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Garg HK, Shashi KK, Fisher P, Winant AJ, Hull NC, Lee EY. Pediatric Upper Abdominal Masses: Current Practical Imaging Assessment. Semin Roentgenol 2024; 59:299-311. [PMID: 38997183 DOI: 10.1053/j.ro.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Harsha K Garg
- Department of Diagnostic, Molecular and Interventional Radiology and Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY.
| | - Kumar K Shashi
- Department of Radiology, Arkansas Children's Hospital, Little Rock, AR
| | - Paul Fisher
- Department of Diagnostic, Molecular and Interventional Radiology and Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Nathan C Hull
- Department of Radiology, Division of Pediatric Radiology, Mayo Clinic, Rochester, MN
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
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2
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Tee EYF, Clarke S, Wearne C, Anderson G, Gomes L, Thomas G, O'Loughlin E, Lampropoulos B, Kohn M. Double trouble: A case of chronic vomiting. J Paediatr Child Health 2024; 60:332-334. [PMID: 38899588 DOI: 10.1111/jpc.16601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Affiliation(s)
- Elizabeth Yan Fun Tee
- Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Simon Clarke
- Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Christine Wearne
- Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Gail Anderson
- Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Linette Gomes
- Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Gordon Thomas
- Department of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Edward O'Loughlin
- Department of Gastroenterology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Basiliki Lampropoulos
- Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Michael Kohn
- Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, New South Wales, Australia
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Lu X, Chen H, Zhang T. Solid pseudopapillary neoplasm (SPN) of the pancreas: current understanding on its malignant potential and management. Discov Oncol 2024; 15:77. [PMID: 38498246 PMCID: PMC10948659 DOI: 10.1007/s12672-024-00905-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024] Open
Abstract
Solid pseudopapillary neoplasms (SPN) of the pancreas are presently recognized as low-grade malignant tumors that are frequently observed in young females. This tumor has a low incidence and is associated with an excellent prognosis following surgical resection. Typical SPNs primarily affect the pancreas and tend to have moderate or asymptomatic manifestations. Based on retrospective research, it is anticipated that patients with SPN can achieve disease-free survival, even in cases when metastasis is detected during inspection. However, the incidence of malignant SPN has been consistently underestimated, as evidenced by recent research findings. Malignancy of SPN primarily encompasses invasion and infiltration, metastasis, and recurrence after R0 resection. Imaging technologies such as Ultrasound, Computed Tomography, Magnetic Resonance Imaging, and Position Emission Tomography are capable of preliminarily identifying malignant SPN, which is primarily based on its invasive clinical features. Research on risk factors of malignant SPN revealed that larger tumor size, Ki-67 index, and several other parameters had significant correlations with invasive tumor behavior. Pathologic features of malignant SPNs overlay other pancreatic tumors, nevertheless they can provide valuable assistance in the process of diagnosis. Several confirmed specific pathologic biomarkers are related to its cellular origin, characteristic gene mutation, and cell proliferation. Considering the invasiveness of malignant SPN, it is imperative to enhance the comprehensiveness of its therapy. Tumor resection remains a suggested course of action in line with typical SPN, and additional lymph node dissection is seen as reasonable. Compared to benign SPNs, malignant SPNs have worse prognosis, underscoring the necessity of early identification and treatment in comprehensive medical centers to get improved clinical outcomes.
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Affiliation(s)
- Xiaoyue Lu
- Peking Union Medical College, Beijing, China
| | - Hao Chen
- Department of General Surgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Taiping Zhang
- Department of General Surgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
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4
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Adhikari B, Jones R, Haas CJ. Solid Pseudo-papillary Neoplasia: A Rare Malignancy of the Pancreas. J Community Hosp Intern Med Perspect 2023; 13:35-38. [PMID: 38596543 PMCID: PMC11000833 DOI: 10.55729/2000-9666.1254] [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: 05/04/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 04/11/2024] Open
Abstract
Solid pseudopapillary neoplasms (SPNs) are exceedingly rare type of exocrine pancreatic malignancy, representing only 0.9%-2.7% of all exocrine pancreatic malignancies. They predominantly affect young women and unlike other pancreatic malignancies, they have excellent prognoses with 5-year survival following surgical resection approaching 97%. Given the rarity of the disease, little is known about their histopathogenesis as they do not harbor similar genetic mutational abnormalities like other pancreatic tumors. We describe a rare case of SPN in a young female who was found to have the rare diagnosis during the work up for deranged liver function tests.
