neoplasm is essential for the correct diagnosis. We review herein the pathologic and immunohistochemical features of this neoplasm and its differential diagnosis with other pancreatic tumors.
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Affiliation(s)
| | - Carlos Ortiz-Hidalgo
- Departamento de Anatomía Patológica, Hospital y Fundación Médica Sur, Ciudad de México, México; Departamento de Biología Celular y Tisular, Escuela de Medicina, Universidad Panamericana, Ciudad de México, México.
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Lanke G, Ali FS, Lee JH. Clinical update on the management of pseudopapillary tumor of pancreas. World J Gastrointest Endosc 2018; 10:145-155. [PMID: 30283597 PMCID: PMC6162250 DOI: 10.4253/wjge.v10.i9.145] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/28/2018] [Accepted: 06/08/2018] [Indexed: 02/06/2023] Open
Abstract
Solid pseudopapillary neoplasm (SPN) is a rare tumor with malignant potential which is generally located in the tail of pancreas. The prevalence of SPN has increased with widespread use of cross sectional imaging. SPN is often misdiagnosed due to nonspecific clinical presentation and accurate diagnosis is essential for optimal management. Endoscopic ultrasound-FNA with immunohistochemistry can help in preoperative diagnosis. Surgery is the treatment of choice and a successful R0 resection is curative. Overall, SPN has a good prognosis. This review article focuses on pathogenesis, diagnosis and management of SPN.
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Affiliation(s)
- Gandhi Lanke
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Faisal S Ali
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Jeffrey H Lee
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
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Frantz's tumour. Unusual presentation in two adolescents. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2018. [DOI: 10.1016/j.hgmx.2017.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Wang P, Wei J, Wu J, Xu W, Chen Q, Gao W, Jiang K, Miao Y. Diagnosis and treatment of solid-pseudopapillary tumors of the pancreas: A single institution experience with 97 cases. Pancreatology 2018; 18:415-419. [PMID: 29548800 DOI: 10.1016/j.pan.2017.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES We evaluated the diagnoses and surgical management of solid pseudopapillary tumors of the pancreas (SPTP) in a single center setting. METHODS Demographic details, clinical presentations, imaging features, surgical strategies, and pathological findings of 97 consecutive patients who underwent surgery for pathologically confirmed SPTP between 2008 and 2016 were analyzed retrospectively. RESULTS A total of 97 patients with SPTP accounted for 2.15% of total pancreatic surgeries (N = 4508). The mean age at diagnosis was 31.6 ± 13.92 years (range: 7-83 years), and males:females were 85:12. Chief complaints were abdominal pain or discomfort (n = 50). The mean transverse tumor diameter was 53.2 ± 2.76 mm (range: 14-170 mm). Tumors were localized to the pancreatic head (38.1%; 37/97), neck (12.4%; 12/97), body and tail (49.5%; 48/97). There were no significant differences in age of onset, presenting symptoms, and sites between males and females. A significant difference was found in the maximum diameter of SPTP across different age groups. Partial pancreatectomy was performed for patient with tumor ≥ 5 cm, and enucleation was performed when tumor was smaller than 5 cm. Pancreatic fistula was the main complication. Immunohistochemical markers for endocrine, exocrine and epithelial factors were used for a final diagnosis. During a median follow-up of 54 months (range: 7-121 months), 84 patients were alive without evidence of recurrence, and 13 patients were lost to follow-up. CONCLUSION SPTP surgical resection is a safe procedure with low morbidity and mortality, which is also effective even in the presence of invasiveness and metastases. Accurate initial diagnoses and follow up are essential.
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Affiliation(s)
- Peng Wang
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jishu Wei
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Junli Wu
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wenbin Xu
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Qiuyang Chen
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wentao Gao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Kuirong Jiang
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yi Miao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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Contribution of 18F-FDG PET/CT in the Staging of Pancreatic Solid Pseudopapillary Neoplasms: A Case Report. IRANIAN JOURNAL OF RADIOLOGY 2017. [DOI: 10.5812/iranjradiol.63250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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