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Gonzaga APFC, Pacheco EO, Favaro LR, Torres US, D'Ippolito G. Solid Pseudopapillary Neoplasm of the Pancreas: Typical, Atypical, and Mimicking Lesions-A Pictorial Review. Semin Ultrasound CT MR 2025:S0887-2171(25)00018-6. [PMID: 40216034 DOI: 10.1053/j.sult.2025.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2025]
Abstract
Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare tumors that predominantly affect young women and are characterized by encapsulated lesions with a mixture of solid and cystic components. Although typically indolent with a favorable prognosis after surgical resection, SPNs can exhibit atypical features that complicate diagnosis, including dense calcifications, multiplicity, or occurrence in male and elderly patients. Magnetic resonance imaging plays a pivotal role in distinguishing SPNs from other pancreatic lesions, leveraging its superior contrast resolution to identify hallmark findings such as hemorrhage, cystic degeneration, and enhancement patterns. This review highlights both typical and atypical imaging presentations of SPNs and discusses key differential diagnoses, including pancreatic adenocarcinoma, neuroendocrine tumors, and mucinous cystic neoplasms. By broadening awareness of the variable manifestations of SPNs and integrating imaging with clinical and epidemiological data, this study aims to improve diagnostic accuracy and guide effective management strategies for ambiguous pancreatic lesions.
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Affiliation(s)
| | - Eduardo O Pacheco
- Grupo Fleury, São Paulo, SP, Brazil.; Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Larissa Rossini Favaro
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ulysses S Torres
- Grupo Fleury, São Paulo, SP, Brazil.; Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil..
| | - Giuseppe D'Ippolito
- Grupo Fleury, São Paulo, SP, Brazil.; Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Sapkota A, Paudel R, Pandey S, Bhatt N. Solid pseudopapillary neoplasm of the pancreas in an adolescent: A case report and review of the literature. World J Gastrointest Oncol 2025; 17:101859. [PMID: 40092930 PMCID: PMC11866218 DOI: 10.4251/wjgo.v17.i3.101859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Revised: 11/27/2024] [Accepted: 12/19/2024] [Indexed: 02/14/2025] Open
Abstract
BACKGROUND Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare epithelial tumor that primarily affects young women. Since the condition is often asymptomatic or presents with non-specific symptoms, its diagnosis can be difficult. CASE SUMMARY This report details the case of a 15-year-old girl who presented with a 2-year history of abdominal pain, with no significant findings during physical examination. Abdominal ultrasound revealed a well-defined heterogeneous solid-cystic mass in the epigastric region, likely originating from the tail of the pancreas. A subsequent contrast-enhanced computed tomography scan indicated a well-defined cystic lesion with an enhancing solid component and capsule in the tail of the pancreas, suggestive of a cystic neoplasm. The patient underwent an open distal pancreatectomy with splenectomy, and histopathological analysis confirmed the diagnosis of SPN of the pancreas. CONCLUSION This case highlights the risk of SPN in adolescent girls and the necessity of early diagnosis and intervention for better outcomes.
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Affiliation(s)
- Aakriti Sapkota
- Department of Medicine, B.P. Koirala Institute of Health Sciences, Dharan 56700, Koshi, Nepal
| | - Rajesh Paudel
- Department of Radiodiagnosis and Imaging, B.P. Koirala Institute of Health Sciences, Dharan 56700, Koshi, Nepal
| | - Sandip Pandey
- Department of Medicine, B.P. Koirala Institute of Health Sciences, Dharan 56700, Koshi, Nepal
| | - Navin Bhatt
- Department of Medicine, NYC Health + Hospitals/Elmhurst, Icahn School of Medicine at Mount Sinai, Elmhurst, NY 11373, United States
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Saritas AG, Gul MO, Ulku A, Gumus S, Aydin I, Akcam AT. Diagnosis and treatment of solid pseudopapillary tumor of the pancreas: A single center's experience. North Clin Istanb 2024; 11:328-335. [PMID: 39165713 PMCID: PMC11331207 DOI: 10.14744/nci.2023.36776] [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: 06/16/2023] [Revised: 08/13/2023] [Accepted: 09/05/2023] [Indexed: 08/22/2024] Open
Abstract
OBJECTIVE The present study reviews the records of patients with solid pseudopapillary pancreas neoplasm (SPT). METHODS A total of 13 patients diagnosed with SPT were included in the study. The criteria for SPT in the pathology specimens were the presence of cells with an oval round orthochromatic nucleus, with a thin chromatin structure and no nucleolus distinction, lined around a fibrovascular papilla in cystic areas. RESULTS The study included 11 female and two male patients, with a mean age of 33.07 (range: 16-73) years. All operated patients underwent open surgery, with five undergoing a subtotal pancreatectomy and splenectomy; one a distal pancreatectomy and splenectomy; four a spleen-preserving distal pancreatectomy; and one a pancreaticoduodenectomy. None of the operated patients developed recurrence during the long-term follow-up. The mean follow-up time of operable patients was 69.18 (range: 22-97) months, and none had metastasis at follow-up. The mean follow-up time for the malignant SPT patients was 2.75 (1.5-4) months. CONCLUSION SPTs are rare pancreatic tumors encountered more frequently today due to advances in imaging methods and have a low potential of recurrence and a good prognosis.
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Affiliation(s)
- Ahmet Gokhan Saritas
- Department of General Surgery, Cukurova University Balcali Training and Research Hospital, Adana, Turkiye
| | - Mehmet Onur Gul
- Department of Surgical Oncology, Malatya Training and Research Hospital, Malatya, Turkiye
| | - Abdullah Ulku
- Department of General Surgery, Cukurova University Balcali Training and Research Hospital, Adana, Turkiye
| | - Serdar Gumus
- Department of Surgical Oncology, Hatay Training and Research Hospital, Hatay, Turkiye
| | - Ishak Aydin
- Department of Surgical Oncology, Cukurova University Balcali Training and Research Hospital, Adana, Turkiye
| | - Atilgan Tolga Akcam
- Department of General Surgery, Cukurova University Balcali Training and Research Hospital, Adana, Turkiye
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Mazzarella G, Muttillo EM, Coletta D, Picardi B, Rossi S, Rossi Del Monte S, Gomes V, Muttillo IA. Solid pseudopapillary tumor of the pancreas: A systematic review of clinical, surgical and oncological characteristics of 1384 patients underwent pancreatic surgery. Hepatobiliary Pancreat Dis Int 2024; 23:331-338. [PMID: 37236826 DOI: 10.1016/j.hbpd.2023.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Pancreatic solid pseudopapillary tumors (SPTs) are rare clinical entity, with low malignancy and still unclear pathogenesis. They account for less than 2% of exocrine pancreatic neoplasms. This study aimed to perform a systematic review of the main clinical, surgical and oncological characteristics of pancreatic SPTs. DATA SOURCES MEDLINE/PubMed, Web of Science and Scopus databases were systematically searched for the main clinical, surgical and oncological characteristics of pancreatic SPTs up to April 2021, in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) standards. Primary endpoints were to analyze treatments and oncological outcomes. RESULTS A total of 823 studies were recorded, 86 studies underwent full-text reviews and 28 met inclusion criteria. Overall, 1384 patients underwent pancreatic surgery. Mean age was 30 years and 1181 patients (85.3%) were female. The most common clinical presentation was non-specific abdominal pain (52.6% of cases). Mean overall survival was 98.1%. Mean recurrence rate was 2.8%. Mean follow-up was 4.2 years. CONCLUSIONS Pancreatic SPTs are rare, and predominantly affect young women with unclear pathogenesis. Radical resection is the gold standard of treatment achieving good oncological impact and a favorable prognosis in a yearly life-long follow-up.
