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Singh S, Zhao Q, Sachs TE, Hartshorn K. Reporting a Case of Solid Pseudopapillary Neoplasm of the Pancreas in a 44-Year-Old Woman with Parallel Analysis of Literature. Case Rep Oncol Med 2023; 2023:1768926. [PMID: 37153719 PMCID: PMC10162882 DOI: 10.1155/2023/1768926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/31/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023] Open
Abstract
We present a distinctive case of solid pseudopapillary neoplasm as seen in a 44-year-old woman who presented with an abdominal mass but unremarkable labs with no elevation in any of the tumor markers. Her symptomatology ranged from typical symptoms suggestive of malignancy such as weight loss, lethargy, and anorexia to complaints like abdominal pain and jaundice. Prior to presenting at our center, she was given no hope or much in terms of treatment options. She was found to have a substantial mass over the body and tail of pancreas with characteristic and typical gross as well as histological features. Subsequently, she underwent a successful surgery and has found herself in remission since.
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Affiliation(s)
- Sargun Singh
- Division of Gastroenterology and Liver Disease, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Qing Zhao
- Department of Pathology, Boston University School of Medicine, Boston, MA, USA
| | - Teviah E. Sachs
- Section of Surgical Oncology, Department of Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Kevan Hartshorn
- Section of Hematology Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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Pregnancy Complicated With a Giant Pancreatic Tumor and Decompensation of Liver Cirrhosis: A Case Report and Literature Review. MATERNAL-FETAL MEDICINE 2022. [DOI: 10.1097/fm9.0000000000000168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Molecular Alterations in Solid Pseudopapillary Neoplasm of the Pancreas: The Achilles Heel in Conquering Pancreatic Tumorigenesis. Pancreas 2021; 50:1343-1347. [PMID: 35041331 DOI: 10.1097/mpa.0000000000001928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Solid pseudopapillary neoplasms of the pancreas are overwhelmingly benign tumors predominately observed in women in the third decade of life. However, their malignant potential, based on local recurrences and metastases, has brought into question the available evidence on their biological behavior. Solid pseudopapillary neoplasms have distanced themselves from other pancreatic tumors with varying morphological appearance, immune profile, and histogenesis. In review of the literature, PubMed was queried using search strings, including "solid pseudopapillary neoplasm" and "molecular," and "immunohistochemistry." Alternative searches were also conducted given the variability in tumor name, including "solid pseudopapillary tumor" and "Frantz tumor." This article provides an in-depth review into the molecular pathways that contribute to the pathogenesis of solid pseudopapillary neoplasms. It also discusses the implications of existing molecular pathways toward tumor aggressiveness and recurrence potential.
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Milanetto AC, Gais Zürcher AL, Macchi L, David A, Pasquali C. Pancreatic solid pseudopapillary neoplasm in male patients: systematic review with three new cases. Updates Surg 2020; 73:1285-1295. [PMID: 33123945 PMCID: PMC8397648 DOI: 10.1007/s13304-020-00905-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 10/20/2020] [Indexed: 12/30/2022]
Abstract
Pancreatic solid pseudopapillary neoplasm (pSPN) is a rare exocrine neoplasm, which generally occurs in young women. This study analyses the clinical characteristics of pSPN in male patients through a systematic review of the literature, adding three new cases from our institution. We reviewed our experience in Pspns, and we performed a systematic review of pSPN of all articles published in English in PubMed and SCOPUS from 1980. Using the final included articles, we evaluated clinic-pathological features, surgical treatment and prognosis of male patients affected by pSPN. From the literature review and our cases, we collected 246 male patients with a proven pSPN. Mean age was 34.3 (range 4–78) years, with 26.2% patients younger than 18 years. Patients were asymptomatic in 35.9% of cases, despite a mean tumour size of 6.3 cm. In 63.7% of cases, the pSPN was located in the body–tail region. Distant metastases were reported at diagnosis in only 10 (4.1%) patients. A correct pre-operative diagnosis (including cytopathology) was provided in 53.6% of patients, with only 40 fine-needle aspiration/biopsy performed. Standard pancreatic resections represented 90.4% of surgical procedures. Beta-catenin and progesterone receptors were positive at immunostaining in 100% and 77.8% of cases, respectively. Fourteen (7.2%) patients relapsed after a mean disease-free survival of 43.1 months. After a mean follow-up of 47 (range 4–180) months, 89.5% of patients were alive and disease-free. Although rare, when dealing with a solid-cystic pancreatic mass, even in asymptomatic male patients, a pSPN should be considered as a possible diagnosis.
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Affiliation(s)
- Anna Caterina Milanetto
- Clinica Chirurgica 1, Pancreatic and Endocrine Digestive Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, via Giustiniani, 2 - 35128, Padua, Italy.
| | - Anna-Lea Gais Zürcher
- Clinica Chirurgica 1, Pancreatic and Endocrine Digestive Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, via Giustiniani, 2 - 35128, Padua, Italy
| | - Lorenzo Macchi
- Clinica Chirurgica 1, Pancreatic and Endocrine Digestive Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, via Giustiniani, 2 - 35128, Padua, Italy
| | - Alina David
- Clinica Chirurgica 1, Pancreatic and Endocrine Digestive Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, via Giustiniani, 2 - 35128, Padua, Italy
| | - Claudio Pasquali
- Clinica Chirurgica 1, Pancreatic and Endocrine Digestive Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, via Giustiniani, 2 - 35128, Padua, Italy
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Zou Y, Huang Y, Hong B, Xiang X, Zhou B, Wei S. Comparison of the clinicopathological features of pancreatic solid pseudopapillary neoplasms between males and females: gender does matter. Histol Histopathol 2019; 35:257-268. [PMID: 31478554 DOI: 10.14670/hh-18-156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Solid pseudopapillary neoplasms (SPN) of the pancreas are a rare and low-grade malignant entity with a female predominance. However, it also occurs in males, but the rarity and lack of concern makes its clinicopathological features unclarified. METHODS The morphological, immunohistochemical, prognostic features and CTNNB1 exon 3 mutation status of SPN were compared semi-quantitively between 9 male and 21 female patients. RESULTS SPN in males grew in a distinctive solid pattern, with abundant fibrotic stroma and clear cells. Collagen tended to be the main component of tumor stroma in males, while hyaluronan composed a considerable proportion in females. A much stronger expression of androgen receptor (AR) was found in males, and CD56 and/or synaptophysin (Syn) was expressed frequently in both genders. All patients survived. One male patient had post-operational liver nodules and accepted interventional therapy without biopsy. Mutations of CTNNB1 exon 3 were observed in all cases, distributed at codon 32, 33 and 37 in both genders, as well as 34, 41 and 62 in females. CONCLUSION SPN in males presented with significantly different morphological features from that in females, which might be helpful in differential diagnosis, especially when with extensive positivity for CD56 and/or Syn. The stronger expression of AR in males might be a clue to explore the underlying mechanism of the gender difference.
