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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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2
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Meliti A, Al-Maghrabi J. Solid Pseudopapillary Neoplasm of the Pancreas: A Clinicopathological Study of 12 Cases With Emphasis on Diagnostic Pitfalls. Cureus 2023; 15:e49858. [PMID: 38169685 PMCID: PMC10758586 DOI: 10.7759/cureus.49858] [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: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Solid pseudopapillary neoplasm of the pancreas (SPNP) is a rare primary neoplasm with distinct clinicopathological features. The tumor most commonly occurs in younger (premenopausal) women and is typified by low malignant potential and an excellent overall prognosis. METHODS A retrospective search over 20 years at two referral tertiary care institutions (King Faisal Hospital and Research Center and King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia) revealed 12 female patients diagnosed with SPNPs. The reslts of ancillary studies performed at the time of diagnosis were also reviewed and placed in the context of current recommendations. RESULTS The clinical and pathological findings were reviewed. All patients were females, aged 18 to 30 years. Eight patients presented with abdominal pain, of which two experienced significant weight loss, and four presented with abdominal mass/discomfort. The tumor size ranged from 1.5 and 15 cm. Two cases were initially diagnosed as neuroendocrine tumors (NETs). One of the cases presented as a multifocal disease. All patients were treated surgically with a follow-up period between one and 11 years. Only one patient presented with peritoneal metastasis after seven years of follow-up, but generally, all are doing well. CONCLUSIONS We have analyzed 12 SPNP cases in our population over 20 years (2001-2021) in this study. In brief, SPNP is a low-grade malignant potential tumor. Even though SPNP is a recognized entity, diagnostic challenges can arise particularly in the setting of limited sampling. Pathologists must be aware of the classic morphological features of SPNP and the characteristic profile of immunohistochemistry and be able to differentiate SPNP from other mimickers, especially well-differentiated NETs of the pancreas, and ultimately to avoid misdiagnosis and unnecessary oncologic treatment. Adequate surgical resection with negative margins is associated with an excellent outcome.
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Affiliation(s)
- Abdelrazak Meliti
- Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
- Pathology, Alfaisal University College of Medicine, Riyadh, SAU
| | - Jaudah Al-Maghrabi
- Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
- Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
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3
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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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Ogawa D, Okabe H, Masuda T, Sugita H. Long-term survivor of giant pancreatic solid pseudopapillary neoplasm with splenic infiltration and lymph node metastasis. BMJ Case Rep 2023; 16:e253554. [PMID: 36731944 PMCID: PMC9896223 DOI: 10.1136/bcr-2022-253554] [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: 02/04/2023] Open
Abstract
A man in his 70s with a 10 cm abdominal mass in the tail of the pancreas was diagnosed with pancreatic tail cancer. Distal pancreatectomy with curative intent was performed. Since tumour invasion of the spleen and transverse colon was suspected, pancreatectomy with splenectomy, left adrenalectomy and partial transverse colectomy was performed. Pathological examination of the resected specimen showed a giant pancreatic tumour, and a diagnosis of locally invasive solid pseudopapillary neoplasm (SPN) of the pancreas was made. The patient achieved 8-year survival without any recurrences. We herein report a very rare case of a giant pancreatic SPN with splenic infiltration and lymph node metastasis that was cured by resection.
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Affiliation(s)
- Daisuke Ogawa
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Hirohisa Okabe
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Toshiro Masuda
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Hiroki Sugita
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
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5
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Wang L, Nie F, Dong T, Li M, Li Y, Yin C. Role of contrast-enhanced ultrasound with time-intensity curve analysis for differentiating hypovascular solid pancreatic lesions. Eur Radiol 2023:10.1007/s00330-023-09393-7. [PMID: 36725721 DOI: 10.1007/s00330-023-09393-7] [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: 07/02/2022] [Revised: 12/08/2022] [Accepted: 12/23/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To evaluate the clinical value of contrast-enhanced ultrasound (CEUS) with time-intensity curve (TIC) in distinguishing different types of hypovascular solid pancreatic lesions. METHODS A total of 89 patients with 90 pancreatic lesions (all confirmed by surgery or biopsy pathology) that manifested hypoenhancement on contrast-enhanced ultrasound (CEUS) were included in this study. Six peak enhancement patterns were proposed for differentiating hypovascular pancreatic lesions. CEUS qualitative and TIC-based quantitative parameters were analyzed, and each lesion was scored based on the statistically significant qualitative parameters to evaluate the diagnostic ability of CEUS for hypovascular solid pancreatic lesions. RESULTS Qualitative parameters such as peak enhancement pattern II/III/IV, penetrating vessels, centripetal enhancement, and early washout were reliable indicators of malignant lesions, and lesions scored based on these qualitative parameters, with a score ≥ 2, were highly suspected to be malignant lesions. Pattern I had an accuracy of 83.33% for predicting mass-forming pancreatitis (MFP), pattern V had an accuracy of 96.67% for predicting solid pseudopapillary tumors of the pancreas (SPTP), and pattern VI had an accuracy of 81.11% for predicting neuroendocrine tumors/carcinomas (NETs/NECs). For quantitative analysis, nodule/pancreatic parenchyma echo intensity reduction ratio was significantly greater in malignant lesions. CONCLUSIONS CEUS qualitative and TIC-based quantitative parameters have clinical value in distinguishing malignant from benign hypovascular pancreatic lesions. KEY POINTS • Contrast-enhanced ultrasound helps clinicians assess patients with pancreatic lesions. • Six peak enhancement patterns are proposed for differentiating pancreatic hypovascular lesions. • Qualitative parameters such as peak enhancement pattern II/III/IV, penetrating vessels, centripetal enhancement, early washout, and quantitative parameter nodule/pancreatic parenchyma echo intensity reduction ratio were important characteristics to discriminate malignant from hypovascular benign lesions.