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Affiliation(s)
- Gennaro Mazzarella
- Division of General and Emergency Surgery, San Filippo Neri Hospital, 00136 Rome, Italy; Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
| | - Edoardo Maria Muttillo
- Division of General and Emergency Surgery, San Filippo Neri Hospital, 00136 Rome, Italy; Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Diego Coletta
- Department of Surgical Sciences, Umberto I University Hospital, Sapienza University of Rome, 00136 Rome, Italy; Department of General Surgery, Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy
| | - Biagio Picardi
- Division of General and Emergency Surgery, San Filippo Neri Hospital, 00136 Rome, Italy
| | - Stefano Rossi
- Division of General and Emergency Surgery, San Filippo Neri Hospital, 00136 Rome, Italy
| | | | - Vito Gomes
- Department of Pathology, San Filippo Neri Hospital, 00136 Rome, Italy
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Clinical Course, Genetic, and Immunohistochemical Characterization of Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumors) in a Brazilian Cohort. Genes (Basel) 2022; 13:genes13101809. [PMID: 36292694 PMCID: PMC9601385 DOI: 10.3390/genes13101809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 11/17/2022] Open
Abstract
Frantz tumors or solid pseudopapillary pancreatic neoplasm (SPN) are rare exocrine neoplasms that carry a favorable prognosis; they represent up to 3% of all tumors located in the region of the pancreas and have specific age and gender predispositions. In recent years, the rising curve of diagnosis is entitled to the evolution and access of diagnostic imaging. In this paper, we have retrospectively reviewed and described the clinical course of 40 patients with SPN from three institutions in Brazil, who had their diagnosis between 2005 and 2020, and analyzed the clinicopathological, genetic, and surgical aspects of these individuals. In accordance with the literature, most patients were women, 60% with unspecified symptoms at diagnosis, with tumors mainly located in the body and tail of the pancreas, of whom 70% underwent a distal pancreatectomy with sparing splenectomy as a standard procedure, and none of the cases have experienced recurrence to date. Surgery still remains the mainstay of treatment given the low metastatic potential, but more conservative approaches as observed in this cohort are evolving to become the standard of care. Herein, we present an in-depth analysis of cases focusing on the latest literature and report some of the smallest tumor cases in the literature. To our knowledge, this is the first report evaluating germline genetic testing and presenting a case of detected Li-Fraumeni syndrome.
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Tasar P, Kilicturgay SA. Solid pseudopapillary neoplasms of the pancreas: Is there a factor determining the prognosis? Experience of a single institution. Medicine (Baltimore) 2022; 101:e30101. [PMID: 36042645 PMCID: PMC9410631 DOI: 10.1097/md.0000000000030101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Solid pseudopapillary neoplasms (SPNs) are frequently seen in young women. Although the behavior pattern varies, these rare lesions generally have a low malignant potential. In this study, the aim was to investigate the effect of clinicopathological features of lesions on the recurrence in and survival of patients. In this study, patients of our clinic who were pathologically diagnosed with SPN after pancreatic surgery between July 2008 and December 2020 were evaluated retrospectively. Patients' age, gender, comorbidities, symptoms at the time of application, preoperative CA 19-9, CEA value, preoperative cross-sectional diagnostic imaging method and lesion characteristics, surgery, postoperative complications, length of hospital stay, and histopathological features were evaluated. Early and late mortality, overall survival, disease-free survival, and recurrence rate were determined. Four of the 23 patients diagnosed with SPN were male and the median age was 29 (23-47) years. Of the study patients, 69.56% experienced pain symptoms and 30.43% were asymptomatic. The median tumor size was 4 cm (1.5-15). The most common surgical procedure was distal pancreatectomy (56.5%). The median length of hospital stays was 5 (3-120) days and morbidity was observed in 9 cases (39.13%). The mortality rate was 4.35%. The mean follow-up period in the series was 53 (8-132) months and none of the patients developed recurrence. In this study, no significant difference was found regarding recurrence in patients with SPN with histopathologically aggressive biological behavior. The overall survival rate was 95.7%. SPNs are rare lesions with low malignant potential. SPNs are associated with longer-term survival after surgical resection.
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Affiliation(s)
- Pinar Tasar
- Department of General Surgery, School of Medicine, Uludag University, Gorukle, Bursa, Turkey
| | - Sadik Ayhan Kilicturgay
- Department of General Surgery, School of Medicine, Uludag University, Gorukle, Bursa, Turkey
- *Correspondence: Sadik Ayhan Kilicturgay, Department of General Surgery, Uludag University, Gorukle, Bursa/Turkey (e-mail: )
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Wang R, Li J, Tan CL, Liu XB, Chen YH. Prospects and applications of enucleation in solid pseudopapillary neoplasms of the pancreas. World J Gastrointest Oncol 2022; 14:1227-1238. [PMID: 36051095 PMCID: PMC9305568 DOI: 10.4251/wjgo.v14.i7.1227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/30/2022] [Accepted: 06/21/2022] [Indexed: 02/06/2023] Open
Abstract
Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare, low-grade, malignant neoplasms that are mostly seen in young women in the second and third decades of life and are quite uncommon in children. Standard resection for benign and borderline neoplasms of the pancreas is associated with a substantial risk of postoperative morbidity and long-term functional impairment, whereas enucleation leads to less morbidity and preserves healthy parenchyma as well as exocrine and endocrine function. Enucleation of SPNs has been increasingly reported to be feasible and safe for preserving the normal physiological function of the pancreas, especially in teenagers and children. This review summarizes findings published in recent years on the enucleation of SPNs as well as potential future developments and directions. Enucleation has undoubtedly come to stay as an alternative surgical procedure for SPNs. However, many questions remain unresolved, and future directions toward the best surgical indication, the prevention and intervention of complications, especially pancreatic fistula, intraoperative resection margin safety assessment, and long-term oncology prognosis remain to be evaluated and should be explored in future clinical trials.
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Affiliation(s)
- Rui Wang
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu 610037, Sichuan Province, China
| | - Jing Li
- Department of Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610037, Sichuan Province, China
| | - Chun-Lu Tan
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu 610037, Sichuan Province, China
| | - Xu-Bao Liu
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu 610037, Sichuan Province, China
| | - Yong-Hua Chen
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu 610037, Sichuan Province, China
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Brunner M, Häberle L, Esposito I, Grützmann R. [Pancreatic cystic space-occupying lesions-Diagnostics, treatment and follow-up care : Current recommendations taking the current German S3 guidelines on pancreatic cancer into account]. Chirurg 2022; 93:461-475. [PMID: 35316346 DOI: 10.1007/s00104-022-01616-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/03/2022]
Abstract
Due to their increased detection pancreatic cystic space-occupying lesions are becoming increasingly relevant in the clinical routine and represent a morphologically and biologically heterogeneous and thus clinically demanding as well as potentially (pre)malignant entity. As a result, recommendations for the diagnostics and treatment of pancreatic cystic tumors have now been incorporated into the current German S3 guidelines on pancreatic cancer. The diagnostics of pancreatic cystic space-occupying lesions are based on the following three elements: collection of relevant clinical information, performance of high-resolution imaging procedures and if diagnostic uncertainty persists, puncture diagnostics. Differentiated diagnostics are of essential importance as these represent the basis for an adequate treatment decision. Pancreatic cystic lesions with a relevant risk of malignant transformation, e.g., main duct intraductal papillary mucinous neoplasms (IPMN), followed by mucinous cystic neoplasms (MCN), solid pseudopapillary neoplasms (SPN) and generally pancreatic cystic lesions with risk factors independent of the entity, should be resected, whereas a differentiated and individualized approach is necessary, especially for branch-duct IPMNs. The serous cystic neoplasms (SCN) have no malignant potential and do not require any treatment if they are asymptomatic. Important principles in surgery of pancreatic cancer, such as adequate surgical resection taking oncological standards into account and standardized appropriate histopathological processing of the specimens as well as intraoperative frozen section analysis also play an important role in pancreatic cystic space-occupying lesions. An annual follow-up seems to be meaningful, especially for IPMNs.
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Affiliation(s)
- Maximilian Brunner
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum der Friedrich-Alexander-Universität Erlangen, Erlangen, Deutschland
| | - Lena Häberle
- Institut für Pathologie, Universitätsklinikum der Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Irene Esposito
- Institut für Pathologie, Universitätsklinikum der Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
| | - Robert Grützmann
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum der Friedrich-Alexander-Universität Erlangen, Erlangen, Deutschland.
- , Krankenhausstr. 12, 91054, Erlangen, Deutschland.
