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1
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Achemlal A, Essaoudi MA, Jidal M, Bah MF, Najih M, Bouchentouf SM, Berrag S, Nejjari F, Adioui T, Tamzaourte M. Solid pseudopapillary tumor of the pancreas mistaken for gastrointestinal stromal tumor: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241255497. [PMID: 38764914 PMCID: PMC11102672 DOI: 10.1177/2050313x241255497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 04/29/2024] [Indexed: 05/21/2024] Open
Abstract
Solid pseudopapillary epithelial neoplasms of the pancreas are rare entities, first described in 1959 by Frantz. These tumors represent less than 2% of pancreatic cancers and mainly affect young women. They can reach a significant size and its radiological features can lead to diagnostic pitfalls, such as gastrointestinal stromal tumors, which are rare soft-tissue sarcomas that can appear anywhere along the gastrointestinal tract. Clinicians and radiologists need to be aware of the existing diagnostic pitfalls between these two entities, because of their possible similarities. We report here the case of a 33-year-old woman with a solid pseudopapillary epithelial neoplasms of the pancreas initially misdiagnosed as an exophytic gastric stromal tumor.
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Affiliation(s)
- Amine Achemlal
- Department of Gastroenterology 1, Mohammed V Military Training Hospital, Rabat, Morocco
| | | | - Manal Jidal
- Department of Radiology, Mohammed V Military Training Hospital, Rabat, Morocco
| | | | - Mohammed Najih
- Department of Digestive Surgery I, Mohammed V Military Training Hospital, Rabat, Morocco
| | | | - Sanaa Berrag
- Department of Gastroenterology 1, Mohammed V Military Training Hospital, Rabat, Morocco
| | - Fouad Nejjari
- Department of Gastroenterology 1, Mohammed V Military Training Hospital, Rabat, Morocco
| | - Tarik Adioui
- Department of Gastroenterology 1, Mohammed V Military Training Hospital, Rabat, Morocco
| | - Mouna Tamzaourte
- Department of Gastroenterology 1, Mohammed V Military Training Hospital, Rabat, Morocco
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2
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Muacevic A, Adler JR. Solid Pseudopapillary Epithelial Neoplasm of the Pancreas in the Paediatric Population: A Report of Two Cases. Cureus 2022; 14:e29805. [PMID: 36337824 PMCID: PMC9620738 DOI: 10.7759/cureus.29805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
A rare pathology, the solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas accounts for approximately 1% of pancreatic neoplasms. Initially called ‘Frantz’s tumour’, it has now been renamed to SPEN by the World Health Organization (WHO). This tumour has a predilection for females and a good prognosis with surgical excision being the treatment of choice. Palpable abdominal masses in children are of significant clinical importance. Identifying cystic lesions in the pancreas from CT or MRI scans always warrant further investigations. Primary pancreatic neoplasms account for 0.1% of pancreatic tumours in the paediatric population; an extremely rare circumstance constituting a diagnostic and therapeutic challenge to surgeons. This article comprises two paediatric cases of SPEN in 14- and 11-year-old females, respectively, and a literature review on current management.
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3
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Michael S, Kassam NM, Njau A, Sherman OA, Chuwa H, Surani S. A Rare Case of Solid Pseudopapillary Neoplasm of the Pancreas. Cureus 2021; 13:e14720. [PMID: 34079673 PMCID: PMC8159312 DOI: 10.7759/cureus.14720] [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: 01/13/2023] Open
Abstract
Solid pseudopapillary neoplasm of pancreas (SPN) is a rare entity. It is almost exclusively seen in females within the second and third decades of life with only small minority affecting children. Due to the paucity of the number of cases seen, the natural history of the disease is not fully understood. SPN tumors of the pancreas are usually found incidentally and usually have an excellent prognosis. We herein present a case of a 33-year-old lady diagnosed with SPN, who presented with abdominal fullness, two weeks post cesarean section.
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Affiliation(s)
- Steven Michael
- Surgery, Aga Khan University Medical College, Dar es Salaam, TZA
| | - Nadeem M Kassam
- Internal Medicine, Aga Khan University Medical College, Dar es Salaam, TZA
| | - Aidan Njau
- Surgery, Aga Khan University Medical College, Dar es Salaam, TZA
| | | | | | - Salim Surani
- Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA.,Internal Medicine, University of North Texas, Denton, USA
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4
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Yamaguchi H, Morisaka H, Sano K, Nagata K, Ryozawa S, Okamoto K, Ichikawa T. Seeding of a Tumor in the Gastric Wall after Endoscopic Ultrasound-guided Fine-needle Aspiration of Solid Pseudopapillary Neoplasm of the Pancreas. Intern Med 2020; 59:779-782. [PMID: 31787691 PMCID: PMC7118382 DOI: 10.2169/internalmedicine.3244-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is widely used as a first-line procedure for the definitive diagnosis of pancreatic solid tumor. Adverse events associated with the EUS-FNA procedure include acute pancreatitis, bleeding, infection, and duodenal perforation. Rarely, pancreatic tumors disseminate in the peritoneal cavity or seed in the gastric wall via the biopsy needle tract after EUS-FNA. Such seeding has been noted primarily in cases of adenocarcinomas and has not been associated with solid pseudopapillary neoplasm (SPN), a rare and potentially malignant tumor of the pancreas. This is the first report of a case of tumor seeding in the gastric wall after EUS-FNA of pancreatic SPN.
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Affiliation(s)
- Haruomi Yamaguchi
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Japan
| | - Hiroyuki Morisaka
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Japan
| | - Katsuhiro Sano
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Japan
| | - Koji Nagata
- Department of Pathology, Saitama Medical University International Medical Center, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Japan
| | - Kojun Okamoto
- Department of Surgery, Saitama Medical University International Medical Center, Japan
| | - Tomoaki Ichikawa
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Japan
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5
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Prata ALP, Mendes GG, Chojniak R. Locoregional recurrence of Frantz' tumor: a case report and review of the literature. Rev Assoc Med Bras (1992) 2018; 64:577-580. [PMID: 30365656 DOI: 10.1590/1806-9282.64.07.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 12/25/2017] [Indexed: 11/22/2022] Open
Abstract
Frantz' tumours or solid pseudopapillary tumours of the pancreas are rare neoplasms with low malignant potential. Young women in the second to third decades of life are more frequently affected. The treatment of choice is resection of the lesion, which is often curative. The recurrence is uncommon when radical surgical resection is used. Radiological characteristics are important for the correct diagnosis, since the preoperative planning is fundamental to obtain the cure. The objective of this study is to report a rare case of locoregional recurrence and to review the radiological findings of solid pseudopapillary tumours of the pancreas in the literature, as well to know the incidence and risk factors of tumor recurrence. This case report is from a 37-year-old female patient evaluated at an Oncologic Hospital, in the city of São Paulo, Brazil, who presented an uncommon evolution of the disease, characterized by local recurrence despite the complete resection of the primary lesion with free margins.