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Affiliation(s)
- Lan Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China.,Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China. .,Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China.
| | - Tiantian Dong
- Ultrasound Medical Center, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China.,Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Ming Li
- Ultrasound Medical Center, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China.,Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Yuanyuan Li
- Ultrasound Medical Center, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China.,Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Ci Yin
- Ultrasound Medical Center, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, China.,Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
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Zulfiqar AM, Bertsch RA. Solid Pseudopapillary Neoplasm of the Pancreas: A Case Report of a Rare Tumor Detected by Sonography. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221092326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This case presentation describes a solid pseudopapillary neoplasm found in a young 41-year-old female. This mass was initially detected with sonography and later confirmed with an ultrasound-guided biopsy. The neoplasm was scheduled to be surgically resected, as a cure, which has a favorable long-term prognosis. This case provides information on the imaging characteristics and natural history of this benign neoplasm.
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Affiliation(s)
| | - Ruth Ann Bertsch
- Kaiser Permanente Sacramento Medical Center, Sacramento, CA, USA
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Abstract
The basic pancreatic lesions include location, size, shape, number, capsule, calcification/calculi, hemorrhage, cystic degeneration, fibrosis, pancreatic duct alterations, and microvessel. One or more basic lesions form a kind of pancreatic disease. As recognizing the characteristic imaging features of pancreatic basic lesions and their relationships with pathology aids in differentiating the variety of pancreatic diseases. The purpose of this study is to review the pathological and imaging features of the basic pancreatic lesions.
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8
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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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Abubakar I, Bashir B, Agbo S, Umar M, Sani H, Abdullahi M, Emetuma F. Pancreatic cystic lesions: An 11 years (2010–2020) of experience at Usmanu Danfodiyo University teaching hospital, Sokoto. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_73_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Massaras D, Masourou Z, Papazian M, Psarras G, Polydorou A. Solid Pseudopapillary Tumor of the Pancreas in a 25-Year-Old Female: A Rare Entity of Pancreatic Tumors. Cureus 2021; 13:e14747. [PMID: 34084675 PMCID: PMC8164176 DOI: 10.7759/cureus.14747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Solid pseudopapillary neoplasms (SPMs) of the pancreas are extremely rare tumors of the pancreas that typically affect young women and have a favorable prognosis. Herein, we report a 25-year-old female with solid pseudopapillary tumor of the pancreas who presented with atypical epigastric pain. The patient underwent pancreatoduodenectomy (Whipple procedure). She remained asymptomatic and showed no signs of disease after one year of follow-up. This type of pancreatic tumors is amenable to cure after complete surgical resection, even in cases with capsular invasion, unlike any other malignant tumors of the pancreas.
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Affiliation(s)
- Dimitrios Massaras
- Surgery, Aretaieio University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Zoi Masourou
- Anesthesiology, Aretaieio University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Maria Papazian
- Pathology, Aretaieio University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Grigorios Psarras
- 1st Department of Radiology, Aretaieio University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Andreas Polydorou
- Surgery, Aretaieio University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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Chen H, Huang Y, Yang N, Yan W, Yang R, Zhang S, Yang P, Li N, Feng Z. Solid-Pseudopapillary Neoplasm of the Pancreas: A 63-Case Analysis of Clinicopathologic and Immunohistochemical Features and Risk Factors of Malignancy. Cancer Manag Res 2021; 13:3335-3343. [PMID: 33883945 PMCID: PMC8055352 DOI: 10.2147/cmar.s304981] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/26/2021] [Indexed: 01/17/2023] Open
Abstract
Purpose Solid-pseudopapillary neoplasm (SPN) of the pancreas, a rare tumor, has low malignant potential. However, some patients develop metastasis and recurrence after resection, with aggressive biological behaviors. This study aimed to explore the features and risk factors associated with the aggressive biological behaviors of SPNs. Patients and Methods We retrospectively analyzed the clinicopathological and long-term follow-up data of 63 patients diagnosed with SPN at the First Affiliated Hospital of Bengbu Medical College between January 2007 and February 2019. Results Sixty-three patients presented atypical clinical symptoms. The median tumor size was 7.0 cm (range, 2.4–17 cm), and imaging features were solid and cystic or solid tumors with uneven density. Frequent and diffuse nuclear LEF1 protein expression (94.2%) was observed with LEF1 having a higher sensitivity and specificity. Overall survival significantly correlated with tumor size, Ki-67 index, and lymph node metastasis (P < 0.05). Conclusion SPN is a rare low-grade malignancy with a specific pseudopapillary structure. LEF1 is an effective biomarker of SPNs. Although SPNs generally display indolent biological behavior, a large tumor size, high proliferation index, and lymph node metastasis may be risk factors for the aggressive behavior and poor prognosis of SPN.