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Liu F, Li J, Fang X, Meng Y, Zhang H, Yu J, Feng X, Wang L, Jiang H, Lu J, Bian Y, Shao C. Differentiation of Solid Pseudopapillary Tumor and Non-Functional Neuroendocrine Tumors of the Pancreas Based on CT Delayed Imaging: A Propensity Score Analysis. Acad Radiol 2022; 29:350-357. [PMID: 33731286 DOI: 10.1016/j.acra.2021.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/15/2021] [Accepted: 02/21/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of the delayed-phase difference between tumor and pancreas for differentiating solid pseudopapillary tumors (SPTs) from non-functional neuroendocrine tumors (NF-NETs) of the pancreas. METHODS This retrospective review included 148 consecutive patients with SPT and 98 consecutive patients with NF-NET confirmed by pathology. Patients with SPT and NF-NET were matched via propensity score matching (PSM). All patients underwent multidetector computed tomography (MDCT). For each patient, the delayed-phase difference between the tumor and pancreas was measured, and the performance of this variable was assessed based on its discriminative ability and clinical utility. RESULTS After PSM, 27 patients with SPT and 27 patients with NF-NET were included in the matched analysis. There were no statistically significant differences in clinical and CT characteristics between the resulting two groups (p > 0.05). The delayed-phase difference values between the tumor and pancreas were significantly lower in patients with SPT (median: -0.45; range: -2.05 to 0.73) than in patients with NF-NET (median: 0.71; range: -1.39 to 2.38). The delayed-phase difference between tumor and pancreas had a high diagnostic accuracy (area under the curve=0.88). The best cutoff point based on maximizing the sum of the sensitivity and specificity was -0.23 (sensitivity = 88.89%; specificity = 88.89%; accuracy = 0.89). CONCLUSIONS The delayed-phase difference between tumor and pancreas can accurately and noninvasively differentiate SPT from NF-NET.
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Wei G, Luo Q, Fang J, Li X, Shi Y, Li Y, Sun L. The Sex Features of Patients With Solid Pseudopapillary Neoplasms of the Pancreas: A Retrospective Study. Front Oncol 2022; 12:844182. [PMID: 35252013 PMCID: PMC8894654 DOI: 10.3389/fonc.2022.844182] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/25/2022] [Indexed: 01/17/2023] Open
Abstract
Background Solid pseudopapillary neoplasms of the pancreas (SPNs) in male patients are more frequently reported. The aim of the study was to evaluate the sex features of SPN and the risk factors that predict tumor recurrence. Methods From 2013 to 2019, patients who were pathologically confirmed to have SPNs were retrospectively reviewed. The baseline study parameters were compared between males and females. A logistic regression model was established to identify the independent risk factors for tumor recurrence. Results In total, 221 patients were included in this study. Of them, 53 patients (24.0%) were males. Male patients were older than female patients (39.1 vs 31.6 years, P=0.001), and the tumor size in male patients was smaller than that in female patients (50.38 vs 39.65 mm, P=0.038). The preoperative imaging diagnostic accuracy was significantly higher in females than in males (70.5% vs 54%, P=0.02). SPNs in male patients tended to be misdiagnosed with other malignant tumors (37.7% vs 10.7%, P<0.0001), with a more solid component observed in images (66.8% vs 24.7%, P<0.0001). For immunohistochemical staining, the expression of beta catenin was significantly lower in male patients (P=0.002), and the expression of vimentin was the opposite (P=0.01). The overall survival rate and disease-free survival were not different. Based on multivariate analysis, older age [hazard ratio (HR)= 1.094, 95% confidence interval (CI): 1.005-1.190] and KI 67 index grade III (HR=12.029, 95% CI: 2.399-60.311) were independent risk factors for tumor recurrence. Conclusion The clinical and imaging features of SPN in males were not in full accord with those in females; however, the differences did not influence prognosis.
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Affiliation(s)
- Guangmin Wei
- Department of Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Qiong Luo
- Department of Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Jiankai Fang
- Department of Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Xiaolou Li
- Department of Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Yanhong Shi
- Department of Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Yuqiong Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
- *Correspondence: Yuqiong Li, ; Liqi Sun,
| | - Liqi Sun
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
- Department of Gastroenterology, 72 Group Army Hospital, Huzhou University, Huzhou, China
- *Correspondence: Yuqiong Li, ; Liqi Sun,
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11
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Hashimoto S, Nakaoka K, Tanaka H, Kuzuya T, Kawabe N, Nagasaka M, Nakagawa Y, Miyahara R, Shibata T, Hirooka Y. Transabdominal ultrasonographic diagnosis of relatively rare pancreatic neoplasms. J Med Ultrason (2001) 2022; 49:187-197. [PMID: 35149959 DOI: 10.1007/s10396-022-01192-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
Abstract
There are various types of pancreatic neoplasms, and their prognosis and treatment methods are different. Therefore, accurate diagnosis is important to determine the best treatment strategy. Transabdominal ultrasonography is frequently used as a screening examination for diagnostic imaging of pancreatic neoplasms. In this review, we have focused on the characteristics of ultrasonic findings for relatively rare pancreatic neoplasms.
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Affiliation(s)
- Senju Hashimoto
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1‑98 Dengakugakubo, Kutukake‑cho, Toyoake, Aichi, 470‑1192, Japan
| | - Kazunori Nakaoka
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1‑98 Dengakugakubo, Kutukake‑cho, Toyoake, Aichi, 470‑1192, Japan
| | - Hiroyuki Tanaka
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1‑98 Dengakugakubo, Kutukake‑cho, Toyoake, Aichi, 470‑1192, Japan
| | - Teiji Kuzuya
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1‑98 Dengakugakubo, Kutukake‑cho, Toyoake, Aichi, 470‑1192, Japan
| | - Naoto Kawabe
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1‑98 Dengakugakubo, Kutukake‑cho, Toyoake, Aichi, 470‑1192, Japan
| | - Mitsuo Nagasaka
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1‑98 Dengakugakubo, Kutukake‑cho, Toyoake, Aichi, 470‑1192, Japan
| | - Yoshihito Nakagawa
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1‑98 Dengakugakubo, Kutukake‑cho, Toyoake, Aichi, 470‑1192, Japan
| | - Ryoji Miyahara
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1‑98 Dengakugakubo, Kutukake‑cho, Toyoake, Aichi, 470‑1192, Japan
| | - Tomoyuki Shibata
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1‑98 Dengakugakubo, Kutukake‑cho, Toyoake, Aichi, 470‑1192, Japan
| | - Yoshiki Hirooka
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1‑98 Dengakugakubo, Kutukake‑cho, Toyoake, Aichi, 470‑1192, Japan.
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12
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Surkova VS, Volchenko NN, Vorobyev NV, Gevorgyan GS, Yudakova ME, Tkachuk AV. [Metastatic solid pseudopapillary tumor in the perinephric fat without a primary identified focus]. Arkh Patol 2021; 83:39-44. [PMID: 34859985 DOI: 10.17116/patol20218306139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Solid pseudopapillary tumor of the pancreas is an extremely rare neoplasm of the exocrine portion of this organ, which affects mostly young women and is characterized by a low malignancy potential and a relatively benign clinical course. According to the literature, even in disease progression as metastases, the overall 5-year survival rate is more than 95%. The paper describes a clinical case of a female patient with a solid pseudopapillary pancreatic tumor regarded as a metastatic neoplasm in the retroperitoneal space after surgical treatment previously performed in 2001.