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Affiliation(s)
- Biplov Adhikari
- Medstar Health Internal Medicine Residency Training Program, Baltimore, MD,
USA
| | - Robert Jones
- Department of Pathology, Medstar Franklin Square Medical Center, Baltimore, MD,
USA
| | - Christopher J. Haas
- Medstar Health Internal Medicine Residency Training Program, Baltimore, MD,
USA
- Department of Medicine, Georgetown University Medical Center, Washington, DC,
USA
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Xie D, Wang Z, Sun B, Qu L, Zeng M, Feng L, Guo M, Wang G, Hao J, Zhou G. High frequency of alternative splicing variants of the oncogene Focal Adhesion Kinase in neuroendocrine tumors of the pancreas and breast. Front Med 2023; 17:907-923. [PMID: 37682378 DOI: 10.1007/s11684-023-1009-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/17/2023] [Indexed: 09/09/2023]
Abstract
The characteristic genetic abnormality of neuroendocrine neoplasms (NENs), a heterogeneous group of tumors found in various organs, remains to be identified. Here, based on the analysis of the splicing variants of an oncogene Focal Adhesion Kinase (FAK) in The Cancer Genome Atlas datasets that contain 9193 patients of 33 cancer subtypes, we found that Box 6/Box 7-containing FAK variants (FAK6/7) were observed in 7 (87.5%) of 8 pancreatic neuroendocrine carcinomas and 20 (11.76%) of 170 pancreatic ductal adenocarcinomas (PDACs). We tested FAK variants in 157 tumor samples collected from Chinese patients with pancreatic tumors, and found that FAK6/7 was positive in 34 (75.6%) of 45 pancreatic NENs, 19 (47.5%) of 40 pancreatic solid pseudopapillary neoplasms, and 2 (2.9%) of 69 PDACs. We further tested FAK splicing variants in breast neuroendocrine carcinoma (BrNECs), and found that FAK6/7 was positive in 14 (93.3%) of 15 BrNECs but 0 in 23 non-NEC breast cancers. We explored the underlying mechanisms and found that a splicing factor serine/arginine repetitive matrix protein 4 (SRRM4) was overexpressed in FAK6/7-positive pancreatic tumors and breast tumors, which promoted the formation of FAK6/7 in cells. These results suggested that FAK6/7 could be a biomarker of NENs and represent a potential therapeutic target for these orphan diseases.
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Affiliation(s)
- Dawei Xie
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zheng Wang
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Beibei Sun
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Liwei Qu
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences & University of Chinese Academy of Sciences, Beijing, 100101, China
| | - Musheng Zeng
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Lin Feng
- Department of Gastroenterology & Hepatology and Department of Pathology, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Mingzhou Guo
- Department of Gastroenterology & Hepatology and Department of Pathology, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.
| | - Guizhen Wang
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Jihui Hao
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
| | - Guangbiao Zhou
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Solanki P, Bose B, Mondal A, Kottayasamy Seenivasagam R. Solid pseudopapillary neoplasm of the pancreas mimicking gastrointestinal stromal tumour. BMJ Case Rep 2023; 16:e254805. [PMID: 37723092 PMCID: PMC10510940 DOI: 10.1136/bcr-2023-254805] [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] [Indexed: 09/20/2023] Open
Abstract
Solid pseudopapillary neoplasm (SPN) of pancreas is an uncommon low-grade malignant tumour that has a remarkable postoperative cure rate. Improved awareness and widespread use of imaging have resulted in more frequent diagnosis of these tumours. We report a case of a woman in her 20s who had an abdominal lump identified as a gastrointestinal stromal tumour on imaging elsewhere. The patient was reevaluated in our hospital and given a provisional diagnosis of SPN on radiology, which was later confirmed on postoperative histopathology.
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Ba-Shammakh SA, Alrayes B, Awaisheh U, Hamad H, Al-Qannas MS, Abu-Obead HM. Frantz's Tumor in Focus: The Tale of a 34-Year-Old Yemeni Female Patient. Cureus 2023; 15:e45258. [PMID: 37842463 PMCID: PMC10576631 DOI: 10.7759/cureus.45258] [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] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
A solid pseudopapillary tumor (SPT) of the pancreas, which mainly occurs in young women, is an uncommon pancreatic tumor that often presents diagnostic and therapeutic dilemmas. This case study discusses the symptoms and treatment approach for a 34-year-old woman from Yemen diagnosed with SPT. The patient was diagnosed through abdominal and pelvis CT scan, followed by ultrasound-guided biopsy confirming the presence of SPPT. Management through the Whipple procedure and portal vein reconstruction proved successful, with no recurrence or metastasis noted in a year-long follow-up. The importance of comprehensive understanding and surgical expertise in handling SPT is emphasized.