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Affiliation(s)
- Yi Zou
- Department of Pathology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Yan Huang
- Department of Pathology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Bo Hong
- Department of Pathology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Xueping Xiang
- Department of Pathology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Bin Zhou
- Department of Pathology, Yuyao People's Hospital of Zhejiang Province, Yuyao, Zhejiang, China
| | - Shumei Wei
- Department of Pathology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China. .,Zhejiang Provincial Key Laboratory of Pancreatic Disease, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Zhejiang Provincial Innovation Center for the Study of Pancreatic Disease, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Pancreatic Solid Pseudopapillary Tumor Associated with Elevated DHEA and Testosterone. Case Rep Gastrointest Med 2019; 2019:8128376. [PMID: 31032125 PMCID: PMC6458863 DOI: 10.1155/2019/8128376] [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] [Received: 10/09/2018] [Revised: 02/11/2019] [Accepted: 03/18/2019] [Indexed: 11/18/2022] Open
Abstract
Solid pseudopapillary neoplasms (SPN) of the pancreas are extremely rare epithelial tumors with low malignant potential. They account for only 1-2% of pancreatic lesions. These masses often go unnoticed and when they become symptomatic it is often due to mass effect on neighboring structures. We encountered an unusual presentation in a healthy 34-year-old female who was found to have elevated dehydroepiandrosterone (DHEA) and testosterone levels during the evaluation of irregular menses. Subsequent abdominal imaging revealed an enhancing 2.7 cm pancreatic tail mass that was concerning for a pancreatic neoplasm. The patient underwent endoscopic ultrasound which confirmed the presence of a hypoechoic, 2.3 x 1.7 cm mass in the pancreatic tail. An intact interface was seen between the mass and adjacent structures, suggesting the absence of local invasion. Fine needle biopsy was performed and cytology was consistent with SPN. The patient later underwent curative distal pancreatectomy, with subsequent normalization of her menses. SPN are generally inactive on laboratory screening modalities (i.e., AFP, CEA, CA 19-9, and CA 125) and our patient showed no evidence of pancreatic insufficiency, pancreatic parenchymal injury, abnormal liver function, or cholestasis. Similarly to our patient, most SPN are asymptomatic. One retrospective study (spanning 15 years) reported vague abdominal pain in ~70% of patients, on initial presentation. Symptoms of tumor mass effect were the second most common. To our knowledge, this is the first reported presentation of elevated DHEA and testosterone levels associated with a solid pseudopapillary tumor in the absence of an underlying adrenal lesion or dysfunction. Despite extensive workup, no alternate etiology or correlatable medical condition could be elucidated for our patient's hormonal dysregulation. We, therefore, recommend further review and investigation into this potential correlative relationship in an effort to guide the future diagnosis and management of this unusual neoplasm.
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Wang P, Wei J, Wu J, Xu W, Chen Q, Gao W, Jiang K, Miao Y. Diagnosis and treatment of solid-pseudopapillary tumors of the pancreas: A single institution experience with 97 cases. Pancreatology 2018; 18:415-419. [PMID: 29548800 DOI: 10.1016/j.pan.2017.12.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES We evaluated the diagnoses and surgical management of solid pseudopapillary tumors of the pancreas (SPTP) in a single center setting. METHODS Demographic details, clinical presentations, imaging features, surgical strategies, and pathological findings of 97 consecutive patients who underwent surgery for pathologically confirmed SPTP between 2008 and 2016 were analyzed retrospectively. RESULTS A total of 97 patients with SPTP accounted for 2.15% of total pancreatic surgeries (N = 4508). The mean age at diagnosis was 31.6 ± 13.92 years (range: 7-83 years), and males:females were 85:12. Chief complaints were abdominal pain or discomfort (n = 50). The mean transverse tumor diameter was 53.2 ± 2.76 mm (range: 14-170 mm). Tumors were localized to the pancreatic head (38.1%; 37/97), neck (12.4%; 12/97), body and tail (49.5%; 48/97). There were no significant differences in age of onset, presenting symptoms, and sites between males and females. A significant difference was found in the maximum diameter of SPTP across different age groups. Partial pancreatectomy was performed for patient with tumor ≥ 5 cm, and enucleation was performed when tumor was smaller than 5 cm. Pancreatic fistula was the main complication. Immunohistochemical markers for endocrine, exocrine and epithelial factors were used for a final diagnosis. During a median follow-up of 54 months (range: 7-121 months), 84 patients were alive without evidence of recurrence, and 13 patients were lost to follow-up. CONCLUSION SPTP surgical resection is a safe procedure with low morbidity and mortality, which is also effective even in the presence of invasiveness and metastases. Accurate initial diagnoses and follow up are essential.
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Affiliation(s)
- Peng Wang
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jishu Wei
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Junli Wu
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wenbin Xu
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Qiuyang Chen
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wentao Gao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Kuirong Jiang
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yi Miao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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McCluney S, Wijesuriya N, Sheshappanavar V, Chin-Aleong J, Feakins R, Hutchins R, Abraham A, Bhattacharya S, Valente R, Kocher H. Solid pseudopapillary tumour of the pancreas: clinicopathological analysis. ANZ J Surg 2018; 88:891-895. [DOI: 10.1111/ans.14362] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 11/20/2017] [Accepted: 11/23/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Simon McCluney
- Barts and the London HPB Centre, Department of Surgery; The Royal London Hospital, Barts Health NHS Trust; London UK
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Nilukshi Wijesuriya
- Barts and the London HPB Centre, Department of Surgery; The Royal London Hospital, Barts Health NHS Trust; London UK
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Vinayata Sheshappanavar
- Barts and the London HPB Centre, Department of Surgery; The Royal London Hospital, Barts Health NHS Trust; London UK
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Joanne Chin-Aleong
- Barts and the London HPB Centre, Department of Surgery; The Royal London Hospital, Barts Health NHS Trust; London UK
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Roger Feakins
- Barts and the London HPB Centre, Department of Surgery; The Royal London Hospital, Barts Health NHS Trust; London UK
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Robert Hutchins
- Barts and the London HPB Centre, Department of Surgery; The Royal London Hospital, Barts Health NHS Trust; London UK
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Ajit Abraham
- Barts and the London HPB Centre, Department of Surgery; The Royal London Hospital, Barts Health NHS Trust; London UK
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Satyajit Bhattacharya
- Barts and the London HPB Centre, Department of Surgery; The Royal London Hospital, Barts Health NHS Trust; London UK
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Roberto Valente
- Barts and the London HPB Centre, Department of Surgery; The Royal London Hospital, Barts Health NHS Trust; London UK
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Hemant Kocher
- Barts and the London HPB Centre, Department of Surgery; The Royal London Hospital, Barts Health NHS Trust; London UK
- Barts Cancer Institute; Queen Mary University of London; London UK
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9
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Solid Pseudopapillary Neoplasm of the Pancreas: Clinicopathologic Feature, Risk Factors of Malignancy, and Survival Analysis of 53 Cases from a Single Center. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5465261. [PMID: 29094047 PMCID: PMC5637868 DOI: 10.1155/2017/5465261] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/09/2017] [Accepted: 07/31/2017] [Indexed: 12/16/2022]
Abstract
Introduction Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor of low malignant potential. The aim of this study was designed to evaluate the clinicopathologic feature, predictive factors of malignancy, and survival from experience of a single center. Methods 53 consecutive patients who underwent surgery for a pathologically definitive SPN were retrospectively reviewed. Results A total of 53 cases included 7 male cases and 46 female cases with the median age of 35.4 years (14-67). Abdominal pain and mass were the most common clinical presentations. The radiological presentations were consistent with solid and cystic pattern in 18 cases, solid pattern in 25 cases, and cystic pattern in 10 cases. The predominant location of tumor was pancreatic body and tail. The mean size of the tumors was 6.4 cm. Aggressive en bloc resection combined with organ-preserving should be indicated whenever feasible. Follow-up information was available for 48 patients with a median follow-up time of 48 months. The 5-year disease-specific survival was 95.7%. Incomplete capsule was not only the predictive factor of malignancy but also the significant predictor of disease-specific survival. Conclusion Incomplete capsule may suggest a malignant SPN and a prognostic indicator of disease-specific survival. We recommend that surgeons consider a more radical resection with an incomplete capsule of tumor.
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10
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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: 1.5] [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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Ersen A, Agalar AA, Ozer E, Agalar C, Unek T, Egeli T, Ozbilgin M, Astarcioglu I, Olguner M, Obuz F, Sagol O. Solid-Pseudopapillary neoplasm of the pancreas: A clinicopathological review of 20 cases including rare examples. Pathol Res Pract 2016; 212:1052-1058. [DOI: 10.1016/j.prp.2016.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/17/2016] [Accepted: 09/12/2016] [Indexed: 02/07/2023]
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12
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Ohara Y, Oda T, Hashimoto S, Akashi Y, Miyamoto R, Enomoto T, Satomi K, Morishita Y, Ohkohchi N. Pancreatic neuroendocrine tumor and solid-pseudopapillary neoplasm: Key immunohistochemical profiles for differential diagnosis. World J Gastroenterol 2016; 22:8596-8604. [PMID: 27784972 PMCID: PMC5064041 DOI: 10.3748/wjg.v22.i38.8596] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/04/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To reveal better diagnostic markers for differentiating neuroendocrine tumor (NET) from solid-pseudopapillary neoplasm (SPN), focusing primarily on immunohistochemical analysis.