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Affiliation(s)
- V S Surkova
- P.A. Herzen Moscow Oncology Research Institute - Branch of the National Medical Radiology Research Center of the Ministry of Health of Russia, Moscow, Russia
| | - N N Volchenko
- P.A. Herzen Moscow Oncology Research Institute - Branch of the National Medical Radiology Research Center of the Ministry of Health of Russia, Moscow, Russia
| | - N V Vorobyev
- P.A. Herzen Moscow Oncology Research Institute - Branch of the National Medical Radiology Research Center of the Ministry of Health of Russia, Moscow, Russia
| | - G S Gevorgyan
- P.A. Herzen Moscow Oncology Research Institute - Branch of the National Medical Radiology Research Center of the Ministry of Health of Russia, Moscow, Russia
| | - M E Yudakova
- P.A. Herzen Moscow Oncology Research Institute - Branch of the National Medical Radiology Research Center of the Ministry of Health of Russia, Moscow, Russia.,Multidisciplinary Medical Center Bank of Russia, Moscow, Russia
| | - A V Tkachuk
- P.A. Herzen Moscow Oncology Research Institute - Branch of the National Medical Radiology Research Center of the Ministry of Health of Russia, Moscow, Russia
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13
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Paredes O, Paredes K, Kawaguchi Y, Luque-Vasquez C, Chavez I, Celis J, Payet E, Ruiz E, Berrospi F. Clinicopathological factors associated with recurrence in patients undergoing resection of pancreatic solid pseudopapillary neoplasm. Discov Oncol 2021; 12:53. [PMID: 35201506 PMCID: PMC8777513 DOI: 10.1007/s12672-021-00451-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/17/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Solid pseudopapillary neoplasm (SPN) is an uncommon pathology with a low-grade malignancy. Surgery is the milestone treatment. Nevertheless, despite appropriate management, some patients present recurrence. Risk factors associated with recurrence are unclear. The objective was to identify the clinicopathological factors associated with recurrence in patients with SPN treated with pancreatic resection. METHODS Medical records of patients treated with pancreatic resection during 2006-2020 were evaluated. Patients with histological diagnosis of SPN were included. Survival analysis was performed to identify the clinicopathological factors related to recurrence. RESULTS Seventy-four patients were diagnosed with SPN; 70 (94.6%) patients were female, and the median age was 20 years old. The median tumor diameter was 7.9 cm. Multivisceral resection was performed in 9 (12.2%) patients. Four (5.4%) patients presented lymph node metastasis.R0 resection was achieved in all cases. Six (8%) patients presented recurrence and the liver was the most frequent recurrence site (n = 5).After a median follow-up of 40.2 months, 9 (12%) patients died. Five (6.8%) patients died of disease progression. The 1-3- and 5-year overall survival (OS) was 97.1%, 90.2% and 79.9%, respectively. The 1-3-and-5-year recurrence-free survival (RFS) was 98.4%, 89.9% and 87%, respectively. In the univariate Cox-regression analysis, age ≥ 28 years(HR = 8.61, 95% CI 1.1-73.8),tumor diameter ≥ 10 cm(HR = 9.3, 95% CI 1.12-79.6),invasion of adjacent organs (HR = 7.45, 95% CI 1.5-36.9), lymph node metastasis (pN +) (HR = 16.8, 95% CI 2.96-94.9) and, AJCC Stage III (HR = 10.1, 95% CI 1.2-90.9) were identified as predictors for recurrence. CONCLUSIONS SPN is more frequently diagnosed in young women with a good overall prognosis after an R0 surgical resection even with disease recurrence. Age ≥ 28 years, larger tumors ≥ 10 cm, invasion of adjacent organs, lymph node metastasis(pN +) and, AJCC Stage III were predictors factors of recurrence in resected SPN.
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Affiliation(s)
- Oscar Paredes
- Department of Abdominal Surgery, National Institute of Neoplastic Diseases INEN, Lima, Peru.
- , Montesquieu Street 277, Lima, Perú.
| | - Kori Paredes
- Department of Abdominal Surgery, National Institute of Neoplastic Diseases INEN, Lima, Peru
| | - Yoshikuni Kawaguchi
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Carlos Luque-Vasquez
- Department of Abdominal Surgery, National Institute of Neoplastic Diseases INEN, Lima, Peru
| | - Iván Chavez
- Department of Abdominal Surgery, National Institute of Neoplastic Diseases INEN, Lima, Peru
| | - Juan Celis
- Department of Abdominal Surgery, National Institute of Neoplastic Diseases INEN, Lima, Peru
| | - Eduardo Payet
- Department of Abdominal Surgery, National Institute of Neoplastic Diseases INEN, Lima, Peru
| | - Eloy Ruiz
- Department of Abdominal Surgery, National Institute of Neoplastic Diseases INEN, Lima, Peru
| | - Francisco Berrospi
- Department of Abdominal Surgery, National Institute of Neoplastic Diseases INEN, Lima, Peru
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14
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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 2021; 73:1285-1295. [PMID: 33123945 PMCID: PMC8397648 DOI: 10.1007/s13304-020-00905-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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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15
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Abudalou M, Vega EA, Dhingra R, Holzwanger E, Krishnan S, Kondratiev S, Niakosari A, Conrad C, Stallwood CG. Solid pseudopapillary neoplasm-diagnostic approach and post-surgical follow up: Three case reports and review of literature. World J Clin Cases 2021; 9:1682-1695. [PMID: 33728313 PMCID: PMC7942041 DOI: 10.12998/wjcc.v9.i7.1682] [Citation(s) in RCA: 6] [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] [Received: 10/07/2020] [Revised: 11/23/2020] [Accepted: 01/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Solid pseudopapillary neoplasm (SPN) is a rare tumor that was first described by Frantz in 1959. Although this tumor is benign, some may have malignant potential that can be predicted based on demographics, imaging characteristics, and pathologic evaluation. This case series presents 3 SPN cases with discussion on gender differences, preoperative predictors of malignancy, and a suggested algorithm for diagnostic approach as well as post-surgical follow up.
CASE SUMMARY Three adult patients in a tertiary hospital found to have SPN, one elderly male and two young females. Each of the cases presented with abdominal pain and were discovered incidentally. Two cases underwent endoscopic ultrasound with fine needle aspiration and biopsy to assess tumor markers and immuno-histochemical staining (which were consistent with SPN before undergoing surgery), and one case underwent surgery directly after imaging. The average tumor size was 5 cm. Diagnosis was confirmed by histology. Two patients had post-surgical complications requiring intervention.
CONCLUSION Demographic and imaging characteristics can be sufficient to establish diagnosis for SPN, while malignant cases require pre-operative evaluation with endoscopic ultrasound fine needle aspiration/fine needle biopsy.
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Affiliation(s)
- Mohammad Abudalou
- Department of Internal Medicine, St. Elizabeth Medical Center, Brighton, MA 02135, United States
| | - Eduardo A Vega
- Department of General Surgery, St. Elizabeth Medical Center, Brighton, MA 02135, United States
| | - Rohit Dhingra
- Department of Gastroenterology, Tufts Medical Center, Boston, MA 02111, United States
| | - Erik Holzwanger
- Department of Gastroenterology, Tufts Medical Center, Boston, MA 02111, United States
| | - Sandeep Krishnan
- Department of Gastroenterology, St. Elizabeth Medical Center, Brighton, MA 02135, United States
| | - Svetlana Kondratiev
- Department of Pathology, St. Elizabeth Medical Center, Brighton, MA 02135, United States
| | - Ali Niakosari
- Department of Radiology, St. Elizabeth Medical Center, Brighton, MA 02135, United States
| | - Claudius Conrad
- Department of General Surgery, St. Elizabeth Medical Center, Brighton, MA 02135, United States
| | - Christopher G Stallwood
- Department of Gastroenterology, St. Elizabeth Medical Center, Brighton, MA 02135, United States
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16
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Sasaki Y, Ishikawa T, Kawashima H, Ohno E, Shimoyama Y, Ishikawa E, Fujishiro M. Gender difference in the transabdominal ultrasound findings of solid-pseudopapillary neoplasm. Pancreatology 2020; 20:997-1003. [PMID: 32694007 DOI: 10.1016/j.pan.2020.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/10/2020] [Accepted: 06/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Solid-pseudopapillary neoplasm (SPN) is a rare tumour that is mostly observed in young females. However, onset in males is also observed, and they do not necessarily present with typical findings. A comparison between male and female SPN patients focusing on the ultrasound findings was performed. METHODS Sixteen patients including 5 males who received transabdominal ultrasounds and were diagnosed with SPN based on their resected specimens were compared by sex in terms of the following: 1) age, 2) symptoms, 3) ultrasound findings, 4) preoperative ultrasound diagnoses, and 5) histology. RESULTS 1) The age was significantly higher in males (43 vs. 31, P = 0.004). 2) Symptoms were not observed in any of the males while 4/11 females were symptomatic (P = 0.245). 3) Tumour size was significantly smaller in males (20 mm vs. 33 mm, P = 0.014), and there was a higher percentage of cystic components in females (0% vs. 73%, P = 0.026). 4) SPN was listed as the first differential diagnosis in 9/11 females as opposed to 2/5 males (P = 0.139). 5) Cystic areas on the ultrasound corresponded to necrosis and hemorrhage. All cases showed expression of progesterone and androgen receptors regardless of sex. CONCLUSIONS There were significant differences between male and female SPN patients in terms of age, tumour size, and presence of cystic components. Attention should be paid to the finding that onset in males was more common from middle age onwards in comparison to females and that a cystic component was not observed.