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Affiliation(s)
| | | | - Rubens Chojniak
- Imaging Department, A.C.Camargo Cancer Center, São Paulo, Brasil
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6
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El Imad T, Haddad FG, Kesavan M, Deeb L, Andrawes S. Solid Pseudopapillary Tumor of the Pancreas: An Unusual Cause of Abdominal Pain. Cureus 2017. [PMID: 28649475 PMCID: PMC5473724 DOI: 10.7759/cureus.1252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Solid-pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor that accounts for less than one percent of pancreatic tumors. The diagnosis could be challenging as SPN tend to manifest with nonspecific abdominal symptoms, variable radiological features, and inconsistent morphology. The cellular origin of SPN is unclear and might involve ductal, acinar and endocrine stem cells. We report a rare case of a 27-year-old female who presented with intermittent abdominal pain for two years, associated with a decrease in appetite. Her medical history was significant for abdominoplasty five years ago. Vital signs were stable. Physical examination revealed mild epigastric tenderness. Laboratory tests were unremarkable. Contrast computed tomography (CT) scan of the abdomen showed a 2 x 2 cm indeterminate pancreatic tail lesion. An endoscopic ultrasound (EUS) disclosed a 2.1 x 1.8 cm hypoechoic mass in the tail of the pancreas.Trans-gastric fine needle aspiration was obtained to show clusters of uniform neoplastic cells with abundant cytoplasm and oval bean-shaped nuclei. Immunohistochemical stains were positive for beta-catenin, Vimentin, CD10, CD56, cytokeratin-7 (Ck7), Cyclin D1, and negative for chromogranin, epithelial-cadherin (E cadherin) which was consistent with a pseudopapillary tumor. The patient underwent a robotic assisted en-bloc distal pancreatectomy and splenectomy. There were no intra-abdominal metastases. SPN is a rare tumor characterized by a specific immunohistological pattern which makes it highly distinct from other pancreatic neoplasms particularly neuroendocrine tumors, acinar carcinomas, and carcinoids. It is important to differentiate SPN from other pancreatic neoplasms because it is characterized as low potential for malignancy and a favorable prognosis after resection, with a five-year survival rate approaching 85%-95%.
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Affiliation(s)
- Talal El Imad
- Department of Internal Medicine, Staten Island University Hospital
| | - Fady G Haddad
- Department of Internal Medicine, Staten Island University Hospital
| | | | - Liliane Deeb
- Department of Gastroenterology, Staten Island University Hospital
| | - Sherif Andrawes
- Department of Gastroenterology, Staten Island University Hospital
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7
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Fu XB, Hao ZQ, He JY, Shang H, Fu QC, Hua XD, Liu YF, Lin J. Pathology comparative study on the characteristic CT signs in solid pseudopapillary neoplasm of the pancreas. Exp Ther Med 2017; 13:3523-3528. [PMID: 28587436 DOI: 10.3892/etm.2017.4382] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/30/2016] [Indexed: 01/16/2023] Open
Abstract
In order to analyze characteristic CT signs in the solid pseudopapillary tumor of the pancreas, a retrospective analysis was conducted on 49 patients with pseudopapillary tumor of the pancreas who where treated in Liaoning Cancer Hospital. All of the patients were confirmed by pathology, CT signs were analyzed and a pathology contrast was conducted. Furthermore, all cases had single lesions; 7 cases in the pancreatic head, 23 cases in the pancreatic body, 15 cases in the pancreatic body-tail and 4 cases in the pancreatic tail. The boundaries of the lesions were clear and the tumors, which may outline the pancreas, were composed of solid and polycystic parts. In addition, calcifications could be observed in the lesions and CT results revealed varying degrees of contrast enhancement of the solid components in the arterial phase, as well as a gradual contrast enhancement in the venous and delayed phase. Enhancement of capsule could be observed, and the enhancement region was observed in the solid part, no enhancement in cystic part.. In conclusion, CT manifestations of solid pseudopapillary tumors of the pancreas are specific, which is helpful to the diagnosis.
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Affiliation(s)
- Xi Bo Fu
- Department of Hepatobiliary Surgery, Liaoning Cancer Hospital, Shenyang, Liaoning 110042, P.R. China
| | - Zhi Qiang Hao
- Department of Hepatobiliary Surgery, Liaoning Cancer Hospital, Shenyang, Liaoning 110042, P.R. China
| | - Jin Yun He
- Department of General Surgery, Liaohe Oil Field General Hospital, Panjin, Liaoning 124010, P.R. China
| | - Hai Shang
- Department of Hepatobiliary Surgery, Liaoning Cancer Hospital, Shenyang, Liaoning 110042, P.R. China
| | - Qing Cai Fu
- Department of Hepatobiliary Surgery, Liaoning Cancer Hospital, Shenyang, Liaoning 110042, P.R. China
| | - Xiang Dong Hua
- Department of Hepatobiliary Surgery, Liaoning Cancer Hospital, Shenyang, Liaoning 110042, P.R. China
| | - Ye Fu Liu
- Department of Hepatobiliary Surgery, Liaoning Cancer Hospital, Shenyang, Liaoning 110042, P.R. China
| | - Jie Lin
- Department of Hepatobiliary Surgery, Liaoning Cancer Hospital, Shenyang, Liaoning 110042, P.R. China
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8
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Zhang JB, Shang D, Yeo TP, Cannaday S, Maley WR, Yeo CJ. A Persistent Solid Pseudopapillary Tumor of the Pancreas: Case Report and Brief Literature Review. Case Rep Pancreat Cancer 2015; 1:11-15. [PMID: 30631803 PMCID: PMC6319675 DOI: 10.1089/crpc.2015.29006.jbz] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Solid pseudopapillary tumors (SPTs) of the pancreas are uncommon neoplasms, first reported in 1934, well described by Frantz in 1959, and later further characterized by Hamoudi in 1970. Ninety percent of these tumors occur in young females in their second to third decade of life. An interesting case of a persistent solid pseudopapillary neoplasm is described in this report. Case presentation: A 24-year-old woman from a Middle Eastern country presented with an 8.2 × 7.6 cm heterogeneous-enhancing lesion growing within the uncinate process of the pancreas. She had first experienced symptoms at the age of 12 years. Imaging studies showed that the mass closely abutted the superior mesenteric vein as well as the superior mesenteric artery (SMA). The patient underwent an open cholecystectomy and a classic pancreaticoduodenectomy. During the resection, the SMA was transected due to tumor adherence. The vessel was subsequently reapproximated in an end-to-end manner. On the first postoperative day, thrombosis of the SMA occurred and a bile leak developed. The patient returned to the operating room for SMA embolectomy and for repair of a hepaticojejunostomy leak, with redo of the biliary-enteric anastomosis. Histopathological examination showed solid pseudopapillary-arranged cells and cystic areas, showing strong cellular immunoreactivity for CD56, CD10, vimentin, and β-catenin, and weak diffuse staining for synaptophysin. The tumor stained negative for chromogranin A, trypsin, AE1/AE3, and E-cadherin. Molecular genetic analysis was negative for the MYB gene deletion. At nearly 1 year of follow-up, the patient is well with no evidence of tumor recurrence. Conclusion: SPTs of the pancreas should be included in the differential diagnosis of pancreatic tumors, especially in young women.