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Affiliation(s)
| | - Bourhan Alrayes
- Department of General Surgery, The Islamic Hospital, Amman, JOR
| | - Uwise Awaisheh
- Department of General Surgery, The Islamic Hospital, Amman, JOR
| | - Hisham Hamad
- Department of General Surgery, The Islamic Hospital, Amman, JOR
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Damous SHB, Yamazumi MH, Cavassin GP, Rasslan R, Leal RS, Utiyama EM. Case report of peritoneal carcinomatosis in the clinical course of pancreatic solid pseudopapillary neoplasm (Frantz's tumor) in a patient with a history of blunt abdominal trauma. Int J Surg Case Rep 2023; 108:108472. [PMID: 37429208 PMCID: PMC10382840 DOI: 10.1016/j.ijscr.2023.108472] [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: 03/27/2023] [Revised: 06/17/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION Pancreatic solid pseudopapillary neoplasm (SPN), or Frantz's tumor, is a rare tumor with low malignant potential and a high cure rate when treated by complete surgical resection. There have been few reports of metastatic disease as a result of blunt abdominal trauma. PRESENTATION OF CASE A 13-year-old female patient was a victim of blunt abdominal trauma in 2019. A computed tomography (CT) scan showed a voluminous hemoperitoneum associated with a tumor in the pancreatic tail whose characteristics suggested a pseudopapillary tumor. The patient remained hemodynamically stable and nonoperative treatment was chosen. Two months later, a CT scan showed resolution of the hemoperitoneum and delimitation of the neoplasm in the tail of the pancreas. Elective body and tail pancreatectomy with laparoscopic splenectomy was performed. The patient remained asymptomatic for 15 months until she developed abdominal pain and constipation. A CT scan suggested peritoneal carcinomatosis, which was confirmed by biopsy of the lesions. CLINICAL DISCUSSION A pancreatic SPN, in the context of an abdominal injury, can undergo metastatic progression despite surgical resection with curative intent and adherence to the precepts of minimally invasive oncological surgery. It is important to plan for the long-term follow-up of patients, as well as to understand the risk factors for recurrence. CONCLUSION Although pancreatic SPN has a good prognosis, rupture of its capsule due to external trauma, as reported in the present case, may be a mechanism for peritoneal dissemination of the tumor with a consequent reduction in the length of disease-free survival.
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Affiliation(s)
- Sérgio Henrique Bastos Damous
- Division of General Surgery and Trauma, Department of Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), 255 Dr Enéas de Carvalho Aguiar Av. Cerqueira Cesar, São Paulo 05402-000, Brazil.
| | - Marcia Harumi Yamazumi
- Division of General Surgery and Trauma, Department of Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), 255 Dr Enéas de Carvalho Aguiar Av. Cerqueira Cesar, São Paulo 05402-000, Brazil
| | - Guilherme Pasquini Cavassin
- Division of General Surgery and Trauma, Department of Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), 255 Dr Enéas de Carvalho Aguiar Av. Cerqueira Cesar, São Paulo 05402-000, Brazil
| | - Roberto Rasslan
- Division of General Surgery and Trauma, Department of Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), 255 Dr Enéas de Carvalho Aguiar Av. Cerqueira Cesar, São Paulo 05402-000, Brazil.
| | - Renato Silveira Leal
- Division of General Surgery and Trauma, Department of Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), 255 Dr Enéas de Carvalho Aguiar Av. Cerqueira Cesar, São Paulo 05402-000, Brazil.
| | - Edivaldo Massazo Utiyama
- Division of General Surgery and Trauma, Department of Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), 255 Dr Enéas de Carvalho Aguiar Av. Cerqueira Cesar, São Paulo 05402-000, Brazil.