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Affiliation(s)
- Hongchun Chen
- Department of Pathology, Bengbu Medical College, Bengbu, Anhui Province, 233000, People's Republic of China.,Department of Pathology, First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, 233000, People's Republic of China
| | - Yuchen Huang
- Department of Pathology, Bengbu Medical College, Bengbu, Anhui Province, 233000, People's Republic of China.,Department of Pathology, First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, 233000, People's Republic of China
| | - Ningning Yang
- Department of Pathology, Bengbu Medical College, Bengbu, Anhui Province, 233000, People's Republic of China.,Department of Pathology, First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, 233000, People's Republic of China
| | - Wentian Yan
- Department of Pathology, Bengbu Medical College, Bengbu, Anhui Province, 233000, People's Republic of China.,Department of Pathology, First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, 233000, People's Republic of China
| | - Ruxue Yang
- Department of Pathology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, 230000, People's Republic of China
| | - Shan Zhang
- Department of Pathology, Second People's Hospital of Hefei, Hefei, Anhui Province, 230000, People's Republic of China
| | - Panpan Yang
- Department of Pathology, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, 230000, People's Republic of China
| | - Nan Li
- Department of Pathology, Bengbu Medical College, Bengbu, Anhui Province, 233000, People's Republic of China.,Department of Pathology, First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, 233000, People's Republic of China
| | - Zhenzhong Feng
- Department of Pathology, Bengbu Medical College, Bengbu, Anhui Province, 233000, People's Republic of China.,Department of Pathology, First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, 233000, People's Republic of China
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Sclerosing Epithelioid Mesenchymal Neoplasm of the Pancreas: Case Report and Literature Review of the Morphologic Characteristics. Pancreas 2021; 50:e47-e48. [PMID: 34016901 PMCID: PMC8195734 DOI: 10.1097/mpa.0000000000001834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Supplemental digital content is available in the text.
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13
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Din NU, Rahim S, Abdul-Ghafar J, Ahmed A, Ahmad Z. Clinicopathological and immunohistochemical study of 29 cases of solid-pseudopapillary neoplasms of the pancreas in patients under 20 years of age along with detailed review of literature. Diagn Pathol 2020; 15:139. [PMID: 33298094 PMCID: PMC7724627 DOI: 10.1186/s13000-020-01058-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/29/2020] [Indexed: 01/12/2023] Open
Abstract
Background Pancreatic Solid Pseudopapillary Neoplasms (SPNs) are rare low-grade malignant tumors with a marked preponderance for young females. Objective was to describe the morphology, differential diagnosis, and prognosis of SPNs in patients under 20 years of age and present a detailed review of literature. Methods A total of 29 cases in patients under 20 years of age reported as SPN during the period January 2014 to December 2019, were included in the study. These included 19 resection specimens, 4 incision biopsies and 6 cases received as blocks for second opinion. Hematoxylin and eosin (H&E) slides as well as immunohistochemistry (IHC) slides of all cases were retrieved and reviewed by the authors. TFE3 and Progesterone Receptor were performed retrospectively. Results Twenty-eight of the 29 patients were females. Ages of patients ranged from 12 to 19 years. Nineteen cases were resections. Tail was the commonest location. Mean tumor size was 9.5 cm. In 89.5% cases, tumor was confined to the pancreas. In 2 cases, distant metastasis was present. In 2 cases, extension beyond pancreas was seen. Solid and pseudopapillary areas were seen in all cases while other features were variable. Beta catenin and Cyclin D1 were positive in most cases while TFE3 was positive in 57% cases. Progesterone Receptor (PR) was positive in all 13 cases in which it was performed. Follow up was available in 14 patients. Follow up period ranged from 3 to 70 months. Twelve were alive and well without recurrence or metastasis while 2 were alive with recurrence and metastasis to liver and omentum respectively. Conclusions Although many studies on SPNs have been published, surgeons, oncologists and even pathologists in this part of the world are often not aware of these rare tumors leading to inaccuracies and delays in diagnosis. In addition, this paper focusses on the interesting observation that the majority of SPNs diagnosed in our department during study period occurred in patients under 20 years of age (29 versus 21 in patients over 20). However, clinico-epidemiological, morphologic and prognostic features were similar in both age groups. Possibility of SPNs should always be considered in case of pancreatic neoplasms occurring in patients under 20 years of age as well. We believe that this is a very interesting and helpful study for the clinicians as well as the pathologists.