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Affiliation(s)
- Jin Bao Zhang
- Department of Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Dong Shang
- Department of Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Theresa P Yeo
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Shawnna Cannaday
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Warren R Maley
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Charles J Yeo
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Karakas S, Dirican A, Soyer V, Koç S, Ersan V, Ates M. A pancreatic pseudopapillary tumor enucleated curatively. Int J Surg Case Rep 2015; 10:118-20. [PMID: 25828476 PMCID: PMC4430137 DOI: 10.1016/j.ijscr.2015.03.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/11/2015] [Accepted: 03/23/2015] [Indexed: 12/23/2022] Open
Abstract
Pancreatic pseudopapillary tumor is an rarely problem. Tumor may be more aggressive at males relatively to females. Complete resection is the main treatment option for these tumors. Introduction Pseudopapillary tumors (PPT) of the pancreas are very rare, comprising 0.3–2.7% of all pancreatic tumors, and they occur mostly in young women. Generally, they are benign, but in rare cases they can enlarge, invade adjacent organs, and metastasize distantly. Radiological assessments and biochemical markers are important for diagnosing tumor characteristics. The main treatment is tumor resection. Presentation of case An 18-year-old female was referred to our department suffering from abdominal discomfort and upper quadrant abdominal pain. Abdominal computed tomography (CT) revealed a 6- × 5-cm mass between the pancreatic head and right adrenal gland (Fig. 1). The histological assessment was a solid PPT of the pancreas with intact surgical borders. Discussion PPT are very rare, comprising approximately 5% of cystic pancreatic tumors and ∼1% of exocrine pancreatic neoplasms and present mainly during the second and third decades of life. PPTs are usually indolent tumors. As such, they tend to produce vague nonspecific symptoms or may be detected incidentally on imaging. Complete surgical resection (R0) is the most effective therapy for PPT. Conclusion Although PPT is a very rare, benign tumor, it has the potential to metastasize to adjacent and distant organs. Consequently, they should be detected early, so that they can be treated surgically before malignant conversion.
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Affiliation(s)
- Serdar Karakas
- Inonu University, Faculty of Medicine, Department of General Surgery, Malatya, Turkey
| | - Abuzer Dirican
- Inonu University, Faculty of Medicine, Department of General Surgery, Malatya, Turkey.
| | - Vural Soyer
- Inonu University, Faculty of Medicine, Department of General Surgery, Malatya, Turkey
| | - Süleyman Koç
- Inonu University, Faculty of Medicine, Department of General Surgery, Malatya, Turkey
| | - Veysel Ersan
- Inonu University, School of Medicine, Department of General Surgery, Malatya, Turkey
| | - Mustafa Ates
- Inonu University, School of Medicine, Department of General Surgery, Malatya, Turkey
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Predicting recurrence of pancreatic solid pseudopapillary tumors after surgical resection: a multicenter analysis in Korea. Ann Surg 2015; 260:348-55. [PMID: 24743622 DOI: 10.1097/sla.0000000000000583] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Solid pseudopapillary tumors (SPTs) of the pancreas are still considered a surgical enigma. Many clinical research trials have failed to identify prognostic factors that predict the malignant behavior of SPTs. MATERIALS AND METHODS This work was a retrospective multicenter study that included a total of 17 medical institutions. Data from 351 patients who underwent surgical resection from January 1990 to December 2008 were retrospectively collected using standardized case report forms requesting clinicopathologic features. RESULTS Thirty-four patients (9.7%) were male, and 317 (90.3%) were female, with a mean age of 36.8 ± 12.4 years. Recently, minimally invasive (P < 0.001) and parenchyma or function-preserving limited surgeries (P = 0.016) have been more frequently applied for the treatment of pancreatic SPTs. Ninety-eight patients (27.9%) had microscopic malignant features. Only 9 patients (2.6%) experienced tumor recurrence after the initial pancreatic SPT resection. Multivariate analysis showed that a tumor size larger than 8 cm [Exp (β) = 7.385, P = 0.018], microscopic malignant features [Exp (β) = 10.009, P = 0.011], and stage IV [Exp (β) = 42.003, P = 0.002] were significant prognostic factors for tumor recurrence. When combined with stage IV, the microscopic malignant features and 2010 World Health Organization definition of solid pseudopapillary carcinoma more successfully differentiated future recurrence risk groups (P < 0.001). CONCLUSIONS More specific pathologic descriptions need to be employed in pathologic report forms to provide proper information to predict SPT recurrence after resection. Future studies emphasizing the standardized pathologic evaluation of pancreatic SPTs may unveil the enigmatic nature of pancreatic SPTs.
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11
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Pattanshetti VM, Vinchurkar K, Pattanshetti SV. Solid pseudo papillary tumor of pancreas: Presenting as acute abdomen in a female child. Indian J Med Paediatr Oncol 2014; 35:184-6. [PMID: 25197185 PMCID: PMC4152640 DOI: 10.4103/0971-5851.139000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Solid pseudo papillary tumor (SPT) or Frantz's tumor is a slow-growing low-grade malignant tumor, commonly seen in young patients with a female predominance, which is commonly located in the body and tail of the pancreas. We report a case of SPT arising from the body of the pancreas in a 12-year-old girl who presented with acute abdomen and was treated successfully by local excision of the tumor with preservation of head of pancreas and spleen.
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Affiliation(s)
- Vishwanath M Pattanshetti
- Department of Surgery, J N Medical College and KLES Dr. Prabhakar Kore Hospital and MRC, Belgaum, Karnataka, India
| | - Kumar Vinchurkar
- Department of Surgery (Oncosurgery), J N Medical College and KLES Dr. Prabhakar Kore Hospital and MRC, Belgaum, Karnataka, India
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12
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Dan D, Rambally R, Cawich SO, Maharaj R, Naraynsingh V. Solid pseudopapillary neoplasms of the pancreas: a report of two cases. Case Rep Med 2014; 2014:356379. [PMID: 24982677 PMCID: PMC4058598 DOI: 10.1155/2014/356379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/17/2014] [Accepted: 04/18/2014] [Indexed: 02/07/2023] Open
Abstract
Solid pseudopapillary neoplasms of the pancreas are uncommon, accounting for only 1-2% of all pancreatic neoplasms. These tumors are being detected at an increased rate, probably due to the increased awareness and the liberal use of imaging. We report two cases of patients with solid pseudopapillary pancreatic tumors and review the existing literature.
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Affiliation(s)
- Dilip Dan
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Rakesh Rambally
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Shamir O. Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Ravi Maharaj
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Vijay Naraynsingh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
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Ganeshan DM, Paulson E, Tamm EP, Taggart MW, Balachandran A, Bhosale P. Solid pseudo-papillary tumors of the pancreas: current update. ABDOMINAL IMAGING 2013; 38:1373-1382. [PMID: 23775388 DOI: 10.1007/s00261-013-0015-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Solid pseudo-papillary tumors are rare pancreatic tumors, which occur in females and are typically indolent neoplasms. However, atypical, aggressive variants can occur with locally advanced disease or metastases. They have characteristic imaging features, which vary according to size. This article provides a current update on the molecular biology, histopathology, clinico-radiological features, and management of these tumors.