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Ishii T, Terasaka T, Nishida K, Wada J. Retroperitoneal Solid Pseudopapillary Tumor Mimicking Adrenal Malignant Tumor in a 67-Year-Old Man. JCEM CASE REPORTS 2023; 1:luad090. [PMID: 37908992 PMCID: PMC10580579 DOI: 10.1210/jcemcr/luad090] [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: 03/08/2023] [Indexed: 11/02/2023]
Abstract
Solid pseudopapillary tumor (SPT) is a low-grade malignant tumor of the pancreas. SPT typically affects women and can occur in ectopic pancreatic region; however, it also occurs rarely in retroperitoneum. The tumor may be bulky at the time of diagnosis since there is no specific clinical manifestation. Here we present an older male case with retroperitoneal SPT. A 67-year-old man consulted for intermittent fever and lumbago. His basal hormonal profile screened out a functional tumor. Computed tomography (CT) showed a gigantic mass in his left adrenal region. A normal left adrenal gland was not identified, and the tumor's feeding artery was recognized as the left adrenal artery by the contrast-enhanced CT. Adrenal malignant tumor was suspected, and tumor resection was performed. The resected tumor size was 15 × 10 × 9 cm. Histologically, epithelial-like cells with round nuclei and a small amount of eosinophilic cytoplasm proliferated in papillary (around the blood vessels) or uniformly solid form. By immunostaining, tumor cells were vimentin, CD56, cytokeratin AE1/AE3, CD10, β-catenin in the nucleus, cyclin D1, and PgR positive. These findings led to the diagnosis of SPT. Although rare, SPT should be considered as a differential diagnosis in cases of a mass arising from the adrenal region.
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Affiliation(s)
- Takahiro Ishii
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan
- Endocrine Center, Okayama University Hospital, Okayama, 700-8558, Japan
| | - Tomohiro Terasaka
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan
- Endocrine Center, Okayama University Hospital, Okayama, 700-8558, Japan
| | - Kenji Nishida
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, 700-8558, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan
- Endocrine Center, Okayama University Hospital, Okayama, 700-8558, Japan
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Bhattarai M, Shrestha A, Bhandari S, Buha N, Baral R, Shrivastav S, Lakhey PJ. Pancreatic solid pseudopapillary neoplasm with concomitant left unilateral renal agenesis and bicornuate uterus: a case report. Ann Med Surg (Lond) 2023; 85:1166-1171. [PMID: 37113970 PMCID: PMC10129163 DOI: 10.1097/ms9.0000000000000360] [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: 11/16/2022] [Accepted: 02/12/2023] [Indexed: 04/29/2023] Open
Abstract
A solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor of the pancreas. Concomitant SPN with urogenital anomalies is a very rare presentation. Case Presentation A 16-year-old female presented with a chief complaint of abdominal pain 30 days back. Solid pseudopapillary neoplasm (SPN) of the pancreas was diagnosed with the aid of ultrasonography and contrast-enhanced computed tomography of the abdomen and pelvis. Incidentally, concomitant left unilateral renal agenesis and bicornuate uterus were also detected in radiological findings. The patient underwent spleen-preserving distal pancreatectomy, and SPN was confirmed with the histopathological report. Discussion Symptomatic SPN patients present with an abdominal mass and pain or very rarely jaundice. Most of the SPNs are benign. Complete surgical excision results in more than 95% cure. SPN with concomitant urogenital anomalies is extremely rare, and their concurrent occurrence can be better attributed to Wnt signaling pathway owing to their similar pathogenic mechanism. Conclusion The solid pseudopapillary tumor has an excellent prognosis if timely resected. Proper evaluation of the patient with imaging is necessary to suspect and diagnose SPN who has urogenital anomalies and vice versa.