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Affiliation(s)
- Nasir Ud Din
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Shabina Rahim
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Jamshid Abdul-Ghafar
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan.
| | - Arsalan Ahmed
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Zubair Ahmad
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
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14
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Berrada G, Belaaroussi S, Chbani K, Salam S, Laoudiyi D, Ouzidane L, Kebir AE, Guebessi NB, Benayad S, Mernissi F, Karkouri M, Anis S, Zemmouri MA. Solid pseudopapillary tumor of the pancreas: a rare entity in children. Pan Afr Med J 2020; 35:137. [PMID: 32655751 PMCID: PMC7335250 DOI: 10.11604/pamj.2020.35.137.22404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/09/2020] [Indexed: 02/06/2023] Open
Abstract
Solid pseudopapillary tumors (SPTs) constitute 0.2 to 2.7% of non-endocrine primary tumors of the pancreas and comprise the majority (70%) of pediatric pancreatic neoplasms. These tumors are of unclear pathogenesis, low malignancy and favorable prognosis. Surgical resection offers an excellent chance for longterm survival, even in the presence of distant metastasis. The objective of this study is to review our experience in the management of SPT in a 12 years old girl at the pediatric hospital of the University hospital of Casablanca, in Morocco and provide an update on current management in pediatric population.
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Affiliation(s)
- Ghita Berrada
- Department of Pediatric Radiology, Abderrahim Harouchi Pediatric Hospital, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Soukaina Belaaroussi
- Department of Pediatric Radiology, Abderrahim Harouchi Pediatric Hospital, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Kamilia Chbani
- Department of Pediatric Radiology, Abderrahim Harouchi Pediatric Hospital, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Siham Salam
- Department of Pediatric Radiology, Abderrahim Harouchi Pediatric Hospital, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Dalal Laoudiyi
- Department of Pediatric Radiology, Abderrahim Harouchi Pediatric Hospital, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Lahcen Ouzidane
- Department of Pediatric Radiology, Abderrahim Harouchi Pediatric Hospital, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Asmaa El Kebir
- Department of Pathology, Ibn Rochd University Hospital, Casablanca, Morocco
| | | | - Samira Benayad
- Department of Pathology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Farida Mernissi
- Department of Pathology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Mehdi Karkouri
- Department of Pathology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Salma Anis
- Department of Surgery, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Mounia Al Zemmouri
- Department of Surgery, Ibn Rochd University Hospital, Casablanca, Morocco
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15
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Shi S, Zhou Y, Hu C. Clinical manifestations and multi-slice computed tomography characteristics of solid pseudopapillary neoplasms of the pancreas between males and females. BMC Med Imaging 2019; 19:87. [PMID: 31718581 PMCID: PMC6852907 DOI: 10.1186/s12880-019-0390-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/23/2019] [Indexed: 02/07/2023] Open
Abstract
Background Solid-pseudo papillary neoplasms of pancreas (SPNP) are rare in men and are often misdiagnosed. This study aimed to analyze the clinical and multi-slice computer tomography (MSCT) features of patients with SPNP, and examine the differences between males and females. Methods In this retrospective cohort study, the clinical and imaging data of 29 patients with histolopathologically confirmed SPNP (seven males and 22 females) that underwent radical resection, and underwent preoperative MSCT at the First People’s Hospital of Lianyungang between August 2010 and December 2018 were collected. All MSCT images were reviewed by two radiologists; disagreements were ruled by a third one. Results The median age of the 29 patients with SPNP was 30 (range, 12–70) years. The male patients were older than the female patients [median, 56 (28–66) vs. 29 (12–70), P = 0.012]. The median tumor size was 3.9 (range, 2.0–6.4) cm in the male SPNP patients, which was significantly lower than the 7.0 (range, 4.6–14.6) cm in the female patients (P < 0.001). The calcification rate of the SPNP was significantly higher in male than in female patients (P = 0.013). The percentage of solid tumor was higher in males than in females (P = 0.036). Capsule, bleeding, and enhancement in the arterial and venous phases were not significantly different between the male and female patients (all P > 0.05). Conclusion The imaging features of male SPNP are distinct from those of female patients. In males with pancreatic lesions, MSCT generally shows relatively small lesions with higher percentages of solid components and calcification, with typical enhancement suggesting SPNP.