METHODS We reviewed 30 pancreatic surgical specimens of NET (24 cases) and SPN (6 cases). We carried out comprehensive immunohistochemical profiling using 9 markers: Synaptophysin, chromogranin A, pan-cytokeratin, E-cadherin, progesterone receptor, vimentin, α-1-antitrypsin, CD10, and β-catenin.
RESULTS E-cadherin staining in NETs, and nuclear labeling of β-catenin in SPNs were the most sensitive and specific markers. Dot-like staining of chromogranin A might indicate the possibility of SPNs rather than NETs. The other six markers were not useful because their expression overlapped widely between NETs and SPNs. Moreover, two cases that had been initially diagnosed as NETs on the basis of their morphological features, demonstrated SPN-like immunohistochemical profiles. Careful diagnosis is crucial as we actually found two confusing cases showing disagreement between the tumor morphology and immunohistochemical profiles.
CONCLUSION E-cadherin, chromogranin A, and β-catenin were the most useful markers which should be employed for differentiating between NET and SPN.
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13
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Sex differences in immunohistochemical expression and capillary density in pancreatic solid pseudopapillary neoplasm. Ann Diagn Pathol 2015; 19:45-9. [DOI: 10.1016/j.anndiagpath.2015.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 02/15/2015] [Indexed: 02/07/2023]
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Yan SX, Adair CF, Balani J, Mansour JC, Gokaslan ST. Solid pseudopapillary neoplasm collides with a well-differentiated pancreatic endocrine neoplasm in an adult man: case report and review of histogenesis. Am J Clin Pathol 2015; 143:283-7. [PMID: 25596255 DOI: 10.1309/ajcp75ryrmwknqve] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare, clinicopathologically distinct neoplasm with a tendency to affect young women. The histogenesis of SPN is not well defined. Pancreatic endocrine neoplasms (PENs) are also uncommon tumors of the pancreas. METHODS Our comprehensive review of the literature did not yield any reported cases of collision tumors of the above two neoplasms. We report a case of such a collision tumor in a 45-year-old man. RESULTS This tumor was an incidental finding on computed tomography, followed by fine-needle aspiration confirmation of a tumor that was initially diagnosed as an SPN only. A histologic examination of a 2.1-cm mass following distal pancreatectomy revealed a 0.7-cm PEN partly engulfed by an SPN. The tumors showed different morphologic and immunohistochemical features, confirming the presence of a collision tumor. CONCLUSIONS A comparative analysis of immunoprofiles of these tumors yielded interesting findings, enabling us to postulate that SPNs may originate from a multipotential primordial cell that may follow different differentiation pathways, such as endocrine, epithelial, and acinar. The ultrastructures and immunophenotypic characteristics appear to support this hypothesis.
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Affiliation(s)
- Shirley X. Yan
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX
| | - Carol F. Adair
- Department of Pathology, Baylor University Medical Center, Dallas, TX
| | - Jyoti Balani
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX
| | - John C. Mansour
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX
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Bai X, Ye L, Zhang Q, Prasoon P, Wang J, Liang T. Surgical resection and outcome of pancreatic cystic neoplasms in China: analysis of a 16-year experience from a single high-volume academic institution. World J Surg Oncol 2014; 12:228. [PMID: 25037860 PMCID: PMC4110239 DOI: 10.1186/1477-7819-12-228] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 07/04/2014] [Indexed: 02/06/2023] Open
Abstract
Background To investigate the clinicopathological features of surgically resected pancreatic cystic neoplasms (PCNs) at a single institution in China. Methods The medical charts of patients who operated in the Second Affiliated Hospital, Zhejiang University School of Medicine between 1 January 1997 and 30 June 2013, were pathologically shown to have PCNs. Results There was a reliable increase trend not just in the overall number of patients (3 to 75) but additionally in the number of incidentally diagnosed patients across the periods (33.3% to 48.0%). In 83 of 111 cases, preoperative diagnoses matched with pathology, whereas the remaining cases (16/28) were misdiagnosed as pancreatic cancer. The proportion of malignancy in mucin producing neoplasms was 24.3% (9 out of 37). Elevated serum carbohydrate antigen (CA19-9) or carcinoembryonic antigen (CEA) was independently associated with malignancy. The overall survival rate was 96.4%. Conclusions The proportion of PCNs within this series differs with that revealed in Western countries. Appropriate preoperative differential diagnosing of PCNs remains challenging. It is strongly recommended that patients with elevated CA19-9 or CEA levels undergo surgical resection.
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Affiliation(s)
| | | | | | | | | | - Tingbo Liang
- Department of Hepatobiliary-Pancreatic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang St, Hangzhou 310009, Zhejiang, China.
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16
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Jurić I, Pogorelić Z, Stepan JG, Kuzmić IP. Extremely rare presentation of Frantz's tumour: synchronous localisation in the pancreatic head and tail. Scott Med J 2014; 59:e8-e12. [PMID: 25035290 DOI: 10.1177/0036933014543222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Solid pseudopapillary tumour of the pancreas is a rare lesion with low malignant potential occurring predominantly in young women. This is a report of an extremely rare occurrence of synchronous presentation of pseudopapillary tumour in the pancreatic head and tail of a 16-year-old female patient. CASE PRESENTATION The patient presented with a three-month intermittent upper abdominal pain and swelling. Computed tomography scan showed two separate masses, involving the pancreatic head and tail. The patient underwent surgery, where successful tumour enucleation of both tumours was performed. Histological report confirmed solid pseudopapillary tumour of the pancreas with the low malignant potential. CONCLUSION To the best of our knowledge, this is the first report of synchronous presentation of pseudopapillary tumour of the pancreas.
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Affiliation(s)
- Ivo Jurić
- Pediatric Surgeon (Attending Physician), Department of Pediatric Surgery, Split University Hospital Centre and Split University School of Medicine, Croatia
| | - Zenon Pogorelić
- Pediatric Surgeon (Attending Physician), Department of Pediatric Surgery, Split University Hospital Centre and Split University School of Medicine, Croatia
| | | | - Ivana Prusac Kuzmić
- Pathologist (Attending Physician), Department of Pathology, Split University Hospital Centre and Split University School of Medicine, Croatia
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17
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Suzuki S, Hatori T, Furukawa T, Shiratori K, Yamamoto M. Clinical and pathological features of solid pseudopapillary neoplasms of the pancreas at a single institution. Dig Surg 2014; 31:143-50. [PMID: 24970563 DOI: 10.1159/000363420] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 05/05/2014] [Indexed: 12/13/2022]
Abstract
AIMS The aim of this study was to determine the clinicopathological features and surgical management of solid pseudopapillary neoplasms (SPNs) of the pancreas at a single institution. METHODS We investigated 34 patients (5 males and 29 females) who underwent surgery for pathologically confirmed SPNs between 1994 and 2012. RESULTS Clinical symptoms were absent in 58.8% of the patients. The median tumor diameter was 42.7 mm. All tumors were successfully removed by R0 resection. Pathologically, 5.9% had duodenum invasion and 2.9% had pancreatic serosal invasion, but there was no lymph node metastasis. Radiological findings showed calcification in 39.4% of the patients, capsule formation in 51.5%, cystic components in 69.7%, solid components in 93.9% and internal bleeding in 36.4%. Immunohistochemically, neuron-specific enolase was positive in 100% of the patients, nuclear accumulation of β-catenin in 100% and CD10 in 78.8%. There were no recurrences reported at the median follow-up (67 months). Regarding gender differences, the cystic component in radiological imaging was the only significant finding among the features studied (p = 0.01). CONCLUSIONS R0 resection with appropriate procedures appears to be sufficient for patients with SPNs, even for locally invasive tumors. There were no significant differences between genders except for the cystic component on radiological imaging.