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Affiliation(s)
- Madhur Bhattarai
- Institute of Medicine, Tribhuvan University, Maharajgunj Medical Campus
| | - Ayush Shrestha
- Institute of Medicine, Tribhuvan University, Maharajgunj Medical Campus
| | - Suyog Bhandari
- Department of Surgical Gastroenterology
- Corresponding author. Address: Institute of Medicine, Tribhuvan University, Maharajgunj 44600, Nepal. Tel. +977-9841881823. E-mail address: (S. Bhandari)
| | | | - Rituraj Baral
- Department of Pathology, Institute of Medicine, Tribhuvan University, Maharajgunj, Nepal
| | - Shreya Shrivastav
- Department of Pathology, Institute of Medicine, Tribhuvan University, Maharajgunj, Nepal
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The Role of MRI in the Diagnosis of Solid Pseudopapillary Neoplasm of the Pancreas and Its Mimickers: A Case-Based Review with Emphasis on Differential Diagnosis. Diagnostics (Basel) 2023; 13:diagnostics13061074. [PMID: 36980388 PMCID: PMC10046973 DOI: 10.3390/diagnostics13061074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/05/2023] [Accepted: 03/09/2023] [Indexed: 03/15/2023] Open
Abstract
Solid pseudopapillary neoplasm (SPN) is rare pancreatic tumor occurring most commonly in young females. The typical imaging appearance of SPN is of well-defined, encapsulated, and large heterogeneous tumors, consisting of solid and cystic components due to various degrees of intralesional hemorrhage and necrosis. However, atypical imaging presentation in the form of small solid tumors or uniformly cystic lesions might also be seen, which can be explained by specific pathological characteristics. Other imaging features such as a round shape, the absence of main pancreatic duct dilatation, and slow growth, in combination with vague symptoms, favor the diagnosis of SPNs. Nevertheless, the radiological findings of SPN might overlap with other solid and cystic pancreatic neoplasms, such as neuroendocrine tumors, serous and mucinous neoplasms, and even small pancreatic adenocarcinomas. In addition, a few benign non-tumorous conditions including walled-of-necrosis, and intrapancreatic accessory spleen may also pose diagnostic dilemmas simulating SPNs on imaging studies. The aim of this manuscript is to provide a comprehensive overview of the typical and atypical imaging features of SPNs and to describe useful tips for differential diagnosis with its potential mimickers.
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12
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Layfield LJ, Zhang T, Esebua M. Molecular features of pancreaticobiliary neoplasms: Implications for diagnosis, prognostication, and therapy selection. Diagn Cytopathol 2023; 51:5-11. [PMID: 35751521 DOI: 10.1002/dc.25005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Molecular diagnostics has impacted the diagnosis, prediction of prognosis, and selection of targeted therapy for many tumor types. While pulmonary adenocarcinomas and melanomas are among the neoplasms most associated with molecular diagnostics and targeted therapy, malignancies of the pancreaticobiliary system have also been impacted by precision medicine. METHODS We undertook an electronic search using PubMed and Embase to review the published literature to determine what forms of molecular testing, mutations and oncogenetic pathways are associated with neoplasms of the pancreaticobiliary system. Keywords utilized were pancreas, bile duct, mutations, ERCP, FNA, KRAS, SMAD4, TP53, next-generation sequencing, serous cystadenoma, pancreatic ductal adenocarcinoma, intraductal papillary mucinous neoplasm, cystic mucinous neoplasm, solid pseudo-papillary neoplasm. RESULTS A search between 1999 and 2022 yielded 6874 manuscripts. Screening of these yielded 302 more focused manuscripts of which 55 were used for the study. Ductal adenocarcinoma of the pancreas is associated with a progression of mutations beginning wit KRAS mutations and ending with a set of mutations in the TP53, SMAD4, and DPC4 genes. Similar mutations are found in neoplastic mucinous cysts. Specific mutations characterize serous cystadenomas, solid, and pseudo papillary neoplasms and adenocarcinomas of the bile ducts. CONCLUSIONS Mutational analysis of cytologic specimens obtained by fine-needle aspiration, and duct brushings and washings are helpful in the diagnosis of pancreaticobiliary neoplasms and may supply prognostic information.
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Affiliation(s)
- Lester J Layfield
- The Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, USA
| | - Tao Zhang
- The Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, USA
| | - Magda Esebua
- The Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, USA
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Shang Y, Zhang Y, Pan E, Yang P, Xu L, Sun J. A refractory liver metastatic solid pseudopapillary neoplasm pancreas harbored CTNNB1 mutation showed good response to celecoxib: A case report. Front Oncol 2022; 12:1022290. [DOI: 10.3389/fonc.2022.1022290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
Solid pseudopapillary neoplasm (SPN) of the pancreas is rare relatively low-grade malignant neoplasm and metastasis rarely. Surgical resection is the primary treatment option for primary and metastatic lesions of SPN, and chemotherapy is often ineffective in non-operable SPNs. SPNs are characterized by the presence of somatic CTNNB1 exon 3 mutations, leading to the activation of Wnt/β-catenin/Cox-2 signal pathway. Here, we firstly report that a refractory liver metastatic pancreatic SPN patient after the failure of multi-line chemotherapies benefited from the Cox-2 selective inhibitor (Celecoxib) based on CTNNB1 D32V mutation detected by next-generation sequencing (NGS), achieving a more than 22-month progression-free survival without any adverse events. Our case provides a potential treatment option for liver metastatic SPN patients with CTNNB1 mutations and highlights the application of NGS for the better treatment decision making.