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Affiliation(s)
- Shuguang Shi
- Medical Imaging Center, the First Affiliated Hospital of Soochow University, No.188 Shizi Street, Suzhou, 215006, Jiangsu, China.,Department of Radiology, First people's Hospital of Lianyungang, Lianyungang, China
| | - Ying Zhou
- Department of Radiology, First people's Hospital of Lianyungang, Lianyungang, China
| | - Chunhong Hu
- Medical Imaging Center, the First Affiliated Hospital of Soochow University, No.188 Shizi Street, Suzhou, 215006, Jiangsu, China.
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16
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Solid Pseudopapillary Neoplasms of the Pancreas: Clinicopathologic and Radiologic Features According to Size. AJR Am J Roentgenol 2019; 213:1073-1080. [DOI: 10.2214/ajr.18.20715] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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17
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Wang C, Cui W, Wang J, Chen X, Tong H, Wang Z. Differentiation between solid pseudopapillary neoplasm of the pancreas and hypovascular pancreatic neuroendocrine tumors by using computed tomography. Acta Radiol 2019; 60:1216-1223. [PMID: 30678482 DOI: 10.1177/0284185118823343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Cheng Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, PR China
- Department of Graduate, Bengbu Medical College, Bengbu, Anhui Province, PR China
- *Equal contributors
| | - Wenjing Cui
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, PR China
- *Equal contributors
| | - Jianhua Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, PR China
| | - Xiao Chen
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, PR China
| | - He Tong
- Department of Graduate, Bengbu Medical College, Bengbu, Anhui Province, PR China
- Department of Medical Imaging Center, PLA Fuzhou General Hospital, Fuzhou, Fujian Province, PR China
| | - Zhongqiu Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, PR China
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18
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Abdelkader A, Hunt B, Hartley CP, Panarelli NC, Giorgadze T. Cystic Lesions of the Pancreas: Differential Diagnosis and Cytologic-Histologic Correlation. Arch Pathol Lab Med 2019; 144:47-61. [PMID: 31538798 DOI: 10.5858/arpa.2019-0308-ra] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT.— Pancreatic cystic lesions (PCLs) are very common, and their detection is increasing with the advances in imaging techniques. Because of the major implications for management, distinguishing between neoplastic and nonneoplastic PCLs is critical. Neoplastic cysts with potential to progress into cancer include mucinous PCLs (intraductal papillary mucinous neoplasms and mucinous cystic neoplasms) and nonmucinous cysts (solid pseudopapillary tumors, serous cystic neoplasms, and neuroendocrine tumors with cystic degeneration). Nonneoplastic cysts with no risk of malignant transformation include pseudocysts, retention cysts, lymphoepithelial cysts, cystic pancreatic lymphangioma, and duplication cyst/ciliated foregut cysts. The role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) cytology with cyst fluid analysis in the diagnosis of PCLs has evolved during the last decade; however, a definitive diagnosis on cytologic specimens is hampered by the sparse cellularity and can be challenging. EUS-FNA can play an important role to differentiate low-risk from high-risk pancreatic cysts and to distinguish between patients with cysts who need clinical follow-up versus those who require surgery. OBJECTIVE.— To provide an integrative approach to diagnose pancreatic cystic lesions using EUS-FNA cytology and cyst fluid analysis, along with clinical, radiologic, histologic, genetic, and molecular characteristics. DATA SOURCES.— The review and analysis of the latest literature describing pancreatic cystic lesions. CONCLUSIONS.— Accurate diagnosis of PCLs requires a multidisciplinary and multimodal team approach, including the integration of clinical findings, imaging, cytology, cyst fluid analysis, and molecular testing.
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Affiliation(s)
- Amrou Abdelkader
- From the Department of Pathology, Medical College of Wisconsin, Milwaukee (Drs Abdelkader, Hunt, Hartley, and Giorgadze); and the Department of Pathology, Albert Einstein College of Medicine, The Bronx, New York (Dr Panarelli)
| | - Bryan Hunt
- From the Department of Pathology, Medical College of Wisconsin, Milwaukee (Drs Abdelkader, Hunt, Hartley, and Giorgadze); and the Department of Pathology, Albert Einstein College of Medicine, The Bronx, New York (Dr Panarelli)
| | - Christopher P Hartley
- From the Department of Pathology, Medical College of Wisconsin, Milwaukee (Drs Abdelkader, Hunt, Hartley, and Giorgadze); and the Department of Pathology, Albert Einstein College of Medicine, The Bronx, New York (Dr Panarelli)
| | - Nicole C Panarelli
- From the Department of Pathology, Medical College of Wisconsin, Milwaukee (Drs Abdelkader, Hunt, Hartley, and Giorgadze); and the Department of Pathology, Albert Einstein College of Medicine, The Bronx, New York (Dr Panarelli)
| | - Tamara Giorgadze
- From the Department of Pathology, Medical College of Wisconsin, Milwaukee (Drs Abdelkader, Hunt, Hartley, and Giorgadze); and the Department of Pathology, Albert Einstein College of Medicine, The Bronx, New York (Dr Panarelli)
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19