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Affiliation(s)
- Yutaka Sasaki
- Department of Medical Technique, Nagoya University Hospital, Nagoya, Japan.
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshie Shimoyama
- Department of Pathology and Laboratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eri Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Pathology and Laboratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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17
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Brunner M, Belyaev O, Bösch F, Müller-Debus CF, Radulova-Mauersberger O, Wellner UF, Keck T, Uhl W, Werner J, Witzigmann H, Grützmann R. [Indications for the Surgical Management of Pancreatic Cystic Lesions]. Zentralbl Chir 2020; 145:344-353. [PMID: 32498095 DOI: 10.1055/a-1158-9536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A steady improvement in modern imaging as well as increasing age in society have led to an increasing number of cystic pancreatic tumours being detected. Pancreatic cysts are a clinically challenging entity because they span a broad biological spectrum and their differentiation is often difficult, especially in small tumours. Therefore, they require a differentiated indication for indication of surgery. To determine recommendations for the surgical indication in cystic tumours of the pancreas, a quality committee for pancreatic diseases of the German Society for General and Visceral Surgery performed a systematic literature search and created this review. Based on the current evidence, signs of malignancy and high-risk criteria (icterus due to cystic pancreatic duct obstruction in the bile duct, enhancing mural nodules ≥ 5 mm or solid components in the cyst or pancreatic duct ≥ 10 mm), as well as symptoms, are a surgical indication, independently of the cyst entity (except pseudocysts). If the entity of the pancreatic cyst is detectable by diagnostic imaging, all main duct IPMN and IPMN of the mixed type, all MCN > 4 cm and all SPN should be resected. SCN and branch-duct IPMN without worrisome features do not constitute an indication for surgery. The indication of operation in branch-duct IPMN with relative risk criteria and MCN < 4 cm is the subject of current discussions and should be individualised. By defining indication recommendations, the present work aims to improve the indication quality in cystic pancreatic tumours. However, the surgical indication should always be individualised, taking into account age, comorbidities and the patient's wishes.
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Affiliation(s)
- Maximilian Brunner
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Erlangen, Deutschland
| | - Orlin Belyaev
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum St. Josef-Hospital Bochum, Deutschland
| | - Florian Bösch
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, LMU, Klinikum der Universität München, Deutschland
| | | | | | | | - Tobias Keck
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Deutschland
| | - Waldemar Uhl
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum St. Josef-Hospital Bochum, Deutschland
| | - Jens Werner
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, LMU, Klinikum der Universität München, Deutschland
| | - Helmut Witzigmann
- Klinik für Allgemein- und Viszeralchirurgie, Städtisches Klinikum Dresden-Friedrichstadt, Deutschland
| | - Robert Grützmann
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Erlangen, Deutschland
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18
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Hepatic metastasis in Frantz's tumor: A case report. Int J Surg Case Rep 2020; 71:66-69. [PMID: 32473553 PMCID: PMC7260607 DOI: 10.1016/j.ijscr.2020.04.037] [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: 02/04/2020] [Revised: 04/01/2020] [Accepted: 04/20/2020] [Indexed: 11/25/2022] Open
Abstract
This is a borderline tumor with indolent biological behavior. There are still multiple poorly understood factors that can dictate its malignant transformation and prognosis. Here, a rare tumor whose age and survival are tangent the literature reports describe. There is a need for a long and rigorous segment to identify possible long-term metastases. Introduction Frantz’s Tumor or Solid Pseudopapillary Neoplasm (SPN) is rare with a solid-cystic pattern, and most common in young women. Presentation of case This study based on guidelines for case reports (SCARE) reports a case of SPN in a teenager aged 13 years at the diagnosis time, attended at a teaching public hospital in Brazil, which evolved into liver metastases. Clinical, laboratory, therapeutic and imaging data were collected from the physical chart and analyzed in light of current publications on the topic. The first consultation occurred in January 2012, where weight loss, fever, vomiting, left-sided hypochondrium and epigastric pain were reported. Imaging exams evidenced an expansive heterogeneous process in the pancreatic tail; however, laboratory exams and tumor markers did not present alteration in relation to reference values. In March of 2012, she underwent caudal body pancreatectomy, splenectomy, segmental colectomy and colo-coloanastomosis as a function of the intraoperative findings. After 63 months, right-sided hepatectomy was performed to resect metastases. Currently, she is undergoing outpatient monitoring, without complaint or alterations in imaging and laboratory exams, totaling 100 months of global survival. Discussion This is an interesting case report of a rare tumor, in so far as without any adjuvant chemotherapies, an 8-year long survival time could be achieved in this particular type of tumor despite initially large tumor expansion and later liver metastases. Conclusion Additional epidemiological studies, molecular and clinical trials are required to increase knowledge on SPN.
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19
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Wright MJ, Javed AA, Saunders T, Zhu Y, Burkhart RA, Yu J, He J, Cameron JL, Makary MA, Wolfgang CL, Weiss MJ. Surgical Resection of 78 Pancreatic Solid Pseudopapillary Tumors: a 30-Year Single Institutional Experience. J Gastrointest Surg 2020; 24:874-881. [PMID: 31073801 DOI: 10.1007/s11605-019-04252-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/25/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Solid pseudopapillary tumors (SPTs) are rare, benign tumors of the pancreas that present as heterogeneous masses. We sought to evaluate the short- and long-term outcomes of surgical resected SPTs. Patients managed via initial surveillance were compared to those who underwent upfront resection. METHODS A prospectively maintained institutional database was used to identify patients who underwent surgical resection for a SPT between 1988 and 2018. Data on clinicopathological features and outcomes were collected and analyzed. RESULTS Seventy-eight patients underwent surgical resection for SPT during the study period. The mean age was 34.0 ± 14.6 years and a majority were female (N = 67, 85.9%) and white (N = 46, 58.9%). Thirty patients (37.9%) were diagnosed incidentally. Imaging-based presumed diagnosis was SPT in 49 patients (62.8%). A majority were located in the body or tail of the pancreas (N = 47, 60.3%), and 48 patients (61.5%) underwent a distal pancreatectomy. The median tumor size was 4.0 cm (IQR, 3.0-6.0), nodal disease was present in three patients (3.9%), and R0 resection was performed in all patients. No difference was observed in clinicopathological features and outcomes between patients who were initially managed via surveillance and those who underwent upfront resection. None of the patients under surveillance had nodal disease or metastasis at the time of resection; however, one of them developed recurrence of disease 95.1 months after resection. At a median follow-up of 36.1 months (IQR, 8.1-62.1), 77 (%) patients were alive and one patient (1.3%) had a recurrence of disease at 95.1 months after resection and subsequently died due to disease. CONCLUSIONS SPTs are rare pancreatic tumors that are diagnosed most frequently in young females. While a majority are benign and have an indolent course, malignant behavior has been observed. Surgical resection can result in exceptional outcomes.
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Affiliation(s)
- Michael J Wright
- The John L. Cameron Division of Hepatobiliary and Pancreatic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ammar A Javed
- The John L. Cameron Division of Hepatobiliary and Pancreatic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Tyler Saunders
- The John L. Cameron Division of Hepatobiliary and Pancreatic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Yayun Zhu
- The John L. Cameron Division of Hepatobiliary and Pancreatic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Richard A Burkhart
- The John L. Cameron Division of Hepatobiliary and Pancreatic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jun Yu
- The John L. Cameron Division of Hepatobiliary and Pancreatic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jin He
- The John L. Cameron Division of Hepatobiliary and Pancreatic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - John L Cameron
- The John L. Cameron Division of Hepatobiliary and Pancreatic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Martin A Makary
- The John L. Cameron Division of Hepatobiliary and Pancreatic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Christopher L Wolfgang
- The John L. Cameron Division of Hepatobiliary and Pancreatic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Matthew J Weiss
- The John L. Cameron Division of Hepatobiliary and Pancreatic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. .,Pancreas Cancer Multidisciplinary Clinic, Liver Cancer Multidisciplinary Clinic, Surgical Oncology Fellowship, Miller Coulson Academy of Clinical Excellence, Johns Hopkins University, 600 N. Wolfe St. / Blalock 685, Baltimore, MD, 21287, USA.