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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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Sawai T, Zuo S, Terai T, Nishiwada S, Nakagawa K, Nagai M, Akahori T, Kanehiro H, Sho M. Nonalcoholic fatty liver disease developed after pancreatoduodenectomy for solid pseudopapillary neoplasm in a 10-year-old girl: a case report. Surg Case Rep 2022; 8:61. [PMID: 35381910 PMCID: PMC8983797 DOI: 10.1186/s40792-022-01414-9] [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: 03/03/2022] [Accepted: 03/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Solid pseudopapillary neoplasms of the pancreas are rare. Moreover, pancreatoduodenectomy (PD) and postoperative care are not common in pediatric surgery. Herein, we report a case of PD and nonalcoholic fatty liver disease (NAFLD) after PD and present a literature review. Case presentation A 10-year-old girl with a suspected liver tumor was referred to our hospital. Echography, enhanced computed tomography and magnetic resonance imaging showed that the tumor coexisted with the solid and cystic parts of the pancreatic head. Since the patient was a young woman and the imaging findings were consistent with that of pancreatic solid pseudopapillary neoplasms (SPNs), we diagnosed her with pancreatic SPN. Thereafter, PD was performed, and she was discharged 10 days after the operation. Although her postoperative course was mostly uneventful, she experienced few episodes of abdominal pain and diarrhea before hospital discharge. These symptoms subsequently became more frequent and severe. The patient was urgently readmitted to the hospital for watery steatorrhea and lower abdominal colic pain. Her serum aspartate aminotransferase and alanine aminotransferase levels were elevated, and a fatty liver was detected on echography. The patient was diagnosed with steatorrhea, peristaltic pain, and NAFLD after PD. Pancrelipase (containing pancreatic digestive enzymes), antidiarrheal agents, and probiotics were started. Dosage increase of these drugs reduced the defecation frequency and abdominal pain and switched diarrhea to loose stools. However, more lipids in meals or more meals caused diarrhea and abdominal pain. Therefore, the doses of these drugs were further increased, and another antidiarrheal agent, loperamide hydrochloride, was added. Exocrine pancreatic enzymes supplementation and careful follow-up should prevent NAFLD progression after PD. At present, the patient has occasional abdominal pain, but has tangible soft stools once or twice a day. Although echography still shows a mottled fatty liver, her hepatic enzymes are only mildly elevated. Conclusions Pediatric PD is rare, and residual pancreatic function is usually sufficient, unlike in adult cases. However, we experienced a case of NAFLD after PD for a pediatric pancreatic SPN, in which pancreatic enzyme supplementation effectively improved this condition. Further attention must be paid to worsening of NAFLD that can develop nonalcoholic steatohepatitis.
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Affiliation(s)
- Toshio Sawai
- Department of Surgery, Nara Medical University, 840 Shijo-chou, Kashihara, Nara, 634-8522, Japan.