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Wang J, Chen X, Wang C, Cui W, Ren S, Wang Z, Li H, Wang Z. Differentiation of aggressive from non-aggressive pancreatic solid pseudopapillary neoplasms using computed tomography. Abdom Radiol (NY) 2019; 44:2448-2458. [PMID: 30850890 DOI: 10.1007/s00261-019-01969-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSES Microscopic aggressive behaviors may be related with the prognosis of solid pseudopapillary neoplasms (SPNs). In this study, we investigate computed tomography (CT) features and differential diagnosis of aggressive and non-aggressive SPNs in pancreas. MATERIALS AND METHODS 122 patients with pathologically proven SPNs in pancreas were included. Patients' age, tumor site, texture, shape, margins, exophytic growth, capsule, calcification, hemorrhage, pancreatic duct dilatation or pancreatic parenchyma atrophy, peripancreatic infiltration or metastases, vascular encasement, and enhancement pattern were assessed. The diagnostic accuracy was analyzed by using the receiver operating characteristic curve (ROC). RESULTS There were 30 aggressive SPNs and 92 non-aggressive SPNs. Aggressive SPNs showed significantly higher frequencies of an ill-defined margin, patient age > 40.5 years, and tumor size < 42.1 mm, but lower frequencies of complete capsule, hemorrhage compared with non-aggressive SPNs (p < 0.05). Lack of complete capsule and age > 40.5 years were independent risk factors of aggressive SPNs (odd ratio 7.08 and 3.1, respectively). When we applied the two predictors in the logistic regression model, the area under the curve (AUC) was 0.77 with sensitivity of 86.7% and specificity of 55.4%. CONCLUSION Size less than 42.1 mm, lack of complete capsule, ill-defined, and absent bleeding are useful CT imaging features for predicating aggressive SPNs. Patient age > 40.5 years and lack of complete capsule showed acceptable diagnostic performance for discriminating aggressive from non-aggressive SPNs.
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Affiliation(s)
- Jianhua Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing, 210029, Jiangsu, China
| | - Xiao Chen
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing, 210029, Jiangsu, China
| | - Cheng Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing, 210029, Jiangsu, China
| | - Wenjing Cui
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing, 210029, Jiangsu, China
| | - Shuai Ren
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing, 210029, Jiangsu, China
| | - Zhonglan Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing, 210029, Jiangsu, China
| | - Hui Li
- Department of Pathology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China
| | - Zhongqiu Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing, 210029, Jiangsu, China.
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Chinnakkulam Kandhasamy S, Sriram JK, Sahoo AK, Goneppanavar M, Nelamangala Ramakrishnaiah VP. Distal Pancreas and Spleen-preserving Central Pancreatectomy in a Locally Aggressive Solid Pseudopapillary Neoplasm of Pancreas: A Novel Extended Warshaw Technique. Cureus 2018; 10:e3742. [PMID: 30800552 PMCID: PMC6384043 DOI: 10.7759/cureus.3742] [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] [Indexed: 11/19/2022] Open
Abstract
Central pancreatectomy (CP) is a well-described procedure done for neck and proximal body tumors of the pancreas. It can be done for benign lesions where an adequate length of normal distal pancreas will be left leading to organ preservation. The currently described benefit of the procedure is decreased long-term morbidity due to retention of both the spleen and the preservation of functioning pancreas. This is usually dependent on the preservation of distal pancreatic vascularity by splenic artery preservation. Many studies have described splenic preservation by Warshaw technique by safeguarding the short gastric (SGA) and left gastroepiploic (LGEA) vessels in case of distal pancreatectomy. However, distal pancreatic preservation during CP with splenic vessels ligation is not given a significant mention in the current literature in relation to Warshaw technique. Here, we present a 19-year-old girl diagnosed with an exophytic solid pseudopapillary tumor of the pancreatic body that was selected for central pancreatectomy. In view of splenic vessels involvement, she underwent ligation of the splenic vessels and splenic preservation was based on the LGEA and SGA. Distal pancreas was anastomosed with a roux en loop of jejunum and intra-operatively, we were able to demonstrate the back flow in the splenic vessels. Postoperative computed tomography showed adequate enhancement of the spleen along with retrograde blood flow into the distal splenic artery with enhancement of the distal pancreas. Her postoperative period went uneventful. Thus CP with extended Warshaw technique is a safe and feasible procedure where indicated.
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Affiliation(s)
| | - Jayanth K Sriram
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Ashok K Sahoo
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Mangala Goneppanavar
- Pathology, Mahatma Gandhi Medical College and Research Institute, Puducherry, IND
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21
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Meckmongkol TT, Polleto E, Grewal H. Solid pseudopapillary neoplasm of the pancreas (Frantz tumor) in a 14-year-old girl. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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22
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Abstract
Pancreatic cystic lesions are being detected with increasing frequency because of increased use and improved quality of cross-sectional imaging techniques. Pancreatic cystic lesions encompass non-neoplastic lesions (such as pancreatitis-related collections) and neoplastic tumors. Common cystic pancreatic neoplasms include serous cystadenomas, mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, and solid pseudopapillary tumors. These cystic pancreatic neoplasms may have typical morphology, but at times show overlapping imaging features on cross-sectional examinations. This article reviews the classical and atypical imaging features of commonly encountered cystic pancreatic neoplasms and presents the limitations of current cross-sectional imaging techniques in accurately classifying pancreatic cystic lesions.
