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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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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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3
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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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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: 33] [Impact Index Per Article: 5.5] [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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Carlotto JRM, Torrez FRA, Gonzalez AM, Linhares MM, Triviño T, Herani-Filho B, Goldenberg A, Lopes-Filho GDJ, Lobo EJ. SOLID PSEUDOPAPILLARY NEOPLASM OF THE PANCREAS. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 29:93-6. [PMID: 27438034 PMCID: PMC4944743 DOI: 10.1590/0102-6720201600020007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/18/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The solid pseudopapillary neoplasm is a rare tumor of the pancreas. However, it´s etiology still maintain discussions. AIM To analyze it´s clinical data, diagnosis and treatment. METHODS A retrospective study of medical records of all patients treated from January 1997 until July 2015. RESULTS Were identified 17 cases. Most patients were women (94.11%) and the average age was 32.88 years. The main complaint was abdominal mass (47.05%). The most frequent location was in the body/tail of the pancreas (72.22%) and the most frequently performed surgery was distal pancreatectomy with splenectomy (64.70%). No patient had metastases at diagnosis. Conservative surgery for pancreatic parenchyma was performed in only three cases. The rate of complications in the postoperative period was 35.29% and the main complication was pancreatic fistula (29.41%). No patient underwent adjuvant treatment. CONCLUSIONS The treatment is surgical and the most common clinical presentation is abdominal mass. Distal pancreatectomy with splenectomy was the most frequently performed surgery for its treatment.
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Affiliation(s)
- Jorge Roberto Marcante Carlotto
- Surgical Gastroenterology Division, Department of Surgery, School of Medicine, Federal University of São Paulo (EPM/UNIFESP)
| | - Franz Robert Apodaca Torrez
- Surgical Gastroenterology Division, Department of Surgery, School of Medicine, Federal University of São Paulo (EPM/UNIFESP).,Study Group of Pancreatic Diseases, São Paulo, SP, Brazil
| | - Adriano Miziara Gonzalez
- Surgical Gastroenterology Division, Department of Surgery, School of Medicine, Federal University of São Paulo (EPM/UNIFESP)
| | - Marcelo Moura Linhares
- Surgical Gastroenterology Division, Department of Surgery, School of Medicine, Federal University of São Paulo (EPM/UNIFESP)
| | - Tarcisio Triviño
- Surgical Gastroenterology Division, Department of Surgery, School of Medicine, Federal University of São Paulo (EPM/UNIFESP).,Study Group of Pancreatic Diseases, São Paulo, SP, Brazil
| | - Benedito Herani-Filho
- Surgical Gastroenterology Division, Department of Surgery, School of Medicine, Federal University of São Paulo (EPM/UNIFESP).,Study Group of Pancreatic Diseases, São Paulo, SP, Brazil
| | - Alberto Goldenberg
- Surgical Gastroenterology Division, Department of Surgery, School of Medicine, Federal University of São Paulo (EPM/UNIFESP).,Study Group of Pancreatic Diseases, São Paulo, SP, Brazil
| | - Gaspar de Jesus Lopes-Filho
- Surgical Gastroenterology Division, Department of Surgery, School of Medicine, Federal University of São Paulo (EPM/UNIFESP)
| | - Edson José Lobo
- Surgical Gastroenterology Division, Department of Surgery, School of Medicine, Federal University of São Paulo (EPM/UNIFESP).,Study Group of Pancreatic Diseases, São Paulo, SP, Brazil
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Singh A, Mohan G, Chaturvedi S, Sarangi L. Solid pseudopapillary tumor of pancreas: A lesser known entity-diagnosis and pitfalls: A case report. J Cytol 2016; 33:229-232. [PMID: 28028341 PMCID: PMC5156989 DOI: 10.4103/0970-9371.190443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Solid pseudopapillary tumor (SPT) is a rare pancreatic neoplasm with a reported incidence of 0.1% to 2.7% of all pancreatic tumors. Because radiological presentation of pancreatic tumors is quite overlapping, distinctive features in fine needle aspiration cytology (FNAC) helps in its diagnosis preoperatively. Being a low-grade malignancy presenting predominantly in young females, correct preoperative diagnosis minimizes the need of extensive surgery. SPT carries good prognosis without any adjuvant chemotherapy/radiotherapy in most cases, even in the presence of metastatic disease. On the other hand, aggressive surgical resection is required for ductal adenocarcinoma which is more common pancreatic tumor (90%). We report here a case of a 49-year-old female diagnosed as SPT. The importance of the need for the radiologist, pathologist, and surgeon to be familiar with SPT is highlighted so that it is more often diagnosed as there are significant therapeutic and prognostic implications.
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Affiliation(s)
- Anshu Singh
- Department of Pathology, Indian Railway Cancer Research Institute (CRI), Varanasi, Uttar Pradesh, India
| | - Gyanendra Mohan
- Department of Pathology, Indian Railway Cancer Research Institute (CRI), Varanasi, Uttar Pradesh, India
| | - Sunanda Chaturvedi
- Department of Pathology, Indian Railway Cancer Research Institute (CRI), Varanasi, Uttar Pradesh, India
| | - Lalatendu Sarangi
- Department of Surgical Oncology, Indian Railway Cancer Research Institute (CRI), Varanasi, Uttar Pradesh, India
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Sashidharan P, Matele A, Matele U, Al Felahi N, Kassem KF. Gastrointestinal stromal tumors: a case report. Oman Med J 2014; 29:138-41. [PMID: 24715944 PMCID: PMC3976734 DOI: 10.5001/omj.2014.34] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 02/05/2014] [Indexed: 11/03/2022] Open
Abstract
Advances in the identification of gastrointestinal stromal tumors, its molecular and immunohiostochemical basis, and its management have been a watershed in the treatment of gastrointestinal tumors. This paradigm shift occurred over the last two decades and gastrointestinal stromal tumors have now come to be understood as rare gastrointestinal tract tumors with predictable behavior and outcome, replacing the older terminologies like leiomyoma, schwannoma or leiomyosarcoma. This report presents a case of gastric gastrointestinal stromal tumor operated recently in a 47-year-old female patient and the outcome, as well as literature review of the pathological identification, sites of origin, and factors predicting its behavior, prognosis and treatment.
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Affiliation(s)
| | - Apoorva Matele
- Department of Radiology, Nizwa Hospital, Sultanate of Oman
| | - Usha Matele
- Department of Radiology, Nizwa Hospital, Sultanate of Oman
| | - Nowfel Al Felahi
- Department of General Surgery, Nizwa Hospital, Sultanate of Oman
| | - Khalid F. Kassem
- Department of Gastroenterology, Nizwa Hospital, Sultanate of Oman
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