| | - Shogo Zuo
- Department of Surgery, Nara Medical University, 840 Shijo-chou, Kashihara, Nara, 634-8522, Japan
| | - Taichi Terai
- Department of Surgery, Nara Medical University, 840 Shijo-chou, Kashihara, Nara, 634-8522, Japan
| | - Satoshi Nishiwada
- Department of Surgery, Nara Medical University, 840 Shijo-chou, Kashihara, Nara, 634-8522, Japan
| | - Kenji Nakagawa
- Department of Surgery, Nara Medical University, 840 Shijo-chou, Kashihara, Nara, 634-8522, Japan
| | - Minako Nagai
- Department of Surgery, Nara Medical University, 840 Shijo-chou, Kashihara, Nara, 634-8522, Japan
| | - Takehiro Akahori
- Department of Surgery, Nara Medical University, 840 Shijo-chou, Kashihara, Nara, 634-8522, Japan
| | - Hiromichi Kanehiro
- Department of Surgery, Nara Medical University, 840 Shijo-chou, Kashihara, Nara, 634-8522, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, 840 Shijo-chou, Kashihara, Nara, 634-8522, Japan
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Wei G, Luo Q, Fang J, Li X, Shi Y, Li Y, Sun L. The Sex Features of Patients With Solid Pseudopapillary Neoplasms of the Pancreas: A Retrospective Study. Front Oncol 2022; 12:844182. [PMID: 35252013 PMCID: PMC8894654 DOI: 10.3389/fonc.2022.844182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/25/2022] [Indexed: 01/17/2023] Open
Abstract
Background Solid pseudopapillary neoplasms of the pancreas (SPNs) in male patients are more frequently reported. The aim of the study was to evaluate the sex features of SPN and the risk factors that predict tumor recurrence. Methods From 2013 to 2019, patients who were pathologically confirmed to have SPNs were retrospectively reviewed. The baseline study parameters were compared between males and females. A logistic regression model was established to identify the independent risk factors for tumor recurrence. Results In total, 221 patients were included in this study. Of them, 53 patients (24.0%) were males. Male patients were older than female patients (39.1 vs 31.6 years, P=0.001), and the tumor size in male patients was smaller than that in female patients (50.38 vs 39.65 mm, P=0.038). The preoperative imaging diagnostic accuracy was significantly higher in females than in males (70.5% vs 54%, P=0.02). SPNs in male patients tended to be misdiagnosed with other malignant tumors (37.7% vs 10.7%, P<0.0001), with a more solid component observed in images (66.8% vs 24.7%, P<0.0001). For immunohistochemical staining, the expression of beta catenin was significantly lower in male patients (P=0.002), and the expression of vimentin was the opposite (P=0.01). The overall survival rate and disease-free survival were not different. Based on multivariate analysis, older age [hazard ratio (HR)= 1.094, 95% confidence interval (CI): 1.005-1.190] and KI 67 index grade III (HR=12.029, 95% CI: 2.399-60.311) were independent risk factors for tumor recurrence. Conclusion The clinical and imaging features of SPN in males were not in full accord with those in females; however, the differences did not influence prognosis.
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Affiliation(s)
- Guangmin Wei
- Department of Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Qiong Luo
- Department of Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Jiankai Fang
- Department of Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Xiaolou Li
- Department of Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Yanhong Shi
- Department of Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Yuqiong Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
- *Correspondence: Yuqiong Li, ; Liqi Sun,
| | - Liqi Sun
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
- Department of Gastroenterology, 72 Group Army Hospital, Huzhou University, Huzhou, China
- *Correspondence: Yuqiong Li, ; Liqi Sun,
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Sibio S, Di Carlo S. Current highlights on solid pseudopapillary neoplasm of the pancreas. World J Hepatol 2022; 14:300-303. [PMID: 35126857 PMCID: PMC8790393 DOI: 10.4254/wjh.v14.i1.300] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/25/2021] [Accepted: 01/05/2022] [Indexed: 02/06/2023] Open
Abstract
Solid pseudopapillary neoplasm of the pancreas is a low-grade malignant tumor that predominantly affects young women in their third and fourth decade. Etiology and risk factors are unknown. Clinical symptoms are aspecific and most commonly due to mass effect. Diagnosis is made by computed tomography scan or magnetic resonance imaging and histological characterization is obtained by endoscopic ultrasound-guided fine needle biopsy. Microscopically, these lesions are composed by both solid and pseudopapillary structures with necrotic and hemorrhagic areas. Occasionally, the biological behavior is aggressive with tumor recurrence and distant metastasis. Usually, curative R0 surgical resection is the best option able to provide long term survival even in advanced disease. Unresectable disease is the main predictor of poor prognosis. Chemotherapy and radiotherapy regimens are not well standardized. However, they could be effective in reducing tumor size as neoadjuvant treatment or disease control in palliative setting. Although complete surgical resection provides a cure rate of > 95%, considering young age of the patients and morbidity associated to pancreatic surgery, further studies are needed to better investigate risk factors and responsiveness to hormones in order to allow early diagnosis and follow up strategies that could avoid unnecessary surgery in less aggressive disease.
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Affiliation(s)
- Simone Sibio
- Department of Surgery Pietro Valdoni, Sapienza University of Rome, Umberto I Hospital, Rome 00161, Italy
| | - Sara Di Carlo
- Minimally Invasive Surgery Unit, Tor Vergata Hospital, Tor Vergata University of Rome, Rome 00133, Italy
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