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Affiliation(s)
- Dhakshina Moorthy Ganeshan
- Department of Diagnostic Imaging, Body Imaging section, Unit 1473, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA,
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14
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Park JK, Cho EJ, Ryu JK, Kim YT, Yoon YB. Natural history and malignant risk factors of solid pseudopapillary tumors of the pancreas. Postgrad Med 2013; 125:92-9. [PMID: 23816775 DOI: 10.3810/pgm.2013.03.2634] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Solid pseudopapillary tumors (SPTs) of the pancreas are unusual neoplasms of uncertain prognosis. Most patients with SPTs have a good prognosis after undergoing surgical resection, but there are rare cases in which a locally infiltrative growth pattern and metastatic variety are exhibited, or recurrence of the disease after surgery occurs; these cases have been reported with very poor clinical outcomes. Our study investigated the natural history of SPTs and delineated the clinicopathologic features that may predict the malignancy potential of the disease. METHODS A total of 100 patients with suspected SPTs were enrolled in our study and 77 patients underwent surgical resection. A resulting 60 tumors were pathologically proven to be SPTs and the affected patients were followed-up regularly after surgery. Clinical and pathologic data for all 100 patients were analyzed. RESULTS Of the 60 total patients with histologically positive SPTs, 55 (92%) were women and 5 (8%) were men. The median patient age was 34 years (range, 13-77 years). Among the 60 patients, 9 had malignant SPTs and 51 had benign SPTs. Deep parenchymal invasion into the surrounding tissue was the most frequent pathologic feature suggesting malignancy (75%) among the 60 patients who underwent surgical resection. Patient clinicopathologic characteristics and demographic factors were compared between those who had benign SPTs and those who had malignant SPTs. There were no significant differences in the various patient features between the 2 groups, including age, sex, symptoms, tumor size, tumor location, internal tumor composition, pattern of tumor calcification, tumor necrosis, hemorrhage, and immunohistochemical tumor tissue patterns. There were 2 patients who had distant metastasis; 1 presented with distal metastasis in the liver and the other patient had recurrence of cancer with a peritoneal mass after surgery. Metastasectomy was performed on the 2 patients and there was no mortality or disease progression during the follow-up period (median, 143 months; range, 53-319 months). CONCLUSION Solid pseudopapillary tumors are low-grade tumors that have a generally good prognosis. However, the clinical development and malignancy potential of SPTs are neither fully understood nor predictable, even with histologically benign tumors. Further investigations in tumor biology, along with long-term patient follow-up, may provide insight into the disease process and clinical development of SPTs.
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Affiliation(s)
- Joo Kyung Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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15
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Wang LJ, Bai L, Su D, Zhang TT, Mao ZY, Guo XC, Jiao SC. Retrospective analysis of 102 cases of solid pseudopapillary neoplasm of the pancreas in China. J Int Med Res 2013; 41:1266-71. [PMID: 23812113 DOI: 10.1177/0300060513488516] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective Clinicopathological features and surgical outcomes in patients with solid pseudopapillary neoplasm (SPN) of the pancreas were analysed. Methods Data regarding clinicopathological features, surgery and outcome for patients with SPN were retrospectively collected and analysed. Patients were followed-up by telephone interview. Results The study included 102 patients (89 females/13 males), 99 of whom underwent surgical resection. A total of 89 patients (87.3%) were followed-up (mean duration 26.98 months, range 2–95 months); 86 (96.6%) had no relapse or metastasis. Conclusions Surgical resection is the primary therapy for SPN, and results in a good prognosis.
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Affiliation(s)
- Li-Jie Wang
- Department of Oncology, Chinese People’s Liberation Army General Hospital, PLA Medical School, Beijing, China
| | - Li Bai
- Department of Oncology, Chinese People’s Liberation Army General Hospital, PLA Medical School, Beijing, China
| | - Dan Su
- Department of Oncology, Chinese People’s Liberation Army General Hospital, PLA Medical School, Beijing, China
| | - Ting-Ting Zhang
- Department of Oncology, Chinese People’s Liberation Army General Hospital, PLA Medical School, Beijing, China
| | - Zhi-Yuan Mao
- Department of Oncology, Chinese People’s Liberation Army General Hospital, PLA Medical School, Beijing, China
| | - Xiao-Chuan Guo
- Department of Oncology, Chinese People’s Liberation Army General Hospital, PLA Medical School, Beijing, China
| | - Shun-Chang Jiao
- Department of Oncology, Chinese People’s Liberation Army General Hospital, PLA Medical School, Beijing, China
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Samad A, Shah AA, Stelow EB, Alsharif M, Cameron SEH, Pambuccian SE. Cercariform cells: another cytologic feature distinguishing solid pseudopapillary neoplasms from pancreatic endocrine neoplasms and acinar cell carcinomas in endoscopic ultrasound-guided fine-needle aspirates. Cancer Cytopathol 2012; 121:298-310. [PMID: 23765692 DOI: 10.1002/cncy.21259] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 09/27/2012] [Accepted: 10/08/2012] [Indexed: 01/17/2023]
Abstract
BACKGROUND Solid pseudopapillary neoplasm (SPPN) is a rare tumor of unknown origin that occurs predominantly in the body or tail of the pancreas in young women. The authors recently identified cercariform (Greek: tailed) cells, similar to those described in urothelial carcinomas, as a consistent cytologic feature in ultrasound-guided fine-needle aspiration (EUS-FNA) samples from SPPNs. The objective of the current multi-institutional study was to define the value of these cells in the differential diagnosis of SPPN with other neoplasms characterized cytologically by the presence of monotonous, uniform cells in pancreatic aspirates: pancreatic neuroendocrine tumors (Pan-NETs) and acinar cell carcinomas (ACCs). METHODS The files of 4 academic hospitals were searched for SPPNs, Pan-NETs, and ACCs that were diagnosed by EUS-FNA. The slides were reviewed, and several cytologic features were recorded semiquantitatively to identify discriminating features between SPPNs, Pan-NETs, and ACCs. RESULTS From the analysis of 18 SPPNs, 4 ACCs, and 20 Pan-NETs, the following cytologic features were identified as common to all 3 neoplasms: single cells and rosettes/acinar cell groups, round-to-plasmacytoid cells, pale-to-granular cytoplasm, fine vacuoles, and binucleated cells. Papillary structures, cercariform cells, large cytoplasmic vacuoles, reniform nuclei, hyaline globules/magenta-colored material, and degenerative features (cholesterol crystals, calcifications, foam cells, or giant cells) were significantly more common in SPPNs. Prominent nuclear grooves were encountered in only 4 of 18 SPPNs. CONCLUSIONS The current results indicated that the presence of cercariform cells is another useful clue for the cytologic diagnosis of SPPN in challenging cases.
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Affiliation(s)
- Arbaz Samad
- Department of Laboratory Medicine and Pathology, University of Minnesota, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota, USA
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17
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Cummins D, Sheehan M, Bruzzi J, McAnena O. Solid pseudopapillary neoplasm of the pancreas. BMJ Case Rep 2012; 2012:bcr.01.2012.5589. [PMID: 23104627 DOI: 10.1136/bcr.01.2012.5589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Solid pseudopapillary neoplasms (SPNs) are rare entities accounting for between 0.13 and 2.7 per cent of pancreatic tumours. This neoplasm has a predilection for females under the age of 35. The authors report this case of a SPN incidentally discovered when a 59-year-old female underwent a chest x-ray to investigate a wheeze. A subsequent CT abdomen revealed a 10 cm well-circumscribed mass adjacent to the tail of the pancreas. This mass was successfully resected. Immunohistochemical markers established the diagnosis of a SPN. The wheeze associated with the presentation of this case was unrelated to the tumour which was an incidental finding. These neoplasms are largely asymptomatic and indolent reaching a large size before detection. Diagnosis is confirmed on histology and in this case surgical resection was curative and there was no metastasis at presentation.