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Affiliation(s)
- Shuji Suzuki
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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18
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Cai YQ, Xie SM, Ran X, Wang X, Mai G, Liu XB. Solid pseudopapillary tumor of the pancreas in male patients: Report of 16 cases. World J Gastroenterol 2014; 20:6939-6945. [PMID: 24944486 PMCID: PMC4051935 DOI: 10.3748/wjg.v20.i22.6939] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 02/07/2014] [Accepted: 03/05/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical characteristics, surgical strategies and prognosis of solid pseudopapillary tumors (SPTs) of the pancreas in male patients.
METHODS: From July 2003 to March 2013, 116 patients were diagnosed with SPT of the pancreas in our institution. Of these patients, 16 were male. The patients were divided into two groups based on gender: female (group 1) and male (group 2). The groups were compared with regard to demographic characteristics, clinical presentations, surgical strategies, complications and follow-up outcomes.
RESULTS: Male patients were older than female patients (43.1 ± 12.3 years vs 33.1 ± 11.5 years, P = 0.04). Tumor size, location, and symptoms were comparable between the two groups. All patients, with the exception of one, underwent complete surgical resection. The patients were regularly followed up. The mean follow-up period was 58 mo. Two female patients (1.7%) developed tumor recurrence or metastases and required a second resection, and two female patients (1.7%) died during the follow-up period.
CONCLUSION: Male patients with SPT of the pancreas are older than female patients. There are no significant differences between male and female patients regarding surgical strategies and prognosis.
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19
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Magnetic resonance imaging spectrum of solid pseudopapillary neoplasm of the pancreas. J Comput Assist Tomogr 2014; 38:249-57. [PMID: 24625600 DOI: 10.1097/01.rct.0000445639.26581.65] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe the magnetic resonance imaging spectrum of solid pseudopapillary tumors (SPTs), with an emphasis on solid SPTs. METHODS Thirty-two patients with proven SPTs with preoperative magnetic resonance were included. The SPTs were classified into 3 types: solid, cystic, and mixed; and 2 radiologists analyzed the images regarding the morphologic features and enhancement pattern. RESULTS Of 11 solid SPTs, 9 SPTs (81.8%) were less than 3 cm. Alternatively, of the 18 mixed SPTs and 3 cystic SPTs, 15 SPTs (71.4%) were larger than 3 cm. The predominant imaging features were homogeneous hypoenhancement with a gradually incremental enhancement pattern showing a sharp margin without hemorrhage, whereas those of the mixed SPTs were heterogeneous enhancement showing a sharp margin with internal hemorrhage. CONCLUSION Solid SPTs frequently present as small, well-defined tumors with a gradual enhancement and without hemorrhage or necrosis, and with features that differ from those of mixed or cystic SPTs.
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20
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Hosokawa I, Shimizu H, Ohtsuka M, Kato A, Yoshitomi H, Furukawa K, Takayashiki T, Ishihara T, Yokosuka O, Miyazaki M. Preoperative diagnosis and surgical management for solid pseudopapillary neoplasm of the pancreas. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 21:573-8. [PMID: 24535774 DOI: 10.1002/jhbp.96] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Preoperative diagnosis of solid pseudopapillary neoplasm of the pancreas (SPN) remains difficult and optimal surgical management for SPN has yet to be fully defined. METHODS Retrospective analysis was undertaken of all 10 patients (six women, four men) who underwent surgery for SPN between 2001 and 2013. RESULTS Mean age was 26 years (range, 16-33 years) for women, and 50 years (range, 35-76 years) for men. Although large SPN showed typical imaging findings, small SPN (≤ 3.0 cm) appears as almost entirely solid tumors. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed in six patients with atypical findings of SPN for differentiation from other pancreatic neoplasms. Definitive preoperative cytological diagnosis was achieved in all patients who underwent EUS-FNA. All 10 patients underwent surgical exploration. One patient with portal vein invasion and multiple lung metastases underwent pancreaticoduodenectomy combined with portal vein resection and reconstruction, followed by two pulmonary resections. This patient remains alive as of 34 months after the initial operation. CONCLUSIONS Endoscopic ultrasound-guided fine-needle aspiration is useful for definitive preoperative diagnosis of SPN. As long-term survival after surgical resection can be achieved even in patients with locally advanced and metastatic SPN, aggressive surgical resection should be performed.
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Affiliation(s)
- Isamu Hosokawa
- Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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21
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Hu S, Huang W, Lin X, Wang Y, Chen KM, Chai W. Solid pseudopapillary tumour of the pancreas: distinct patterns of computed tomography manifestation for male versus female patients. Radiol Med 2013; 119:83-9. [PMID: 24277508 DOI: 10.1007/s11547-013-0327-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 10/02/2012] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to retrospectively assess the features of computed tomography (CT) images and clinical characteristics of male patients with solid pseudopapillary tumours (SPTs) and compare them with those of female patients. MATERIALS AND METHODS Computed tomography images and clinical data of 102 patients with pathologically proven SPTs were reviewed. Details of the location, diameter, shape, encapsulation, calcification, internal composition, CT attenuation, and enhancement pattern of tumours were noted. Statistical analysis was performed using the χ (2) and t tests. RESULTS Data from 16 males and 86 females were collected. Males were significantly older than females (38.5 years vs. 28.7 years; P = 0.004). Except for mean age, no significant statistical difference was observed between the clinical factors of SPTs in males and females. The mean tumour size in males was significantly smaller than that in females (5.3 vs. 7.6 cm; P = 0.037). Solid tumours were more common in males (8/16; 50 %) than in females (5/86; 5.8 %; P < 0.001). CONCLUSION The imaging features of SPTs of males are different from those of females. In males, the finding of small, prominently solid tumours showing enhancement patterns typical of SPTs may suggest a diagnosis of SPT.
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Affiliation(s)
- Shudong Hu
- Department of Radiology, The Affiliated Renmin Hospital, Jiangsu University, Zhenjiang, 212002, Jiangsu, China
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22
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Successful treatment of liver metastasis from solid pseudopapillary tumor of the pancreas: a case report. Contemp Oncol (Pozn) 2013; 17:400-3. [PMID: 24592130 PMCID: PMC3934044 DOI: 10.5114/wo.2013.37225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 07/15/2012] [Accepted: 09/20/2012] [Indexed: 02/05/2023] Open
Abstract
Solid pseudopapillary tumor of the pancreas is a rare pancreatic neoplasm that typically occurs in young females. As a low-grade malignancy, the tumor seldom recurs and metastasizes. Management of liver metastasis from such a tumor remains unclear. We present a case of a young girl with liver metastasis due to solid pseudopapillary tumor of the pancreas. She was admitted with chief complaints of epigastric mass on palpation for 16 months and upper abdominal pain for 2 months. An abdominal CT scan detected a mass in the pancreas and multiple nodules in the liver. Then, percutaneous CT-guided tru-cut biopsy was performed and pathological diagnosis of the biopsy material revealed solid pseudopapillary tumor of the pancreas. At 3 months after surgical resection of the pancreatic and liver tumors, CT scan found nodules in her liver. The patient received treatment with transcatheter arterial chemoembolization. She remained well during the 3 years of follow-up with no evidence of recurrence. Therefore, it is suggested that although solid pseudopapillary tumor of the pancreas may be associated with malignant potentiality, a favorable prognosis can also be obtained via rigorous treatment.