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Affiliation(s)
- Thomas L Bollen
- Department of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Frank J Wessels
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
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23
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Does Computed Tomography Have the Ability to Differentiate Aggressive From Nonaggressive Solid Pseudopapillary Neoplasm? J Comput Assist Tomogr 2018; 42:405-411. [PMID: 29287021 DOI: 10.1097/rct.0000000000000698] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of the study was to assess the ability of contrast-enhanced computed tomography (CECT) to differentiate aggressive from nonaggressive solid pseudopapillary neoplasms (SPNs). MATERIALS AND METHODS Forty treatment-naive patients with pathologically proven pancreatic SPNs were included. Imaging characteristics were determined by consensus of 3 radiologists blinded to histopathologic aggressiveness. All patients underwent 4-phase CECT using a pancreatic protocol. The regions of interest of the tumor and the normal pancreas were documented on all phases. Lymph nodes were considered metastatic if greater than 1.0 cm in short-axis diameter.Fisher exact and Wilcoxon rank-sum tests were used to compare between aggressive and nonaggressive tumors. RESULTS No significant difference was noted between imaging covariates, such as internal hemorrhage, calcification, wall thickness perceptibility, vascular invasion, margins, cystic component, and pancreatic and biliary ductal dilation. Tumors with greater than 62.5 Hounsfield units and progressive enhancement during the delayed phase had aggressive characteristics (P = 0.03). CONCLUSIONS On delayed phase CECT, pathologically aggressive SPNs may show greater enhancement than nonaggressive SPNs.
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24
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De Moura DTH, Coronel M, Ribeiro IB, Farias GFA, Choez MA, Rocha R, Toscano MP, De Moura EGH. The importance of endoscopic ultrasound fine-needle aspiration in the diagnosis of solid pseudopapillary tumor of the pancreas: two case reports. J Med Case Rep 2018; 12:107. [PMID: 29695287 PMCID: PMC5918898 DOI: 10.1186/s13256-018-1585-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 01/27/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Solid pseudopapillary tumor of the pancreas, otherwise known as solid and cystic tumor or Frantz tumor, is an unusual form of pancreatic carcinoma, with unknown etiopathogenesis, that accounts for 0.2 to 2.7% of all pancreatic tumors. It is defined as an exocrine pancreatic neoplasia that mainly affects women between the second and third decade of life, and its management is not well defined. Endoscopic ultrasound offers a key anatomical advantage in accessing the pancreas and endoscopic ultrasound fine-needle aspiration has become the gold standard method for the diagnosis of pancreatic lesions. CASE PRESENTATION Case 1: A 31-year-old white Hispanic woman presented with epigastric pain for 5 months. An abdominal ultrasound revealed a single 2 cm nodule in the uncinate process of her pancreas. Endoscopic ultrasound showed a regular, well-defined solid lesion with alternating cystic areas at the uncinate process of her pancreas, measuring 1.7 × 1.4 cm; endoscopic ultrasound fine-needle aspiration was then performed with cytopathological analysis compatible with solid pseudopapillary tumor. Body computed tomography confirmed the absence of metastases and she underwent conventional duodenopancreatectomy. However, she died 4 days after surgery due to postoperative surgical complications. Case 2: A 35-year-old Hispanic woman presented with left upper quadrant abdominal pain for 3 months, associated with a palpable mass at this region. A computed tomography scan showed a solitary nodule in the pancreatic body. Endoscopic ultrasound showed a regular, well-defined, homogeneous lesion with small anechoic (cystic) areas, measuring 2 × 2 cm, in between the pancreatic body and neck. Endoscopic ultrasound fine-needle aspiration was performed and cytopathological analysis was suggestive of a pseudopapillary solid tumor. She underwent a body-tail laparoscopic pancreatectomy with splenectomy. Nine months after the diagnosis, she remains asymptomatic, continuing regular follow-up in the oncology out-patient clinic. CONCLUSIONS Solid pseudopapillary tumor is a rare pancreatic malignancy. Endoscopic ultrasound fine-needle aspiration is the gold standard method to characterize and diagnose this type of pancreatic lesion, making this an invaluable tool to help guide clinical management and improve the preoperative diagnostic yield.