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Affiliation(s)
- Donna Cummins
- Department of Emergency Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
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18
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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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19
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Navarro S, Ferrer J, Bombí JA, López-Boado MA, Ayuso JR, Ginés A, Fernández-Esparrach G, Vaquero E, Cuatrecasas M, Fernández-Cruz L. [Pseudopapillary solid tumor of the pancreas: report of 6 cases]. Med Clin (Barc) 2012; 138:114-8. [PMID: 22036462 DOI: 10.1016/j.medcli.2011.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 09/06/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Solid pseudopapillary neoplasms (SPNs) are rare tumours of the exocrine pancreas. Although they can develop metastasis, the prognosis is good. The aim of this study was to describe the characteristics of these tumours attended in our hospital. PATIENTS AND METHOD All cases of SPN in the database of the Pathology Department between 1991 and 2010 were included. Age, sex, symptoms, type of surgery, pathologic and immunohistochemical characteristics, and clinical evolution were analyzed. RESULTS Six cases were identified; all of them were women with a median age of 27.5 years. One patient presented haemoperitoneum, 2 abdominal pain and 3 were diagnosed incidentally. The most frequent localization was the pancreatic tail (n=4) and the median size was 7.7 cm. Four tumours were benign and 2 carcinomas. One of them had liver and lymph node metastases. Ki-67 proliferation index was low (1-3%). After a median follow-up of 33.5 months, all patients were alive and without evidence of relapse. CONCLUSION SPNs occur in young women. In most cases surgical resection is curative. A low mitotic index confers a good prognosis and a long survival.
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Affiliation(s)
- Salvador Navarro
- Servicio de Gastroenterología, Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBERehd, Barcelona, España.
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Suk Lee J, Han HJ, Choi SB, Jung CW, Song TJ, Choi SY. Surgical Outcomes of Solid Pseudopapillary Neoplasm of the Pancreas: A Single Institution's Experience for the Last Ten Years. Am Surg 2012. [DOI: 10.1177/000313481207800241] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare neoplasm that accounts for about 1 to 2 per cent of all pancreatic tumors. The aim of this study was to delineate the clinicopathological characteristics and surgical outcomes of solid pseudopapillary neoplasm of the pancreas. We retrospectively reviewed the clinicopathological characteristics and surgical outcomes of 18 patients who underwent surgery for SPN of the pancreas between January 1, 2001 and November 1, 2010. The patient group was comprised of 14 females and four males and the median patient age at diagnosis was 32.4 years (range 10∼68 years). Eleven of the 18 patients were symptomatic at the time of diagnosis. The type of surgery was selected according to the location and presentation of the tumor. The resection margins were negative in all patients. One patient had distant metastasis and recurrent mass node repetitively. She underwent seven operations for recurrence of SPN during the follow-up period of 218 months. Complete surgical excision is the treatment of choice for SPN of the pancreas and can give a good prognosis. Although sometimes patients have repetitive metastases or recurrences, patients undergoing complete surgical excision of the tumor will have a good outcome.
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Affiliation(s)
- Jin Suk Lee
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hyung Joon Han
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Sae Byeol Choi
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Cheol Woong Jung
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Tae Jin Song
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Sang Yong Choi
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
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21
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Solid-pseudopapillary neoplasm of the pancreas: spectrum of findings on multidetector CT. Clin Imaging 2011; 35:21-8. [DOI: 10.1016/j.clinimag.2009.11.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 11/10/2009] [Indexed: 12/18/2022]
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Chang H, Gong Y, Xu J, Su Z, Qin C, Zhang Z. Clinical strategy for the management of solid pseudopapillary tumor of the pancreas: aggressive or less? Int J Med Sci 2010; 7:309-13. [PMID: 20827431 PMCID: PMC2934730 DOI: 10.7150/ijms.7.309] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 08/27/2010] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To further delineate the clinicopathological and radiological features of solid pseudopapillary tumor (SPT) of the pancreas and summarize the surgical therapy strategy for this tumor. METHODS A retrospective review of 18 pathologically confirmed cases of SPT was performed and the clinical and pathological features, radiological findings and surgical interventions were analyzed. RESULTS The patients included 17 females and 1 male with a median age of 23 years. The median diameter of the lesions was 8.0 cm. Abdominal pain was the predominant complaint (8/18). The rest of the patients were asymptomatic and presented with a pancreatic mass detected incidentally. Radiological study revealed a well-demarcated mass which was composed of a solid-cystic portion. On post-contrast CT, the solid portions could be enhanced whereas the cystic parts remained unenhanced. With the preoperative diagnosis of SPT in 11 patients and pancreatic cyst, benign or malignant pancreatic tumor in the rest, pancreatic tumor resection was successfully completed. Surgical exploration findings, pathological characteristics and good prognosis of the patients with SPT, indicated its low-grade malignant potential. CONCLUSION In combination with clinical findings, radiological features of SPT may help to make the correct diagnosis and differentiation from other pancreatic neoplasms. Once diagnosed, given the excellent prognosis and low-grade malignancy, less aggressive surgical resection of the primary lesion is proposed.
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Affiliation(s)
- Hong Chang
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan Shandong, China.
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23
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Kim SH, Cho YT, Kwon HJ, An CM, Kim IH, Kim SW, Lee ST, Lee SO. [A case of atypical Solid-pseudopapillary tumor of the pancreas]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2009; 54:252-6. [PMID: 19844146 DOI: 10.4166/kjg.2009.54.4.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Solid-psudopapillary tumor is an uncommon pancreatic neoplasm of low malignant potential that most frequently affect young woman. Solid-psudopapillary tumor are histologically, clinically, and prognostically quite distinct from the more common ductal adenocarcinoma. Recently, we experienced a 36-year-old male who was suspected to have extrapancreatic tumor based on atypical radiologic imaging study, young age, and male sex, and finally diagnosed as solid-psudopapillary tumor on immunohistochemical stain examination. We report this case with review of the relevant literatures.
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Affiliation(s)
- Seong Hun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
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Abstract
OBJECTIVES Solid pseudopapillary tumor (SPT) of the pancreas is very rare. This study was performed to analyze the expression of Wnt signal target genes (matrix metalloproteinase-7 [MMP-7], cyclin-D1, and c-myc) and Ki-67 in resected SPTs to determine their clinicopathologic characteristics according to their expression. METHODS From January 1995 to December 2005, 23 patients underwent pancreatic resections for SPT of the pancreas. Among 23 formalin-fixed, paraffin-embedded tissues, 12 were evaluated as a pilot study. Immunohistochemistry was performed using various detection and antigen retrieval methods to detect MMP-7, cyclin-D1, c-myc, and Ki-67. The expression of Wnt target genes was correlated with clinicopathologic features of the patients. RESULTS Solid pseudopapillary tumors of the pancreas always showed cytoplasmic/nuclear accumulation of [beta]-catenin, frequent expression of cyclin-D1, and low proliferation index. MMP-7, cyclin-D1, c-myc, and Ki-67 were not correlated with microscopic features suggesting malignant potential (P > 0.05). Tumor size was closely related to microscopic features of malignant potential and apparently has an inverse relationship with the expression of cyclin-D1 and Ki-67 (P < 0.05). CONCLUSIONS Low proliferative index and associated MMP-7 expression may cause an unpredictable clinical course in this tumor. Subtle changes in the intracellular environment, not pathologic (morphologic) changes, may elucidate the unpredictable clinical course of this tumor.