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23
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Hirabayashi K, Zamboni G, Ito H, Ogawa M, Kawaguchi Y, Yamashita T, Nakagohri T, Nakamura N. Synchronous pancreatic solid pseudopapillary neoplasm and intraductal papillary mucinous neoplasm. World J Gastroenterol 2013; 19:3358-3363. [PMID: 23745041 PMCID: PMC3671091 DOI: 10.3748/wjg.v19.i21.3358] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 03/01/2013] [Accepted: 03/15/2013] [Indexed: 02/06/2023] Open
Abstract
Solid pseudopapillary neoplasm (SPN) is a rare and low-grade malignant pancreatic neoplasm composed of poorly cohesive monomorphic neoplastic cells forming solid and pseudopapillary structures with frequent hemorrhagic-cystic degeneration. Intraductal papillary mucinous neoplasm (IPMN) is a pancreatic exocrine tumor composed of intraductal papillary growth of mucin containing neoplastic cells in the main pancreatic duct or its major branches. In the case presented here, a 53-year-old, Japanese man was found to have multiple cystic lesions and dilatation of the main pancreatic duct in the neck of the pancreas. Histological examination revealed a main-duct and branch-duct type IPMN, of the gastric-type, involving the neck of the pancreas, associated with a 0.5 cm SPN in the caudal side of the IPMN. We diagnosed this case as synchronous SPN and IPMN. As far as we know, only one other case of synchronous SPN and IPMN has been reported. Both the present case and the previously reported case showed abnormal nuclear expression of β-catenin in SPN, whereas IPMN showed no abnormal nuclear expression. These results suggest that β-catenin abnormality is not a common pathogenetic factor of synchronous SPN and IPMN.
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MESH Headings
- Biomarkers, Tumor/analysis
- Biopsy
- Carcinoma, Pancreatic Ductal/chemistry
- Carcinoma, Pancreatic Ductal/pathology
- Carcinoma, Pancreatic Ductal/surgery
- Carcinoma, Papillary/chemistry
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/surgery
- Cholangiopancreatography, Endoscopic Retrograde
- Cholangiopancreatography, Magnetic Resonance
- Humans
- Immunohistochemistry
- Male
- Middle Aged
- Neoplasms, Cystic, Mucinous, and Serous/chemistry
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Cystic, Mucinous, and Serous/surgery
- Neoplasms, Multiple Primary/chemistry
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/surgery
- Pancreatectomy
- Pancreatic Cyst/chemistry
- Pancreatic Cyst/pathology
- Pancreatic Cyst/surgery
- Pancreatic Neoplasms/chemistry
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/surgery
- Predictive Value of Tests
- Splenectomy
- Tomography, X-Ray Computed
- Treatment Outcome
- beta Catenin/analysis
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Regi P, Salvia R, Cena C, Girelli R, Frigerio I, Bassi C. Cystic "feminine" pancreatic neoplasms in men. Do any clinical alterations correlate with these uncommon entities? Int J Surg 2012; 11:157-60. [PMID: 23274554 DOI: 10.1016/j.ijsu.2012.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 12/08/2012] [Accepted: 12/18/2012] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Mucinous cystic neoplasm (MCN) and solid pseudopapillary neoplasm (SPN) of the pancreas are uncommon hormone-related pancreatic tumors (HRPTs) with a clear predominance in young women. This trial aims to investigate the possible association between HRPTs development in males and phenotypic and sex hormone alterations. METHODS We performed a retrospective analysis of our database between February 1990 and February 2012. Risk factors for sexual dysfunction were considered exclusion criteria. We investigated secondary sexual characteristics development, sex hormone level and overall sexual dysfunction degree according with the International Index of Erectile Function Questionnaire (IIEF). RESULTS We initially identified 25 patients [(MCN: n = 16 (64%); SPN: n = 9 (36%)]. At follow-up, 5 patients were lost, 8 resulted dead and 3 were excluded according to exclusion criteria. We finally enrolled 9 patients (MCN: n = 5; SPN: n = 4). Puberty occurred within physiological age for 7 patients, whereas it was delayed in 2 cases. Three patients revealed mild to moderate sexual dysfunction, along with low testosterone level in two cases. One patient presented hormonal alteration with a normal IIEF score. DISCUSSION In this study, the first in literature with similar aim, hormonal and/or sexual dysfunction was present in 4 out of 9 patients affected by HRPT. The rarity of these lesions makes further trials to be needed for reliable conclusions.
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Affiliation(s)
- P Regi
- Department of General Surgery, Pancreas Institute, University of Verona, Verona, Italy.
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25
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Morikawa T, Onogawa T, Maeda S, Takadate T, Shirasaki K, Yoshida H, Ishida K, Motoi F, Naitoh T, Rikiyama T, Katayose Y, Egawa S, Unno M. Solid pseudopapillary neoplasms of the pancreas: an 18-year experience at a single Japanese Institution. Surg Today 2012; 43:26-32. [PMID: 23114787 DOI: 10.1007/s00595-012-0345-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 09/07/2011] [Indexed: 12/13/2022]
Abstract
PURPOSE This study investigated the clinicopathological features and surgical management of solid pseudopapillary neoplasms at a single institution in Japan. METHODS Seventeen patients (the largest series in Japan) those underwent surgery for pathologically confirmed solid pseudopapillary neoplasms were retrospectively reviewed. RESULTS Sixteen patients were women and their mean age was 34.1 years. Most patients were asymptomatic (n = 11), and the average tumor diameter was 51.8 mm. The most common imaging characteristic was tumors of solid and cystic type (n = 10), which were most commonly located in the pancreatic body (n = 7). All patients underwent surgical exploration, i.e., distal pancreatectomies in 7 patients (laparoscopically performed in 2); middle pancreatectomies, 4; pancreaticoduodenectomies, 4; enucleation, 1; and liver resection, 1. No surgical mortalities occurred, and postsurgical complications occurred in 9 patients. Four patients had malignant tumors. One patient with liver metastases experienced recurrence, which was well controlled by paclitaxel. The remaining patients were disease free at a median follow-up of 51 months. CONCLUSIONS Solid pseudopapillary neoplasms can be treated by complete tumor resection with limited resection or a minimally invasive approach when applicable. The combination of surgical resection and chemotherapy may therefore prolong survival, even in malignant cases.
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Affiliation(s)
- Takanori Morikawa
- Division of Hepato-Biliary-Pancreatic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8574, Japan
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Speer AL, Barthel ER, Patel MM, Grikscheit TC. Solid pseudopapillary tumor of the pancreas: a single-institution 20-year series of pediatric patients. J Pediatr Surg 2012; 47:1217-22. [PMID: 22703796 DOI: 10.1016/j.jpedsurg.2012.03.026] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 03/06/2012] [Indexed: 12/25/2022]
Abstract
PURPOSE Solid pseudopapillary tumor (SPT) of the pancreas is a rare neoplasm. The objective of this study was to review our institution's experience and provide an update on current management in the pediatric population. METHODS Our pathology database identified all patients with SPT for a 20-year period (1991-2011). Demographics, clinical characteristics, operative details, pathology, and outcomes data were retrospectively reviewed. RESULTS Eleven patients with SPT were identified. Most were female and Hispanic. Median age at resection was 14 years (9-17 years). Most patients presented with abdominal pain. Diagnostic imaging was most commonly an ultrasound or computed tomography. All tumors were resected en bloc. Median greatest tumor diameter was 5 cm (3.5-12 cm). Median length of stay was 8 days (5-19 days). Complications included pancreatic leak, chyle leak, delayed gastric emptying, fat malabsorption, and incisional keloid. Recurrence developed after 2.5 years in 1 patient with positive surgical margins. There were no metastases or deaths. Median follow-up was 1.4 years (0.6-5.9 years). CONCLUSION This pediatric series of SPT from a single institution corroborates previous reports in the literature. In our experience, SPT behaves like a low-grade malignancy and has an excellent prognosis. Surgical resection is dictated by tumor location and remains the treatment of choice.