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20
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Yepuri N, Naous R, Meier AH, Cooney RN, Kittur D, Are C, Jain A, Dhir M. A systematic review and meta-analysis of predictors of recurrence in patients with Solid Pseudopapillary Tumors of the Pancreas. HPB (Oxford) 2020; 22:12-19. [PMID: 31350105 DOI: 10.1016/j.hpb.2019.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 06/02/2019] [Accepted: 06/09/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The recurrence rates and predictors of recurrence in patients with Solid Pseudopapillary tumors (SPT) are unclear, which makes it challenging to determine the duration of follow-up. The aim of the current study was to perform a systematic review and meta-analysis to determine the recurrence rates and pathologic factors associated with recurrence in patients with SPT. METHODS A PubMed, Scopus, and Web of Science search was conducted to identify studies of SPT published during the last 15 years: (09/2002-09/2017). Studies reporting on patients with SPT and follow-up of >5 years were included. The search strategy was conducted per 2009 PRISMA guidelines. RESULTS A total of 103 studies reporting on 2599 non-metastatic SPT patients were identified. Sixty-nine patients (2.6%) developed recurrence during follow-up. Pooled estimates from studies with a sample size >20 (N = 33) noted an overall recurrence rate of 2% (95% CI 1-2%). Male gender (OR 1.960), positive lymph nodes (OR 11.9), R1 margins (OR 11.1), and LVI (OR 5.5), were associated with a significantly (all p < 0.05) increased risk of recurrence. CONCLUSION Current meta-analysis suggests that only 2% of patients with SPT experience recurrence after resection. These data will guide the treating physicians and patients regarding recurrence rates and help identify patients at increased risk of recurrence during follow-up.
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Affiliation(s)
- Natesh Yepuri
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Rana Naous
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Andreas H Meier
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Robert N Cooney
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Dilip Kittur
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Chandrakanth Are
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Ajay Jain
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Mashaal Dhir
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, 13210, USA.
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21
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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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22
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Torres OJM, Rezende MBD, Waechter FL, Neiva RF, Moraes-Junior JMA, Torres CCS, Fernandes EDSM. PANCREATODUODENECTOMY FOR SOLID PSEUDOPAPILLARY TUMOR OF THE PANCREAS: A MULTI-INSTITUTION STUDY. ACTA ACUST UNITED AC 2019; 32:e1442. [PMID: 31460602 PMCID: PMC6713058 DOI: 10.1590/0102-672020190001e1442] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/11/2019] [Indexed: 02/06/2023]
Abstract
Background: Solid pseudopapillary tumor of the pancreas is a rare low-grade malignant
neoplasm. Most patients present with nonspecific symptoms until the tumor
becomes large. Complete surgical resection by pancreatoduodenectomy is the
treatment of choice for tumors located in the head of the pancreas Aim: To analyzed the clinicopathologic features, management, and outcomes of
patients who had solid pseudopapillary tumor of the head pancreas and
underwent surgical resection. Methods: Were analyzed 16 patients who underwent pancreatoduodenectomy for this
condition. Results: Mean age was 25.7 years old, and 15 patients were female (93.7%). Nonspecific
abdominal pain was present in 14 (87.5%). All underwent computed tomography
and/or magnetic resonance imaging as part of diagnostic workup. The median
diameter of the tumor was 6.28 cm, and surgical resection was performed with
open or laparoscopic pancreatoduodenectomy without neoadjuvant chemotherapy.
Postoperative complications occurred in six patients (37.5%) and included
pancreatic fistula without mortality. The mean of hospital stay was 10.3
days. Median follow-up was 3.6 years, and no patient had local recurrence or
metastatic disease. Conclusion: For these patients surgical resection with pancreatoduodenectomy is the
treatment of choice showing low morbidity, no mortality, and good long-term
survival.
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Affiliation(s)
- Orlando Jorge M Torres
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Universidade Federal do Maranhão, São Luiz, MA
| | - Marcelo Bruno de Rezende
- Department of Gastrointestinal and Transplant Surgery, Hospital Israelita Albert Einstein, São Paulo, SP
| | - Fábio Luiz Waechter
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Santa Casa Hospital, Porto Alegre, RS
| | - Romerito Fonseca Neiva
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Universidade Federal do Maranhão, São Luiz, MA
| | - José Maria A Moraes-Junior
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Universidade Federal do Maranhão, São Luiz, MA
| | - Camila Cristina S Torres
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Universidade Federal do Maranhão, São Luiz, MA
| | - Eduardo de Souza M Fernandes
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary and Transplant Unit, Universidade Federal do Rio de Janeiro, RJ, Brazil
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Jin JB, Qin K, Yang Y, Shi YS, Wu ZC, Deng XX, Chen H, Cheng DF, Shen BY, Peng CH. Robotic pancreatectomy for solid pseudopapillary tumors in the pancreatic head: A propensity score-matched comparison and analysis from a single center. Asian J Surg 2019; 43:354-361. [PMID: 31327550 DOI: 10.1016/j.asjsur.2019.05.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/15/2019] [Accepted: 05/31/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Robotic surgery is the most advanced minimally invasive technique for the treatment of complicated solid pseudopapillary tumors (SPT). The aim of this study is to evaluate feasibility of robotic surgery for the treatment of SPTs in the pancreatic head. METHODS A retrospective analysis of the clinical data of 83 SPTs in pancreatic head was conducted. Clinical characteristics were extracted and propensity score matching (PSM) was used to compare and evaluate mid-term outcomes of the two techniques. RESULTS Pancreaticoduodenectomy (PD), duodenum-preserving partial pancreatic head resection (DPPHR-P) and tumor enucleation (En) were performed in 51, 24, and 8 patients, respectively. The robotic approach was associated with a significantly lower volume of blood loss, lower need for transfusion, and faster time to post-surgery recovery. Major complications and costs were comparable for both techniques. CONCLUSION A robotic approach provides an alternative to open surgery for SPTs in the pancreatic head without increasing the incidence of clinically relevant pancreatic fistula (CRPF) or other major complications and with good patient outcomes.
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Affiliation(s)
- Jia-Bin Jin
- Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai 200025, PR China
| | - Kai Qin
- Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai 200025, PR China
| | - Yi Yang
- Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai 200025, PR China
| | - Yu-Sheng Shi
- Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai 200025, PR China
| | - Zhi-Chong Wu
- Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai 200025, PR China
| | - Xia-Xing Deng
- Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai 200025, PR China
| | - Hao Chen
- Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai 200025, PR China
| | - Dong-Feng Cheng
- Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai 200025, PR China.
| | - Bai-Yong Shen
- Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai 200025, PR China.
| | - Cheng-Hong Peng
- Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin Er Road, Shanghai 200025, PR China.
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Zalatnai A, Kis-Orha V. Solid-pseudopapillary Neoplasms of the Pancreas is still an Enigma: a Clinicopathological Review. Pathol Oncol Res 2019; 26:641-649. [PMID: 31209654 PMCID: PMC7242268 DOI: 10.1007/s12253-019-00671-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/20/2019] [Indexed: 02/07/2023]
Abstract
The solid-pseudopapillary neoplasm of the pancreas is a rare but enigmatic entity occurring mainly in young women. Since the first description by V. Frantz in 1959 the terminology of this tumor has continuously changed but it has remained simply descriptive, because the exact histogenesis is still obscure. Although in majority of cases the survival is excellent, nevertheless, the expected prognosis is not exactly predictable. In this review the authors aim to summarize its clinico-pathological features, the expected biological behavior, the molecular alterations, the immune phenotype and discuss the putative histogenesis. From diagnostic point of view, the salient histological characteristic findings are analyzed that would help to differentiate it from other, look-alike pancreatic tumors, and suggestions are made about the desirable content of the histological report.