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Yang F, Fu DL, Jin C, Long J, Yu XJ, Xu J, Ni QX. Clinical experiences of solid pseudopapillary tumors of the pancreas in China. J Gastroenterol Hepatol 2008; 23:1847-1851. [PMID: 18752561 DOI: 10.1111/j.1440-1746.2008.05526.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIMS To discuss the clinical experiences of solid pseudopapillary tumors (SPTs) of the pancreas by summarizing clinical information of patients with this disease in China. METHODS Chinese literature concerning SPTs of the pancreas published between January 1996 and October 2006 were retrospectively reviewed and analyzed. RESULTS A total of 390 cases had been reported, among which 47 were men, with a female to male ratio of 7.30:1. Mean age of the patients was 25.3 years old, more than 50 per cent were between 10 and 24 years. The mean diameter of the tumor was 8.4 cm (range, 2 cm-25 cm). There was no significant difference in patient age and tumor size between male and female. Major clinical presentations included abdominal pain or discomfort, and palpable abdominal masses, however, nearly one third of all patients were asymptomatic. The rate of pre-operative misdiagnosis was rather high. Those who tested positive to metastases or invasions, 14.4% of the patients were diagnosed as malignant SPTs. Sex, age, symptoms, tumor size and tumor markers were not significant clinical factors to predict SPTs with malignant potential. Surgical procedures mainly included pancreatoduodenectomy, distal pancreatectomy and local resection. Three patients developed local recurrence, and one patient developed hepatic metastasis, all within four years after tumor resection. Five patients with malignant SPTs died due to tumor progression within 25 months after surgery. CONCLUSIONS Surgical resection is the most effective means for curing this rare tumor. Despite metastasis, a good satisfactory effect could be achieved by surgical debulking. At least 4-yearly follow-up is mandatory for all patients undergoing surgical resection.
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Affiliation(s)
- Feng Yang
- Department of Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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26
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Machado MCC, Machado MAC, Bacchella T, Jukemura J, Almeida JL, Cunha JEM. Solid pseudopapillary neoplasm of the pancreas: distinct patterns of onset, diagnosis, and prognosis for male versus female patients. Surgery 2007; 143:29-34. [PMID: 18154930 DOI: 10.1016/j.surg.2007.07.030] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Revised: 06/24/2007] [Accepted: 07/05/2007] [Indexed: 12/13/2022]
Abstract
BACKGROUND Solid pseudopapillary neoplasm of the pancreas is a distinctive pancreatic neoplasm with low metastatic potential. This study examines clinical differences and prognosis between male and female patients. METHODS The medical records of 34 consecutive patients with pancreatic solid pseudopapillary neoplasms between 1990 and 2006 were reviewed. Whenever feasible, organ-preserving operation was performed. Statistical analysis was performed using chi-square and Student t test. RESULTS There were 27 women (79%) and seven men (21%) with median age of 23 years. Mean diameter of the tumor was 7 cm. Tumor size tended to be smaller in patients treated in more recent years. Conservative surgery was possible in 11 patients including spleen-preserving distal pancreatectomy in 3, central pancreatectomy in 5, and enucleation in 3 patients. Median hospital stay was 11 days, morbidity rate was 62%, including 17 patients with grade A pancreatic fistula, and there was no operative mortality. Mean follow-up time was 84 months. Tumor recurred in 2 patients (6%). Overall late morbidity rate was 12%. At the time of diagnosis, age was (x +/- SD) higher among male patients (25 +/- 2 years vs 37 +/- 7 years; P <.05) with no difference in tumor size. The neoplasms were more aggressive in male patients; therefore, conservative surgery was less likely. There was no correlation between tumor aggressiveness and age of the patient or size of tumor. CONCLUSION This is the first single center study to demonstrate that solid pseudopapillary neoplasms in male patients have distinct patterns of onset and aggressiveness when compared with female patients. Although valid prognostic criteria are still lacking, it appears that male patients may be best treated by more radical operation and should be observed more closely during follow-up.
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Affiliation(s)
- Marcel C C Machado
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
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27
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Seo HE, Lee MK, Lee YD, Jeon SW, Cho CM, Tak WY, Kweon YO, Kim SK, Choi YH, Bae HI, Kim SG, Yoon YK. Solid-pseudopapillary tumor of the pancreas. J Clin Gastroenterol 2006; 40:919-22. [PMID: 17063112 DOI: 10.1097/01.mcg.0000225671.91722.10] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Solid-pseudopapillary tumor (SPT) of the pancreas is a low-grade malignancy, which has been infrequently observed in adolescent and young adult females since first report by Frantz in 1959. In this article, we describe our experience of 8 cases of SPT with the clinical features, diagnosis, treatments, and outcomes. METHODS We retrospectively reviewed the medical records and images of 8 patients who underwent surgery for SPT between January 1995 and December 2004. RESULTS Seven females and 1 male with the mean age of 29 years (range, 10 to 64) at presentation were identified. Three patients presented palpable abdominal mass, 2 with abdominal pain, and the remainder with no specific symptom. The mean diameter of the tumors was 7.9 cm (range, 4.0 to 10.0). Four were located in the tail, 3 in the body, and 1 in the head. Surgical procedure included distal pancreatectomy with/without splenectomy in 7 patients and Whipple operation in 1 with no surgical morbidity and mortality. All were alive without evidence of recurrence after mean follow-up of 26.4 months (range, 1 to 66). CONCLUSIONS SPT of the pancreas is an unusual neoplasm and typically occurs in young females presenting well-demarcated pancreatic masses, which are amenable to cure by complete surgical resection.
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Affiliation(s)
- Hyang-Eun Seo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
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Darius T, Brouwers J, Van Dijck H, Bernard P. Solid and cystic papillary neoplasm of the pancreas: a rare tumour in young women. Acta Chir Belg 2006; 106:726-729. [PMID: 17290708 DOI: 10.1080/00015458.2006.11679994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this paper, we present an asymptomatic young patient with solid and cystic papillary neoplasm of the pancreas. It is an extremely rare tumour mostly seen in young females. It is often diagnosed incidentially or during investigations of gastrointestinal complaints. In differential diagnosis, any cystic and/or solid pancreatic disease process should be considered. Prognosis is excellent after radical resection and recurrence is rarely seen.
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Affiliation(s)
- T Darius
- Department of General Surgery, AZ St. Maarten, Mechelen, Belgium.
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Hao CY, Lu AP, Xing BC, Huang XF, Gao F, Ji JF. Solid pseudopapillary tumor of the pancreas: report of 8 cases in a single institution and review of the Chinese literature. Pancreatology 2006; 6:291-6. [PMID: 16636602 DOI: 10.1159/000092691] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Accepted: 11/23/2005] [Indexed: 12/11/2022]
Abstract
BACKGROUND Solid pseudopapillary tumor of the pancreas (SPTP) is a rare disease with a low-grade malignant potential. In recent years, the incidence has been increasing. No consensus has been reached regarding diagnostic or therapeutic strategies. METHODS Eight cases of SPTP, admitted from 1996 to March 2005, were analyzed retrospectively, and all the literature concerning SPTP published in Chinese medical journals from January 1994 to March 2005 were analyzed. RESULTS A total of 186 cases have been reported since 1995, among which 162 were females (87.1%), with a male to female ratio of 1:6.8. A histogram of the ages at onset illustrated an approximately smooth skewed distribution with a single peak, which was located between 10 and 19 years. The number of diseases located at the pancreatic head is similar to that located at the body and the tail. Malignancy was pathologically diagnosed in 22 cases (11.6%). Major clinical presentations included abdominal pain of varying degree (43.5%) and palpable abdominal masses (37.1%). Treatment strategies include different types of resection, ranging from tumor enucleation to multiple organ resection, and the prognosis is generally good. CONCLUSIONS SPTP occurs predominantly in adolescent and young females, and a satisfactory effect could be achieved with active and appropriate surgeries.