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Affiliation(s)
- Allison L Speer
- Children's Hospital Los Angeles, Department of Pediatric Surgery, Los Angeles, CA 90027, USA
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27
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Thai E, Dalla Valle R, Silini EM. Primary solid papillary tumor of the liver. Pathol Res Pract 2012; 208:250-3. [PMID: 22401901 DOI: 10.1016/j.prp.2012.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 01/13/2012] [Accepted: 01/30/2012] [Indexed: 11/17/2022]
Abstract
Solid papillary tumor (SPT) is an uncommon lesion of the pancreas whose origin and behavior are poorly understood. Very rare cases of primary extra-pancreatic SPTs have been described, and their clinical, histological, immunophenotypic and ultrastructural features seem to be similar to those arising in the pancreas. Here we report a case of primitive SPT of the liver, the second case described in the literature so far.
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Affiliation(s)
- Elena Thai
- Surgical Pathology Unit, Department of Pathology and Laboratory Medicine, University Hospital, Parma, Italy.
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28
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Tanino M, Kohsaka S, Kimura T, Tabu K, Nishihara H, Sawa H, Kawami H, Kamada H, Shimizu M, Tanaka S. A case of clear cell variant of solid-pseudopapillary tumor of the pancreas in an adult male patient. Ann Diagn Pathol 2012; 16:134-40. [DOI: 10.1016/j.anndiagpath.2010.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 10/21/2010] [Accepted: 11/11/2010] [Indexed: 10/18/2022]
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Ansari D, Elebro J, Tingstedt B, Ygland E, Fabricius M, Andersson B, Andersson R. Single-institution experience with solid pseudopapillary neoplasm of the pancreas. Scand J Gastroenterol 2011; 46:1492-7. [PMID: 22050136 DOI: 10.3109/00365521.2011.627448] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare clinical entity. The objective of this study was to review a single institution's experience with this uncommon tumor, as well as review the literature. MATERIAL AND METHODS Consecutive patients, who underwent surgery for a pathologically confirmed SPN between 1991 and 2010, were retrospectively reviewed. A PubMed search (January 1980-June 2011) was conducted to identify risk factors for death among SPN patients. RESULTS The institutional review identified 16 patients with SPN. Thirteen patients were female and three patients were male (median age 34 years). All patients underwent radical resection. Two patients had metastatic disease at the time of operation as evident by the presence of lymph node metastasis and gallbladder metastasis. One developed liver metastasis 4 months postoperatively and subsequently died. The other patient received adjuvant chemotherapy (gemcitabine and capecitabine), and 23 months after the initial operation, no tumor recurrence was detected and the patient is still alive. All other patients remain disease-free. Analysis of 29 fatalities reported in the English literature (including the present case) revealed several atypical features including male gender, old age, tumor size >5 cm, diffuse growth pattern, cellular or nuclear atypia, high mitotic rate, extensive necrosis, extrapancreatic invasion, metastasis and incomplete resection. CONCLUSIONS SPN is not always indolent. Male patients and those with old age, atypical histopathology (large tumors, diffuse growth, cellular/nuclear atypia, mitotic activity, necrosis, invasion/metastasis) and incomplete resection may have a higher risk of recurrence and death, deserving particular attention.
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Affiliation(s)
- Daniel Ansari
- Department of Surgery, Clinical Sciences Lund, Lund University, Sweden
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30
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Imamura N, Chijiiwa K, Ohuchida J, Hiyoshi M, Takahashi N, Yorita K, Kataoka H. Synchronous solid pseudopapillary neoplasm and intraductal papillary mucinous neoplasm of the pancreas: report of a case. Surg Today 2011; 41:865-71. [PMID: 21626339 DOI: 10.1007/s00595-010-4361-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 04/20/2010] [Indexed: 02/06/2023]
Abstract
Solid pseudopapillary neoplasm (SPN) of the pancreas, most commonly found in young female subjects, is a rare neoplasm with low potential for malignancy. We report an unusual case of a 66-year-old male patient who had a simultaneous malignant SPN and an intraductal papillary mucinous adenoma (IPMA) of the pancreas. The patient was admitted to our department for the evaluation of the main solid tumor with calcification and small multilocular cystic lesions apart from the main tumor in the pancreatic head. We performed pylorus-preserving pancreaticoduodenectomy to treat the calcified tumor and multilocular cystic lesions. The diagnosis of malignant SPN was confirmed on the basis of histological invasion to the adjacent structures. The separate cystic lesions were diagnosed as a branch-type IPMA. The synchronous occurrence of IPMA and SPN in the present case did not demonstrate that there were tumors maintained through the common abnormal Wnt signaling pathway by immunohistochemical study. To our knowledge, this is the first known case of synchronous SPN and IPMA of the pancreas.
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Affiliation(s)
- Naoya Imamura
- Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
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31
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Lin MY, Stabile BE. Solid Pseudopapillary Neoplasm of the Pancreas: A Rare and Atypically Aggressive Disease among Male Patients. Am Surg 2010. [DOI: 10.1177/000313481007601011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Solid pseudopapillary neoplasm (SPN) of the pancreas is uncommon, has low metastatic potential, typically afflicts young females, and expresses progesterone receptors. In the rare male patient, its biologic behavior may be more aggressive and lethal. A retrospective case series analysis and literature review of SPN was performed to compare its clinical behaviors in males and females. The case series identified 11 patients of which only two were males. Ten patients underwent tumor resection with curative intent. The one operated male developed liver metastases 15 months postoperatively and subsequently died. The other male presented with advanced liver metastases and died 2 months later without operation. One female had regional lymph node metastases resected en bloc and all nine females are disease-free after a mean follow-up of 63.4 months. Analysis of 1014 patients reported in the literature revealed only 137 (13.5%) males. Males had a twofold higher incidence of metastases and a threefold higher death rate. In males, SPN has an atypically aggressive biology suggesting that progesterone and/or other sex hormones may have a role in oncoregulation.
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Affiliation(s)
- Matthew Y.C. Lin
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Bruce E. Stabile
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
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32
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Yu PF, Hu ZH, Wang XB, Guo JM, Cheng XD, Zhang YL, Xu Q. Solid pseudopapillary tumor of the pancreas: A review of 553 cases in Chinese literature. World J Gastroenterol 2010; 16:1209-14. [PMID: 20222163 PMCID: PMC2839172 DOI: 10.3748/wjg.v16.i10.1209] [Citation(s) in RCA: 172] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To sum up the clinical and pathological characteristics of solid pseudopapillary tumor (SPT) and the experience with it.
METHODS: A total of 553 SPT patients reported in Chinese literature between January 1996 and January 2009 were retrospectively reviewed and analyzed.
RESULTS: The mean age of the 553 SPT patients included in this review was 27.2 years, and the male to female ratio was 1:8.37. Their symptoms were non-specific, and nearly one third of the patients were asymptomatic. Computed tomography and ultrasonography were performed to show the nature and location of SPT. Most of the tumors were distributed in the pancreatic head (39.8%), tail (24.1%), body and tail (19.5%). Forty-five patients (9.2%) were diagnosed as malignant SPT with metastasis or invasion. None of the clinical factors was closely related to the malignant potential of SPT. Surgery was the main therapeutic modality for SPT. Local resection, distal pancreatectomy and pancreatoduodenectomy were the most common surgical procedures. Local recurrence and hepatic metastasis were found in 11 and 2 patients, respectively, after radical resection. Four patients died of tumor progression within 4 years after palliative resection of SPT. The prognosis of SPT patients was good with a 5-year survival rate of 96.9%.
CONCLUSION: SPT of the pancreas is a rare indolent neoplasm that typically occurs in young females. It is a low-grade malignancy and can be cured with extended resection. The prognosis of such patients is good although the tumor may recur and metastasize.
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Abstract
SPN is a rare neoplasm that affects mainly young women. Despite this feature, SPN have been seen in both genders, multiple races, and at a wide range of ages. The genetic mechanism behind the development of SPN is distinct from the more lethal ductal carcinoma of the pancreas. This difference is reflected in the favorable outcome for patients with SPN. Surgery is typically curative in patents with localized disease and possibly in patients with limited metastasis or local extension. No consensus exists on an effective systemic therapy. There are no reliable predictors for disease-specific mortality or recurrence in the minority of patients who develop aggressive disease.