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Affiliation(s)
- Attila Zalatnai
- First Department of Pathology and Experimental Cancer Research, Faculty of Medicine, Semmelweis University, H-1085 Üllői út, Budapest, 26, Hungary.
| | - Viktória Kis-Orha
- First Department of Pathology and Experimental Cancer Research, Faculty of Medicine, Semmelweis University, H-1085 Üllői út, Budapest, 26, Hungary
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25
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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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26
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Wang J, Gerrard G, Poskitt B, Dawson K, Trivedi P, Foroni L, El-Bahrawy M. Targeted next generation sequencing of pancreatic solid pseudopapillary neoplasms show mutations in Wnt signaling pathway genes. Pathol Int 2019; 69:193-201. [PMID: 30811747 DOI: 10.1111/pin.12778] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/10/2019] [Indexed: 12/11/2022]
Abstract
Solid pseudopapillary neoplasms of the pancreas are rare neoplasms that have been shown to harbor recurrent somatic pathogenic variants in the beta-catenin gene, CTNNB1. Here, we used targeted next generation sequencing to analyze these tumors for other associated mutations. Six cases of solid pseudopapillary neoplasms were studied. DNA extracted from formalin-fixed paraffin embedded tissue blocks was analyzed using the Ion Torrent platform, with the 50-gene Ampliseq Cancer Hotspot Panel v2 (CHPv2), with further variant validation performed by Sanger sequencing. Four tumors (67%) were confirmed to harbor mutations within CTNNB1, two with c.109T > G p.(Ser37Ala) and two with c.94G > A p.(Asp32Asn). One case showed a frameshift deletion in the Adenomatous Polyposis Coli gene, APC c.3964delG p.(Glu1322Lysfs*93) with a variant allele frequency of 42.6%. Sanger sequencing on non-tumoral tissue confirmed the variant was somatic. The patient with the APC mutation developed metastasis and died. In addition to the four cases harboring CTNNB1 variants, we found a case characterized by poor outcome, showing a rare frameshift deletion in the APC gene. Since the APC product interacts with beta-catenin, APC variants may, in addition to CTNNB1, contribute to the pathogenesis of solid pseudopapillary neoplasms via the Wnt signaling pathway.
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Affiliation(s)
- Jayson Wang
- Department of Cellular Pathology, St George's Hospital, London, UK
| | - Gareth Gerrard
- Department of Medicine, Centre for Haematology, Imperial College London, London, UK
- Sarah Cannon Molecular Diagnostics, HCA Healthcare UK, London, UK
| | - Ben Poskitt
- Sarah Cannon Molecular Diagnostics, HCA Healthcare UK, London, UK
| | - Kay Dawson
- Department of Histopathology, Imperial College London, Hammersmith Hospital, London, UK
| | - Pritesh Trivedi
- Department of Histopathology, Imperial College London, Hammersmith Hospital, London, UK
| | - Letizia Foroni
- Department of Medicine, Centre for Haematology, Imperial College London, London, UK
| | - Mona El-Bahrawy
- Department of Histopathology, Imperial College London, Hammersmith Hospital, London, UK
- Faculty of Medicine, Department of Pathology, University of Alexandria, Alexandria, Egypt
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27
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Limaiem F, Mestiri H, Mejri S, Lahmar A, Mzabi S. Solid pseudopapillary neoplasm of the pancreas in two male patients: gender does not matter. Pan Afr Med J 2017; 27:283. [PMID: 29187952 PMCID: PMC5660899 DOI: 10.11604/pamj.2017.27.283.9800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/02/2017] [Indexed: 11/11/2022] Open
Abstract
Solid pseudopapillary tumour (SPT) is an unusual pancreatic neoplasm which predominantly affects young women. Less than 10% of patients with SPT in the reported literature were male. In this paper, the authors report two new cases of SPT that occurred in two male patients aged respectively 25 and 20 years old. Abdominal computed tomography scan showed a well-defined heterogeneous mass involving respectively the tail and the body of the pancreas with peripheral calcifications in the first case. The two patients underwent distal splenopancreatectomy. Histopathological examination of the surgical specimen coupled with immunohistochemical study was compatible with solid pseudopapillary tumour. On postoperative day 8, the first patient developed abdominal wall abscess and peritoneal collection. Postoperative course was uneventful for the second patient. In summary, a large, well-encapsulated cystic mass in the pancreas of a young man should raise suspicion of solid pseudopapillary tumour.
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Affiliation(s)
- Faten Limaiem
- University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisi
| | - Hafedh Mestiri
- University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisi
| | - Saloua Mejri
- University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisi
| | - Ahlem Lahmar
- University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisi
| | - Sabeh Mzabi
- University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisi
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28
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Nagem RG. Is Watchful Waiting an Option in Margin-Positive Solid Pseudopapillary Neoplasms of the Pancreas? J Gastrointest Cancer 2017; 49:104-105. [PMID: 29110226 DOI: 10.1007/s12029-017-0025-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Rachid G Nagem
- Department of Surgery, Ipsemg Hospital, Belo Horizonte, Minas Gerais, Brazil. .,Department of Surgery, School of Medicine, Federal University of Minas Gerais, 190 Alfredo Balena Avenue, Belo Horizonte, MG, 30130-100, Brazil.
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29
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Tanaka K, Misawa T, Haruki K, Saito R, Gocho T, Akiba T. Enucleation of solid pseudopapillary tumor with a preoperative nasopancreatic drainage stent in a child. Asian J Endosc Surg 2017. [PMID: 28635016 DOI: 10.1111/ases.12397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Solid pseudopapillary tumor (SPT) is a rare pancreatic tumor with low-grade malignancy in children. A complete surgical resection can achieve a favorable prognosis. Although several reports have indicated that enucleation is considered a safe and effective treatment, the most significant complication is injury to the main pancreatic duct. The usefulness and safety of tumor enucleation after preoperative placement of an endoscopic nasopancreatic drainage stent (NPDS) has recently been reported. We present the case of SPT in a 10-year-old girl. To avoid and detect injury to the main pancreatic duct during operation, an NPDS was endoscopically placed before laparotomy. The patient underwent a complete enucleation of the tumor with the guidance of an NPDS. Our case is the first report of a successful enucleation of an SPT with a preoperative placement of an NPDS. This procedure may lead to safe enucleation of a pancreatic tumor with low malignancy, such as SPT, in children.
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Affiliation(s)
- Keiichiro Tanaka
- Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Takeyuki Misawa
- Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Koichiro Haruki
- Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Ryota Saito
- Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Takeshi Gocho
- Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Tadashi Akiba
- Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
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30
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Li DL, Li HS, Xu YK, Wang QS, Chen RY, Zhou F. Solid pseudopapillary tumor of the pancreas: clinical features and imaging findings. Clin Imaging 2017; 48:113-121. [PMID: 29073488 DOI: 10.1016/j.clinimag.2017.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 09/16/2017] [Accepted: 10/09/2017] [Indexed: 02/07/2023]
Abstract
This study aimed to report clinical features and CT, MRI, PET/CT findings of solid pseudopapillary tumor (SPT) of the pancreas. Thirty-four patients with pathologically proven SPT were retrospectively reviewed. Most patients were asymptomatic. SPTs in male patients mainly appeared as solid and near solid tumors. Mixed tumors and cystic tumors had larger size than solid and near solid tumors. Solid tumors and solid part of mixed tumors were T2 hyperintense and T1 hypointense and had progressive enhancement. Four tumors (80%) showed markedly even or uneven 18F-FDG uptake. These characteristic features can help differentiate SPT from other pancreatic neoplasms.