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Affiliation(s)
- Chun-Yi Hao
- Department of Surgery, Beijing Cancer Hospital, Peking University School of Oncology, Beijing, PR China
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30
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Abstract
OBJECTIVES It has been suggested that the histopathologic features associated with malignant potential in solid pseudopapillary tumors (SPTs) of the pancreas include cellular polymorphism, mitotic activity, peripancreatic tissue invasion, neural invasion, lymphovascular invasion, and lymph node metastasis. This study aimed to delineate the features predicting SPTs with malignant potential, which can be easily assessed in the clinical setting, and long-term results of patients who underwent resection of SPT. METHODS A retrospective review and analysis were done of 33 patients who had SPTs that were surgically treated. RESULTS Eleven patients (33.3%) had SPTs suggesting malignant potential among surgically treated patients with SPTs. The local invasion to the peripancreatic tissue was the most frequent malignant pathological feature (7/11 patients, 63.7%). Using univariate analysis, tumor size greater than 5 cm was a significant clinical factor to predict SPTs with malignant potential (P = 0.022). The prognosis was excellent. No statistically significant survival difference was noted between groups of malignant potential and benign pathology (P = 0.1904). CONCLUSIONS Malignant SPTs are low-grade tumors with good prognosis. Adequate surgical intervention is necessary. Especially, SPTs over 5 cm in diameter need to be treated carefully because of the chance of malignant pathology. Careful long-term follow-up is necessary in those patients in case of possible tumor recurrences.
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Affiliation(s)
- Chang Moo Kang
- Department of Surgery, Yonsei University, College of Medicine, Seoul, Korea
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Bhanot P, Nealon WH, Walser EM, Bhutani MS, Tang WW, Logroño R. Clinical, imaging, and cytopathological features of solid pseudopapillary tumor of the pancreas: a clinicopathologic study of three cases and review of the literature. Diagn Cytopathol 2006; 33:421-8. [PMID: 16389690 DOI: 10.1002/dc.20365] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Solid pseudopapillary tumors are rare pancreatic neoplasms of uncertain pathogenesis that rarely metastasize and usually occur in young women. We describe the clinical, imaging, and cytopathological features of solid pseudopapillary tumor of the pancreas. We reviewed the clinical presentation, imaging, morphologic/immunochemical features, and follow-up of three women (age range 26-44). Cases 1, 2, and 3 presented with abdominal wall abscess, multiple endocrine neoplasia, and solid/cystic mass in the pancreatic head, respectively, and computed tomography of abdomen revealed solid/cystic masses with heterogeneous enhancement in body, tail and head of the pancreas, respectively. Case 2 also exhibited a left adrenal mass. Case 3 underwent endoscopic ultrasound of the pancreas, which showed a complex solid/cystic mass with septations. Sampling consisted of fine-needle aspiration (percutaneous or endosonography-guided), and additionally, core biopsy of the pancreatic mass and adrenal lesion in case 2. Aspirates and core biopsy revealed vascular structures with attached monotonous neoplastic cells in papillary-like arrays. Tumor cells had bland nuclear features with grooves, cytoplasmic periodic acid Schiff-positive hyaline globules, and associated myxoid/stromal fragments. Immunochemistry expressed alpha-1-antitrypsin, alpha-1-antichymotrypsin, vimentin, and focal neuron-specific enolase. Cases 1 and 3 underwent pancreatectomy with follow-up consisting of yearly imaging and no recurrences. Case 2 proved metastatic disease to adrenal gland and no follow-up was available. In the setting of typical clinical and imaging findings, an accurate preoperative diagnosis of pancreatic solid pseudopapillary tumor can be established by aspiration cytology and immunochemistry with or without concomitant core biopsy, on the basis of which clinicians decide treatment. This tumor can behave in a malignant fashion.
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Affiliation(s)
- Punam Bhanot
- Department of Pathology, University of Texas Medical Branch, Galveston 77555-0548, USA
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Peng CH, Chen DF, Zhou GW, Yang WP, Tao ZY, Lei RQ, Zhange SD, Li HW. The solid-pseudopapillary tumor of pancreas: the clinical characteristics and surgical treatment. J Surg Res 2006; 131:276-82. [PMID: 16457845 DOI: 10.1016/j.jss.2005.11.585] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Revised: 11/02/2005] [Accepted: 11/28/2005] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Since being named and reclassified by WHO in 1996, solid-pseudopapillary tumor (SPT) of pancreas has been recognized as a special entitative disease that is different from pancreatic cancer and should be recognized and treated more accurately in the surgical process. The clinic characteristics and surgical strategy on 25 cases of SPT of pancreas from the authors' center are discussed. METHODS The clinical pathology and the surgical methods of 25 SPTs were retrospectively studied. The analyses were performed by the statistical software package SAS6.12. RESULTS No tumor recurrences were found in all patients. There was significant difference between operative types in radical resection and the tumor position of the pancreas (P = 0.0011). The judgment on the tumor's boundary could directly affect the adoptable operative types (P = 0.0099). CONCLUSIONS As a uniquely entitative disease, SPT is a kind of uncommon neoplasm with low-grade malignancy with a strong rate of occurrence in women. Surgical resection is most favorable in the treatment of SPT, which has excellent prognosis. The course of SPT, the possible malignant cells by the frozen section biopsy, and the tumor's boundary are important for operators to decide an operative scheme. SPT that has infiltrated contiguous vessels, organs, even with local liver metastasis should not be regarded as operative contraindication. The choice of the local tumor resection, the part of pancreas resection or radical resection depends on the judgment of the tumor's boundary, whereas operative types in radical resection depend on the tumor position of the pancreas.
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Affiliation(s)
- Cheng-hong Peng
- Department of Surgery and the Center of the Organ Transplantation, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Second Medical University, Shanghai, China.
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Kasem A, Ali Z, Ellul J. Papillary cystic and solid tumour of the pancreas: report of a case and literature review. World J Surg Oncol 2005; 3:62. [PMID: 16188022 PMCID: PMC1261538 DOI: 10.1186/1477-7819-3-62] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Accepted: 09/27/2005] [Indexed: 11/10/2022] Open
Abstract
Background The papillary cystic and solid tumour of the pancreas (PCSTP) is a rare primary neoplasm of unknown pathogenesis typically found in young women. PCSTP is a low-grade malignant tumour, which is often asymptomatic but it may present with abdominal pain. Case presentation A 38 year old female patient who presented with one day history of epigastric pain was diagnosed as PCSTP. The patient was successfully treated with distal pancreatectomy. Conclusion It is important to differentiate this tumour from other pancreatic tumours because, unlike malignant pancreatic tumours, this neoplasm does not usually metastasise and is amenable to cure after complete surgical resection. However, the cell origin and the aetiology of this tumour are not clear and further studies are warranted in its pathogenesis.
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Affiliation(s)
- Abdul Kasem
- Department of General Surgery, Princess Royal University Hospital,Farnborough Common, Orpington, BR6 8DN UK
| | - Zainab Ali
- Department of Pathology, Princess Royal University Hospital,Farnborough Common, Orpington, BR6 8DN UK
| | - Joseph Ellul
- Department of General Surgery, Princess Royal University Hospital,Farnborough Common, Orpington, BR6 8DN UK
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Huang HL, Shih SC, Chang WH, Wang TE, Chen MJ, Chan YJ. Solid-pseudopapillary tumor of the pancreas: clinical experience and literature review. World J Gastroenterol 2005. [PMID: 15761986 DOI: 10.3748/wjg.v11.i9.1403s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the clinical presentations of solid-pseudopapillary tumor of the pancreas (SPT) and examine the diagnosis, treatment, low grade malignant potential of this rare disease. METHODS We retrospectively reviewed a series of seven patients with SPT managed in our hospital between July 1990 and October 2003. Six females and one male with mean age of 31 years (range 13 to 50 years) were diagnosed with SPT at our institution. RESULTS Clinical presentation included a palpable abdominal mass in two patients and vague abdominal discomfort in another two. Two patients were asymptomatic; their tumors were found incidentally on abdominal sonographic examination for other reasons. The final patient was admitted with hemoperitoneum secondary to tumor rupture. The mean diameter of the tumors in the seven patients was 10.5 cm (range 5 to 20 cm). The lesions were located in the body and tail in five cases and in the head of the pancreas in two. Surgical procedures included distal pancreatectomy (3), distal pancreatectomy with splenectomy (2), pancreaticoduodenectomy (1) and a pylorus-preserving Whipple procedure (1). There were gross adhesions or histological evidence of infiltration to the adjacent pancreas and/or splenic capsule in four cases. None of the patients received adjuvant therapy. The mean follow up was 7 years (range 0.5 to 14 years). One patient developed multiple liver metastases after 14 years of follow up. CONCLUSION SPT is a rare tumor that behaves less aggressively than other pancreatic tumor. However, in cases with local invasion, long-term follow up is advisable.