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Affiliation(s)
- Diogo Turiani Hourneaux De Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cezar, São Paulo, SP ZIP Code 05403-010 Brazil
| | - Martin Coronel
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cezar, São Paulo, SP ZIP Code 05403-010 Brazil
| | - Igor Braga Ribeiro
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cezar, São Paulo, SP ZIP Code 05403-010 Brazil
| | - Galileu Ferreira Ayala Farias
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cezar, São Paulo, SP ZIP Code 05403-010 Brazil
| | - Maria Auxiliadora Choez
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cezar, São Paulo, SP ZIP Code 05403-010 Brazil
| | - Rodrigo Rocha
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cezar, São Paulo, SP ZIP Code 05403-010 Brazil
| | - Marcello Pecoraro Toscano
- Pathology Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, Andar, bloco, Cerqueira Cezar, São Paulo, SP ZIP Code 05403-010 Brazil
| | - Eduardo Guimarães Hourneaux De Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cezar, São Paulo, SP ZIP Code 05403-010 Brazil
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25
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Abstract
Mortality due to pancreatic ductal adenocarcinoma (PDAC) will increase in the near future. The only curative treatment for PDAC is radical resection; however, even small carcinomas exhibit micrometastases leading to early relapse. Accordingly, detection of premalignant precursor lesions is important. In essence, PDAC develops from three precursor lesions: pancreatic intraepithelial lesions (PanIN), intraductal papillary-mucinous neoplasia (IPMN) and mucinous-cystic neoplasia (MCN). Together with serous cystic neoplasia (SCN) and solid pseudopapillary neoplasia (SPN), these cystic lesions constitute the most common cystic neoplasms in the pancreas. In the case of IPMN, main and branch duct IPMN have to be differentiated because of a markedly different malignancy potential. While main duct IPMN and MCN have a high malignancy transformation rate, branch duct IPMNs are more variable with respect to malignant transformation. This shows that differential diagnosis of cystic lesions is important; however, this is often very difficult to accomplish using conventional imaging. Novel biomarkers and diagnostic tools based on the molecular differences of cystic pancreatic lesions could be helpful to differentiate these lesions and facilitate early diagnosis. The aim is to distinguish the premalignant cysts from strictly benign cystic lesions and a timely detection of malignant transformation. This article provides an overview on the molecular characteristics of cystic pancreatic lesions as a basis for improved diagnostics and the development of new biomarkers.
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Affiliation(s)
- A W Berger
- Klinik für Innere Medizin 1, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - T Seufferlein
- Klinik für Innere Medizin 1, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
| | - A Kleger
- Klinik für Innere Medizin 1, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
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Lin YC, Hwu Y, Huang GS, Hsiao M, Lee TT, Yang SM, Lee TK, Chen NY, Yang SS, Chen A, Ka SM. Differential synchrotron X-ray imaging markers based on the renal microvasculature for tubulointerstitial lesions and glomerulopathy. Sci Rep 2017; 7:3488. [PMID: 28615647 PMCID: PMC5471266 DOI: 10.1038/s41598-017-03677-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 05/03/2017] [Indexed: 12/13/2022] Open
Abstract
High resolution synchrotron microtomography capable of revealing microvessels in three dimensional (3D) establishes distinct imaging markers of mouse kidney disease strongly associated to renal tubulointerstitial (TI) lesions and glomerulopathy. Two complementary mouse models of chronic kidney disease (CKD), unilateral ureteral obstruction (UUO) and focal segmental glomerulosclerosis (FSGS), were used and five candidates of unique 3D imaging markers were identified. Our characterization to differentially reflect the altered microvasculature of renal TI lesions and/or glomerulopathy demonstrated these image features can be used to differentiate the disease status and the possible cause therefore qualified as image markers. These 3D imaging markers were further correlated with the histopathology and renal microvessel-based molecular study using antibodies against vascular endothelial cells (CD31), the connective tissue growth factor or the vascular endothelial growth factor. We also found that these 3D imaging markers individually characterize the development of renal TI lesions or glomerulopathy, quantitative and integrated use of all of them provide more information for differentiating the two renal conditions. Our findings thus establish a practical strategy to characterize the CKD-associated renal injuries by the microangiography-based 3D imaging and highlight the impact of dysfunctional microvasculature as a whole on the pathogenesis of the renal lesions.
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Affiliation(s)
- Yu-Chuan Lin
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Yeukuang Hwu
- Institute of Physics, Academia Sinica, Taipei, Taiwan
| | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Michael Hsiao
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Tsung-Tse Lee
- Institute of Physics, Academia Sinica, Taipei, Taiwan
| | - Shun-Min Yang
- Institute of Physics, Academia Sinica, Taipei, Taiwan
| | - Ting-Kuo Lee
- Institute of Physics, Academia Sinica, Taipei, Taiwan
| | - Nan-Yow Chen
- National Center for High-Performance Computing, Hsinchu, Taiwan
| | - Sung-Sen Yang
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ann Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Shuk-Man Ka
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
- Graduate Institute of Aerospace and Undersea Medicine, Academy of Medicine, National Defense Medical Center, Taipei, Taiwan.
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