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Affiliation(s)
- Sushanth Reddy
- John L. Cameron Division of Surgical Oncology, The Sol Goldman Pancreatic Cancer Research Center, Department of Surgery, Johns Hopkins Medical Institutions, 606 Blalock Building, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Solid pseudopapillary neoplasms of the pancreas: a multi-institutional study of 21 patients. J Surg Res 2009; 157:e137-42. [PMID: 19818965 DOI: 10.1016/j.jss.2009.03.091] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 03/12/2009] [Accepted: 03/30/2009] [Indexed: 12/16/2022]
Abstract
BACKGROUND Solid pseudopapillary neoplasms of the pancreas (SPN) account for less than 1% of all pancreatic tumors. The goal of this study was to better understand the nature of these rare tumors through analysis of patients' clinical presentations and outcomes following surgical resection. METHODS A multi-institutional retrospective review was conducted of all patients who underwent surgical resection from 1994 to 2008. RESULTS Twenty-one patients were identified with SPN. Twenty patients were female. Median age at presentation was 34 y. The most common presenting symptom was abdominal pain (67%). All patients underwent resection: distal pancreatectomy (9), pancreaticoduodenectomy (5), central pancreatectomy (6), and laparoscopic excision/enucleation (1). A R(0) resection was obtained in all patients. Median tumor size was 5.5 cm. AJCC stages were stage I (18), stage II (1), stage III (2), and stage IV (0). Postsurgical complications occurred in 52% of patients, with pancreatic fistulae being the most common (29%). The median follow-up time was 55 mo. All patients remain alive without evidence of recurrence. CONCLUSION Solid pseudopapillary neoplasms of the pancreas are atypical pancreatic tumors. SPN usually occur in young women who present with abdominal pain. Oncologic outcomes in patients who undergo surgical resection are excellent.
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Wang DB, Wang QB, Chai WM, Chen KM, Deng XX. Imaging features of solid pseudopapillary tumor of the pancreas on multi-detector row computed tomography. World J Gastroenterol 2009; 15:829-35. [PMID: 19230043 PMCID: PMC2653382 DOI: 10.3748/wjg.15.829] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To retrospectively analyze the imaging features of solid-pseudopapillary tumors (SPTs) of the pancreas on multi-detector row computed tomography (MDCT) and define the imaging findings suggestive of malignant potential.
METHODS: A total of 24 consecutive cases with surgically and pathologically confirmed SPTs of the pancreas underwent preoperative abdominal MDCT studies in our hospital. All axial CT images, CT angiographic images, and coronally and sagittally reformed images were obtained. The images were retrospectively reviewed at interactive picture archiving and communication system workstations.
RESULTS: Of the 24 cases of SPTs, 11 cases (45.8%) occurred in the pancreatic head and seven (29.1%) in the tail. Eighteen were pathologically diagnosed as benign and six as malignant. MDCT diagnosis of SPTs was well correlated with the surgical and pathological results (Kappa = 0.6, P < 0.05). The size of SPTs ranged from 3 to 15 cm (mean, 5.8 cm). When the size of the tumor was greater than 6 cm (including 6 cm), the possibilities of vascular (8 vs 1) and capsular invasion (9 vs 0) increased significantly (P < 0.05). Two pathologically benign cases with vascular invasion and disrupted capsule on MDCT presented with local recurrence and hepatic metastases during follow-up about 1 year after the resection of the primary tumors.
CONCLUSION: Vascular and capsular invasion with superimposed spread into the adjacent pancreatic parenchyma and nearby structures in SPTs of the pancreas can be accurately revealed by MDCT preoperatively. These imaging findings are predictive of the malignant potential associated with the aggressive behavior of the tumor, even in the pathologically benign cases.
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Morandeira Rivas A, Sánchez-Marín A, Sabench Pereferrer F, Hernández González M, del Castillo Déjardin D. Tumor sólido seudopapilar del páncreas. Cir Esp 2008; 84:47-9. [DOI: 10.1016/s0009-739x(08)70605-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kang CM, Yang WI, Lee YH, Choi GH, Lee SW, Kim KS, Choi JS, Lee WJ, Kim BR. A Case of Spleen-Preserving Laparoscopic Distal Pancreatectomy and Concomitant Cholecystectomy in Male Patient with Solid Pseudopapillary Neoplasm of the Pancreas and Gallstone. J Laparoendosc Adv Surg Tech A 2008; 18:259-65. [DOI: 10.1089/lap.2007.0022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chang Moo Kang
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
| | - Woo Ick Yang
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Hee Lee
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Gi Hong Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
| | - Sung Whan Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
| | - Kyung Sik Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
| | - Jin Sub Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
| | - Woo Jung Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
| | - Byong Ro Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
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Solid pseudopapillary tumor of the pancreas: a review of salient clinical and pathologic features. Adv Anat Pathol 2008; 15:39-45. [PMID: 18156811 DOI: 10.1097/pap.0b013e31815e5237] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Solid pseudopapillary tumor (SPT) of the pancreas is a rare tumor of uncertain histogenesis characterized, as the name suggests, by a cystic and solid pattern of growth with formation of pseudopapillae. Accounting for only a small percentage of pancreatic neoplasms, SPT occurs primarily in young women, although cases in older patients and men have been reported. The tumor is thought to have low-grade malignant potential, as the majority of the cases are cured by simple but complete surgical resection. Knowledge of the unique morphologic and demographic characteristics of this neoplasm is essential for accurate diagnosis. Herein, we review the clinical and pathologic features, which can help separate SPTs from other primary pancreatic tumors.
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Shimizu T, Murata S, Mekata E, Miyake T, Abe H, Kurumi Y, Endo Y, Kushima R, Tani T. Clinical potential of an antitumor drug sensitivity test and diffusion-weighted MRI in a patient with a recurrent solid pseudopapillary tumor of the pancreas. J Gastroenterol 2007; 42:918-22. [PMID: 18008037 DOI: 10.1007/s00535-007-2105-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2006] [Accepted: 08/12/2007] [Indexed: 02/04/2023]
Abstract
A solid pseudopapillary tumor (SPT) of the pancreas is a rare type of pancreatic neoplasm found predominantly in young women. SPTs typically behave as though benign; however, in some cases they also have malignant potential. We encountered a rare case of a recurrent SPT that developed 4 years after the initial surgery in an elderly male patient. Abdominal computed tomography (CT) revealed that the 61-year-old patient had four intra-abdominal masses, suggesting a recurrence of SPT. The patient had a history of distal pancreatectomy due to SPT in the pancreatic tail 4 years previously. These tumors showed positive signals on diffusion-weighted magnetic resonance imaging (MRI), and were treated successfully by aggressive surgical resection. Microscopic diagnosis was compatible with recurrent tumors of SPT. A chemosensitivity test, the collagen gel droplet-embedded culture drug sensitivity test (CD-DST), showed that the resected tumors were sensitive to several antitumor drugs. We suggest that the CD-DST may be used to indicate promising antitumor agents for treating SPTs with malignant tendencies. In addition, a diffusion-weighted MRI can be useful for accurately visualizing SPTs of the pancreas.