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Affiliation(s)
- Hsueh-Lien Huang
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Mackay Medicine Nursing and Management College, Taipei, Taiwan, China
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Huang HL, Shih SC, Chang WH, Wang TE, Chen MJ, Chan YJ. Solid-pseudopapillary tumor of the pancreas: clinical experience and literature review. World J Gastroenterol 2005; 11:1403-1409. [PMID: 15761986 PMCID: PMC4250695 DOI: 10.3748/wjg.v11.i9.1403] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2004] [Revised: 08/20/2004] [Accepted: 09/30/2004] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the clinical presentations of solid-pseudopapillary tumor of the pancreas (SPT) and examine the diagnosis, treatment, low grade malignant potential of this rare disease. METHODS We retrospectively reviewed a series of seven patients with SPT managed in our hospital between July 1990 and October 2003. Six females and one male with mean age of 31 years (range 13 to 50 years) were diagnosed with SPT at our institution. RESULTS Clinical presentation included a palpable abdominal mass in two patients and vague abdominal discomfort in another two. Two patients were asymptomatic; their tumors were found incidentally on abdominal sonographic examination for other reasons. The final patient was admitted with hemoperitoneum secondary to tumor rupture. The mean diameter of the tumors in the seven patients was 10.5 cm (range 5 to 20 cm). The lesions were located in the body and tail in five cases and in the head of the pancreas in two. Surgical procedures included distal pancreatectomy (3), distal pancreatectomy with splenectomy (2), pancreaticoduodenectomy (1) and a pylorus-preserving Whipple procedure (1). There were gross adhesions or histological evidence of infiltration to the adjacent pancreas and/or splenic capsule in four cases. None of the patients received adjuvant therapy. The mean follow up was 7 years (range 0.5 to 14 years). One patient developed multiple liver metastases after 14 years of follow up. CONCLUSION SPT is a rare tumor that behaves less aggressively than other pancreatic tumor. However, in cases with local invasion, long-term follow up is advisable.
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Affiliation(s)
- Hsueh-Lien Huang
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Mackay Medicine Nursing and Management College, Taipei, Taiwan, China
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Madan AK, Weldon CB, Long WP, Johnson D, Raafat A. Solid and papillary epithelial neoplasm of the pancreas. J Surg Oncol 2004; 85:193-8. [PMID: 14991875 DOI: 10.1002/jso.20019] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Solid and papillary epithelial (SPEN) is an uncommon pancreatic tumor often seen in young females. Although most of these neoplasms have a benign course, SPEN do have malignant potential. Treatment is surgical which is usually feasible either via enucleation or more radical procedures. Below we discuss diagnosis, treatment, and prognosis in detail.
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Affiliation(s)
- Atul K Madan
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Gandolfi L, Torresan F, Solmi L, Puccetti A. The role of ultrasound in biliary and pancreatic diseases. EUROPEAN JOURNAL OF ULTRASOUND : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY 2003; 16:141-59. [PMID: 12573783 DOI: 10.1016/s0929-8266(02)00068-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The possibilities and the limits of transabdominal ultrasonography (US) in the diagnosis of bilio-pancreatic diseases are reviewed here in the light of the last 10 years' research. US remains the method of choice for the diagnosis of gallstones and is generally accepted as an initial imaging technique in gallstone complications, such as acute cholecystitis. Moreover the method can be useful for the detection of the biliary complications after laparoscopic cholecystectomy and after liver transplantation. US is still considered the first diagnostic procedure when stones are suspected in the common bile duct. The use of color Doppler can provide a differential diagnosis of gallbladder cancer with respect to other benign inflammatory or polypoid lesions. Color Doppler US allows to detect vascular complications of acute pancreatitis such as pseudoaneurysms. US is still considered useful for the initial screening of the pancreatic cancer. However, for staging other imaging techniques must be employed. With US useful informations are obtained in the diagnosis of cystic tumors of the pancreas and of pancreatic metastases. US is generally of little use for the diagnosis of endocrine tumors.
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Affiliation(s)
- Lionello Gandolfi
- Section of Gastroenterology, Policlinic Hospital S.Orsola-Malpighi, Via Albertoni 15, 40138 Bologna, Italy.
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Pettinato G, Di Vizio D, Manivel JC, Pambuccian SE, Somma P, Insabato L. Solid-pseudopapillary tumor of the pancreas: a neoplasm with distinct and highly characteristic cytological features. Diagn Cytopathol 2002; 27:325-34. [PMID: 12451561 DOI: 10.1002/dc.10189] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The solid-pseudopapillary tumor of the pancreas (SPTP) is an unusual low-grade malignant epithelial tumor affecting predominantly adolescent girls and young women. Although approximately 500 cases of SPTP have been described in the last 40 yr, its pathogenesis remains uncertain. However, the clinical features of this neoplasm are very characteristic and SPTP must be suspected in any young woman with a cystic or partially cystic pancreatic mass. In this report, we describe the cytologic features of seven cases of SPTP investigated by preoperative fine-needle aspirates. The analysis of the cytologic features in these cases and in 43 cases collected from the literature reveals that they are highly characteristic and quite distinct from those of other cystic or solid tumors of the pancreas. On this basis, a cytologic diagnosis of SPTP may be rendered with great confidence, not only in clinically typical examples, but also in unusual presentations, such as in older patients, in males, in ectopic locations, and in metastatic sites.
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Affiliation(s)
- Guido Pettinato
- Department of Biomorphological and Functional Sciences, Section of Pathology, Faculty of Medicine, University of Naples Federico II, Naples, Italy.
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Fabre M. Diagnostic des lésions kystiques du pancréas par l'aspiration à l'aiguille fine guidée sous échoendoscopie digestive Quel prélèvement et pourquoi? Utilité de la microbiopsie sur la paroi du kyste et de l'analyse du liquide en technique monocouche. ACTA ACUST UNITED AC 2002. [DOI: 10.1007/bf03018032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
Papillary cystic and solid tumor of the pancreas is a rare neoplasm with low malignancy potential generally found in young women. Although its presentation is typically one of vague abdominal complaints, its radiographic and histologic characteristics are distinct. Recognition of the clinical and pathological spectrum of papillary cystic and solid tumor of the pancreas is essential for diagnosing this uncommon condition and differentiating it from other pancreatic masses encountered in the young.
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Affiliation(s)
- D C Schwartz
- Department of Internal Medicine, University of Miami School of Medicine/Jackson Memorial Hospital, Florida 33136, USA.
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