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Affiliation(s)
- Dong-Li Li
- Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Hong-Sheng Li
- PET Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Yi-Kai Xu
- Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China.
| | - Quan-Shi Wang
- PET Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Rui-Ying Chen
- Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Fang Zhou
- Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China
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31
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Abstract
Mortality due to pancreatic ductal adenocarcinoma (PDAC) will increase in the near future. The only curative treatment for PDAC is radical resection; however, even small carcinomas exhibit micrometastases leading to early relapse. Accordingly, detection of premalignant precursor lesions is important. In essence, PDAC develops from three precursor lesions: pancreatic intraepithelial lesions (PanIN), intraductal papillary-mucinous neoplasia (IPMN) and mucinous-cystic neoplasia (MCN). Together with serous cystic neoplasia (SCN) and solid pseudopapillary neoplasia (SPN), these cystic lesions constitute the most common cystic neoplasms in the pancreas. In the case of IPMN, main and branch duct IPMN have to be differentiated because of a markedly different malignancy potential. While main duct IPMN and MCN have a high malignancy transformation rate, branch duct IPMNs are more variable with respect to malignant transformation. This shows that differential diagnosis of cystic lesions is important; however, this is often very difficult to accomplish using conventional imaging. Novel biomarkers and diagnostic tools based on the molecular differences of cystic pancreatic lesions could be helpful to differentiate these lesions and facilitate early diagnosis. The aim is to distinguish the premalignant cysts from strictly benign cystic lesions and a timely detection of malignant transformation. This article provides an overview on the molecular characteristics of cystic pancreatic lesions as a basis for improved diagnostics and the development of new biomarkers.
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Affiliation(s)
- A W Berger
- Klinik für Innere Medizin 1, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - T Seufferlein
- Klinik für Innere Medizin 1, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
| | - A Kleger
- Klinik für Innere Medizin 1, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
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32
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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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Beltrame V, Pozza G, Dalla Bona E, Fantin A, Valmasoni M, Sperti C. Solid-Pseudopapillary Tumor of the Pancreas: A Single Center Experience. Gastroenterol Res Pract 2016; 2016:4289736. [PMID: 28119738 PMCID: PMC5227167 DOI: 10.1155/2016/4289736] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 12/15/2016] [Indexed: 02/05/2023] Open
Abstract
Aim of this study was to review the institutional experience of solid-pseudopapillary tumors of the pancreas with particular attention to the problems of preoperative diagnosis and treatment. From 1997 to 2013, SPT was diagnosed in 18 patients among 451 pancreatic cystic neoplasms (3.7%). All patients underwent preoperative abdominal ultrasound, computed assisted tomography, and tumor markers (CEA and CA 19-9) determinations. In some instances, magnetic resonance, positron emission tomography, and endoscopic ultrasound with aspiration cytology were performed. There were two males and 16 females. Serum CA 19-9 was slightly elevated in one case. Preoperative diagnosis was neuroendocrine tumor (n = 2), mucinous tumor (n = 2), and SPT (n = 14). Two patients underwent previous operation before referral to our department: one explorative laparotomy and one enucleation of SPT resulting in surgical margins involvement. All patients underwent pancreatic resection associated with portal vein resection (n = 1) or liver metastases (n = 1). One patient died of metastatic disease, 77 months after operation, and 17 are alive and free with a median survival time of 81.5 months (range 36-228 months). Most of SPT can be diagnosed by CT or MRI, and the role of other diagnostic tools is very limited. We lack sufficient information regarding clinicopathologic features predicting prognosis. Caution is needed when performing limited resection, and long and careful follow-up is required for all patients after surgery.
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Affiliation(s)
- Valentina Beltrame
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Gioia Pozza
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Enrico Dalla Bona
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Alberto Fantin
- Gastroenterology Unit, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Michele Valmasoni
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Cosimo Sperti
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
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34
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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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35
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Zhou J, Zhou Y, Mou Y, Xia T, Xu X, Jin W, Zhang R, Lu C, Chen R. Laparoscopic duodenum-preserving pancreatic head resection: A case report. Medicine (Baltimore) 2016; 95:e4442. [PMID: 27512859 PMCID: PMC4985314 DOI: 10.1097/md.0000000000004442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Solid pseudopapillary neoplasms (SPNs) of the pancreas are uncommon neoplasms and are potentially malignant. Complete resection is advised due to rare recurrence and metastasis. Duodenum-preserving pancreatic head resection (DPPHR) is indicated for SPNs located in the pancreatic head and is only performed using the open approach. To the best of our knowledge, there are no reports describing laparoscopic DPPHR (LDPPHR) for SPNs. METHODS Herein, we report a case of 41-year-old female presented with a 1-week history of epigastric abdominal discomfort, and founded an SPN of the pancreatic head by abdominal computed tomography/magnetic resonance, who was treated by radical LDPPHR without complications, such as pancreatic fistula and bile leakage. Histological examination of the resected specimen confirmed the diagnosis of SPN. RESULTS The patient was discharged 1 week after surgery following an uneventful postoperative period. She was followed up 3 months without readmission and local recurrence according to abdominal ultrasound. CONCLUSION LDPPHR is a safe, feasible, and effective surgical procedure for SPNs.
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Affiliation(s)
- Jiayu Zhou
- Department of General Surgery, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yucheng Zhou
- Department of General Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Yiping Mou
- Department of General Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Tao Xia
- Department of General Surgery, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Xiaowu Xu
- Department of General Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Weiwei Jin
- Department of General Surgery, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Renchao Zhang
- Department of General Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Chao Lu
- Department of General Surgery, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Ronggao Chen
- Department of General Surgery, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
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AKIMOTO Y, KATO H, HARADA R, UCHIDA D, SEKI H, TOMODA T, MATSUMOTO K, YAMAMOTO N, HORIGUCHI S, TSUTSUMI K, MURO SI, UEKI T, ODA S, FUSHIMI S, YAGI T, OKADA H. Gender differences in clinicopathological features of 20 cases with solid pseudopapillary neoplasms of the pancreas. ACTA ACUST UNITED AC 2016. [DOI: 10.2958/suizo.31.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yutaka AKIMOTO
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Hironari KATO
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Ryo HARADA
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Daisuke UCHIDA
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Hiroyuki SEKI
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Takeshi TOMODA
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Kazuyuki MATSUMOTO
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Naoki YAMAMOTO
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Shigeru HORIGUCHI
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Koichiro TSUTSUMI
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | | | - Toru UEKI
- Department of Internal Medicine, Fukuyama City Hospital
| | - Shinsuke ODA
- Department of Pathology, Okayama University Hospital
| | | | - Takahito YAGI
- Department of Hepato-Biliary-Pancreatic Surgery, Okayama University Hospital
| | - Hiroyuki OKADA
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
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Zhang C, Liu F, Chang H, Li H, Zhou X, Lu J, Qin C, Sun Y, Sun H, Lin J. Less Aggressive Surgical Procedure for Treatment of Solid Pseudopapillary Tumor: Limited Experience from a Single Institute. PLoS One 2015; 10:e0143452. [PMID: 26599966 PMCID: PMC4658154 DOI: 10.1371/journal.pone.0143452] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/04/2015] [Indexed: 01/17/2023] Open
Abstract
Objectives To evaluate the clinical characteristics and radiological features of solid pseudopapillary tumor (SPT) and assess surgical therapy strategy. Methods A retrospective review was performed in 62 patients pathologically confirmed of SPT treated between 2003 and 2014. The clinical features, radiological examinations and surgical strategies were analyzed. Results 56 females and 6 males were included in this study, mean age was 26 years old (range: 8–66 years old) with mean size of the tumor was 7.2 cm (range: 3–15 cm), and most tumor were commonly located in the head of pancreas (n = 29). Among all the cases, 3 patients had liver metastasis and underwent resection of SPT and liver metastasis. Furthermore, we performed 29 cases of local tumor excision; other patients underwent pancreaticoduodenectomy, middle pancreatectomy, middle pancreatectomy with splenectomy, distal pancreatectomy with spleen preservation, distal pancreatectomy with splenectomy and duodenum-preserving pancreatic head resection. No patient suffered from lymph node metastases. After median follow-up of 46 months (range: 2–135 months), no mortality or local recurrence or distant metastasis was found. Conclusions Solid pseudopapillary tumor is a latent malignant tumor with excellent prognosis. If feasible, less aggressive resection without regular lymphadenectomy is recommended for treatment of patients with SPT.
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Affiliation(s)
- Chi Zhang
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Fangfeng Liu
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Hong Chang
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
- * E-mail:
| | - Hongguang Li
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Xu Zhou
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Jun Lu
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Chengkun Qin
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Yongjie Sun
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Huidong Sun
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Jianbo Lin
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
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