Published online Mar 6, 2021. doi: 10.12998/wjcc.v9.i7.1682
Peer-review started: October 7, 2020
First decision: November 8, 2020
Revised: November 23, 2020
Accepted: January 22, 2021
Article in press: January 22, 2021
Published online: March 6, 2021
Processing time: 144 Days and 12.7 Hours
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.
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.
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.
Core Tip: Solid pseudopapillary neoplasm accounts for approximately 0.7% of pancreatic cystic tumors. It is benign in 85% of the cases, while 15% can have malignant behavior. The advancement of cross sectional imaging has led to increased detection. Demographic and characteristic imaging findings might be sufficient to make a diagnosis and predict malignant behavior, which can direct the need towards further testing or to proceed directly with surgery. Definitive treatment is surgical resection and the type of surgery depends on location and presence of peripancreatic invasion.