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Affiliation(s)
- Tomoharu Shimizu
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowa, Otsu 520-2192, Japan
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Goh BKP, Tan YM, Cheow PC, Chung AYF, Chow PKH, Wong WK, Ooi LLPJ. Solid pseudopapillary neoplasms of the pancreas: an updated experience. J Surg Oncol 2007; 95:640-4. [PMID: 17477365 DOI: 10.1002/jso.20735] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The aim of this study is to report an update of the surgical experience at a single institution with these unusual tumors. METHODS Sixteen consecutive patients who underwent surgery for a pathologically confirmed solid pseudopapillary neoplasm (SPPN) were retrospectively reviewed. RESULTS Fifteen of the patients were female and the median age at diagnosis was 30 years (range, 14-53 years). Abdominal and back pain were the most common presenting symptoms. The tumors appeared on cross-sectional imaging as solid and cystic (n = 14) or cystic (n = 2) masses. The median tumor size was 9.5 cm (range, 5.0-24.0 cm). All 16 patients had curative resections including 3 pancreaticoduodenectomies and 13 distal pancreatectomies. Three patients required extended resections including pancreaticoduodenectomy with portal vein resection, distal pancreatectomy with tranverse colectomy, and distal pancreactomy with omentectomy. Two of the resections were R1 whereas 14 were R0. All patients were alive and disease-free at a median follow-up of 43 months (range, 3-186 months). CONCLUSION SPPNs should be considered in young women presenting with a large solid-cystic pancreatic mass. Aggressive en bloc resection should always be attempted including resection of concomitant metastases as patients demonstrate excellent long-term survival even in the presence of distant spread.
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Affiliation(s)
- Brian K P Goh
- Department of Surgery, Singapore General Hospital, Singapore
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Hernandez JM, Centeno BA, Kelley ST. Solid Pseudopapillary Tumors of the Pancreas: Case Presentation and Review of the Literature. Am Surg 2007. [DOI: 10.1177/000313480707300321] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Solid-pseudopapillary tumors of the pancreas are a rare pancreatic neoplasm that carries a 95 per cent 5-year survival rate. However, despite the excellent overall prognosis, aggressive variants been described that likely represent malignant degeneration in an otherwise indolent tumor. Therefore, surgical resection is indicated in all instances. We report a case in a young Hispanic woman, including appropriate work-up and operative intervention.
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Affiliation(s)
- Jonathan M. Hernandez
- Department of Surgery, University of South Florida, Tampa, Florida and H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Barbara A. Centeno
- Department of Surgery, University of South Florida, Tampa, Florida and H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Scott T. Kelley
- Department of Surgery, University of South Florida, Tampa, Florida and H. Lee Moffitt Cancer Center, Tampa, Florida
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Francis WP, Goldenberg E, Adsay NV, Steffes CP, Webber JD. Solid-pseudopapillary tumors of the pancreas: case report and literature review. ACTA ACUST UNITED AC 2007; 63:469-72. [PMID: 17084780 DOI: 10.1016/j.cursur.2006.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 06/09/2006] [Accepted: 06/14/2006] [Indexed: 11/24/2022]
Abstract
Solid pseudopapillary tumors (SPT) of the pancreas are rare neoplasms of low malignant potential that mostly affect young women. These tumors are of unclear pathogenesis, are slow growing, and can become considerably large before causing symptoms. Complete resection is curative in most cases. This is the case of a 39-year-old African-American woman undergoing evaluation for Roux-en-Y gastric bypass, who was found to have a pancreatic mass. Image-guided biopsy revealed SPT. The patient underwent complete excision of the tumor and had an open Roux-en-Y gastric bypass performed concurrently. The patient had an uneventful postoperative course. A review of the literature is presented.
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Affiliation(s)
- Wesley P Francis
- Department of Surgery, Wayne State University, Detroit, Michigan 48201, USA
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Abstract
OBJECTIVES Although a potential role for estrogen receptors (ER) in pancreatic tumors has been debated for many years, the importance of the receptors in these neoplasms remains unknown. Even the expression of the 2 ER isoforms, ER-alpha and ER-beta, in histological subtypes of pancreatic neoplasms is controversial. The aim of the present study was to systematically review the available literature about ER expression in pancreatic tumors and to discuss the potential importance of estrogen signaling in them. METHODS We performed a comprehensive literature search and analyzed the results regarding ER expression in pancreatic tumors, with special emphasis on the specificity of the antibodies used for immunohistochemistry. RESULTS Many articles have been published investigating the expression of ERs in pancreatic tumors, but the results are inconsistent. Moreover, most studies used antibodies that detected only ER-alpha, not ER-beta. Thus, the expression pattern of ER-beta in pancreatic neoplasm remains especially unclear. CONCLUSIONS The lack of detailed studies evaluating the expression of both ER-alpha and ER-beta receptors using isoform-specific antibodies likely contributes to the inconsistency of published results concerning ER expression in pancreatic tumors. Available published evidence suggests that a thorough reexamination of the potential role of ERs in pancreatic neoplasms is warranted.
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Affiliation(s)
- Makoto Satake
- Division of General Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-7330, USA
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Vargas-Serrano B, Domínguez-Ferreras E, Chinchón-Espino D. Four cases of solid pseudopapillary tumors of pancreas: Imaging findings and pathological correlations. Eur J Radiol 2006; 58:132-9. [PMID: 16377114 DOI: 10.1016/j.ejrad.2005.11.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Revised: 11/22/2005] [Accepted: 11/23/2005] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Solid pseudopapillary tumor of the pancreas (SPTP tumor) is a rare pancreatic neoplasm with low malignant potential, which usually affects female patients in the second or third decades of life. It is a non-functional, slow-growing neoplasm that very often reaches considerable size before the first symptoms appear. Symptomatology is frequently related to tumor size. Surgical excision is usually curative in most cases. Infrequently the tumor can appear in male patients or in aged women, which can make the diagnosis more difficult. Some patients develop liver metastases in the follow-up that can be resected. Our purpose is to review the radiological and pathological findings of SPTP with emphasis on these infrequent cases. SUBJECTS AND METHODS The medical records and radiological findings of patients who underwent surgery for SPTP between 2000 and 2005 were retrospectively reviewed. Study eligibility required that patients had undergone surgical resection and that a SPTP had been pathologically proved. RESULTS Four cases of solid pseudopapillary tumor of the pancreas were diagnosed and treated in our institution in the study period. Two of the patients, developed on follow-up liver metastases, and peritoneal, hepatic, and nodal metastases, respectively. CONCLUSION Solid pseudopapillary tumors are well-encapsulated neoplasms that usually have a good prognosis after surgical excision. A malignant behavior is uncommon and in this case lymph node involvement, hepatic metastases and occasionally peritoneal invasion may also occur. Resection of liver metastases can prolong the long-term survival of the patients.
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Affiliation(s)
- Blanca Vargas-Serrano
- Servicio de Radiología, Hospitales Universitarios Virgen del Rocío, Avda Manuel Siurot s/n, Sevilla 41013, Spain
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Hibi T, Ojima H, Sakamoto Y, Kosuge T, Shimada K, Sano T, Sakamoto M, Kitajima M, Yamasaki S. A solid pseudopapillary tumor arising from the greater omentum followed by multiple metastases with increasing malignant potential. J Gastroenterol 2006; 41:276-81. [PMID: 16699862 DOI: 10.1007/s00535-005-1753-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Accepted: 12/14/2005] [Indexed: 02/04/2023]
Abstract
Solid pseudopapillary tumor is a rare, indolent neoplasm almost exclusively seen in the pancreas. We describe an unusual case of solid pseudopapillary tumor arising in the greater omentum of a 45-year-old man with subsequent multiple liver metastases and peritoneal dissemination. The patient underwent a total of ten laparotomies and died of unresectable disease 8 years after the initial presentation. Microscopically, the primary tumor and the relapsed tumors consistently exhibited identical growth patterns, which were characterized by solid sheets intermingling with pseudopapillary arrangements of uniformly small cells. Immunohistochemical staining was diffusely positive for vimentin and focally positive for alpha-1-antitrypsin. These features were compatible with those of conventional pancreatic solid pseudopapillary tumors. We also performed quantitative evaluation of Ki-67 immunoreactivity and mitotic figures, which indicated malignant transformation of this extremely rare tumor. This is the first detailed report of solid pseudopapillary tumor arising outside the pancreas complicated by repetitive liver metastases and peritoneal carcinomatosis, suggesting the existence of a more lethal subgroup of tumors.
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Affiliation(s)
- Taizo Hibi
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Tokyo, 104-0045, Japan
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