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Bondarenko N, Bilokha A, Bielosludtsev O, Hrytsenko P, Shponka I. Solid pseudopapillary neoplasm of the pancreas in a 54-year-old woman: A case report and the literature analysis. Pathol Res Pract 2025; 266:155799. [PMID: 39753018 DOI: 10.1016/j.prp.2024.155799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2024] [Revised: 12/23/2024] [Accepted: 12/24/2024] [Indexed: 05/01/2025]
Abstract
INTRODUCTION Solid pseudopapillary neoplasm (SPN) is a rare pancreatic tumor typically occurring in young females. This case presents an instance of SPN in a 54-year-old Caucasian female, highlighting atypical age of onset and providing new insights into the tumor's clinical and histopathological diversity. CASE REPORT A 54-year-old female with no significant past medical history presented with upper abdominal discomfort and weakness. Initial diagnostic imaging suggested a pancreatic tumor. The patient underwent laparotomic resection with pancreatic-gastric anastomosis. Histopathological analysis revealed a 2 cm tumor with mixed growth patterns - solid, trabecular, microcystic, and pseudopapillary - with varying cell types including vacuolated, eosinophilic, and clear cells. Despite showing malignant features such as local invasion in the adjacent pancreatic parenchyma, lymphovascular and perineural invasion, areas of haemorrhage, and focal nuclear atypia, no metastasis was observed. Immunohistochemistry confirmed the diagnosis of SPN with aberrant β-catenin expression. The tumor was resected successfully, and the patient had an uneventful recovery with no additional therapy required. A 60-month follow-up showed no recurrence. CONCLUSION This case underscores the rarity of SPN in older patients and the variability in its histopathological presentation. Different growth patterns and microscopic malignant features of SPNs should be taken into account during histological evaluation and pathological reporting, as they may be important for determination of tumor prognostic potential and treatment strategies. Further research is needed to standardize pathologic evaluations and improve understanding of SPN recurrence and management.
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Affiliation(s)
| | - Alina Bilokha
- Dnipro State Medical University, Dnipro 49044, Ukraine
| | - Oleksii Bielosludtsev
- Communal Institution, Dnipro Regional Clinical Oncological Dispansary of Dnipro Regional Council, Dnipro 49055, Ukraine
| | | | - Ihor Shponka
- Dnipro State Medical University, Dnipro 49044, Ukraine
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Devkota S, Acharya K, Poudel N, Shrestha A, Bhattarai A, Kansakar PBS. Spontaneous ruptured solid pseudopapillary tumor of pancreas: a rare condition identified in a patient presenting with features of shock. Ann Med Surg (Lond) 2025; 87:949-952. [PMID: 40110276 PMCID: PMC11918701 DOI: 10.1097/ms9.0000000000002941] [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: 08/06/2024] [Accepted: 01/05/2025] [Indexed: 03/22/2025] Open
Abstract
Introduction Solid pseudopapillary tumor of pancreas are rare benign tumors of pancreas, that typically affects the young women. They are usually asymptomatic or minimally symptomatic, and are usually diagnosed by different imaging modalities. Case presentation We herein present a case of solid pseudopapillary tumor of pancreas in an 18-year-old female patient who presented to our emergency department with features of shock following its spontaneous rupture. Imaging showed features suggestive of solid pseudopapillary tumor of pancreas, and she was managed by exploratory laparotomy following initial resuscitation. Discussion Solid pseudopapillary tumors of pancreas are one of the rare exocrine pancreatic tumors. Their origin is not exactly clear, the most accepted theory states that these tumors originate from the multipotent primordial cells. Preoperative diagnosis can be made showing features distinct from other pancreatic solid/cystic neoplasms. Surgical management is the preferred treatment modality in these tumors. Conclusion These are rare entities of pancreas, and may present with vague abdominal symptoms. Sometimes, these tumors may undergo spontaneous rupture, presenting with features of shock.
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Affiliation(s)
- Shishir Devkota
- Department of General Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Kshitiz Acharya
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Navin Poudel
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Aron Shrestha
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Abhishek Bhattarai
- Department of General Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Prasan B S Kansakar
- Department of General Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Ahamed N, S P, Srinivasan K, P V, Ahanatha Pillai S. Unraveling a Rare Case of Pediatric Solid Pseudopapillary Neoplasm With a Replaced Common Hepatic Artery Arising From the Superior Mesenteric Artery. Cureus 2024; 16:e73332. [PMID: 39655108 PMCID: PMC11626987 DOI: 10.7759/cureus.73332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2024] [Indexed: 12/12/2024] Open
Abstract
Pancreatic solid pseudopapillary epithelial neoplasm (SPEN) is a rare pancreatic tumor with low-grade malignant potential. They often present in young women in their second and third decade of life, with only a small minority concerning children. It has a good prognosis, with a five-year survival rate of up to 97%. A common hepatic artery (CHA) arising from the superior mesenteric artery (SMA) is a rare occurrence. A 12-year-old girl, admitted with features of obstructive jaundice, was evaluated to have a heterogeneously enhancing mass lesion of size 7.5 × 7.2 cm involving the head of the pancreas on contrast-enhanced CT of the abdomen (CECT). CT angiogram showed a CHA trunk arising from the SMA and a type V hepatic arterial variation. Whipple's pancreaticoduodenectomy was done for the patient, and the postoperative period was uneventful. The subsequent histopathology report was confirmatory for SPEN, with an R0 margin of resection. SPENs of the pancreas are extremely rare, and after surgical resection, they often have an excellent long-term prognosis. Variations in hepatic artery anatomy, as in this case, need meticulous dissection to avoid inadvertent vascular insult.
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Affiliation(s)
- Niyas Ahamed
- Surgical Gastroenterology, Madurai Medical College, Madurai, IND
| | - Padmanabhan S
- Surgical Gastroenterology, Madurai Medical College, Madurai, IND
| | | | - Venkatesan P
- General Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Carmona AL, Fayek SA. A Unique Presentation of Solid Pseudopapillary Neoplasm of the Pancreas Requiring Pancreaticoduodenectomy Without Pancreatojejunostomy: A Case Report and Literature Review. Cureus 2024; 16:e63603. [PMID: 39087146 PMCID: PMC11290407 DOI: 10.7759/cureus.63603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2024] [Indexed: 08/02/2024] Open
Abstract
Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare tumors that predominantly affect young females and are typically located in the body and tail of the pancreas. Here, we present the case of a 59-year-old male with a large, heavily calcified SPN in the pancreatic head. His surgical history includes an aborted pancreaticoduodenectomy due to vascular involvement, followed by a gastrojejunostomy. Twenty years after the initial discovery, a pancreaticoduodenectomy was performed - the first of its kind - where the pancreas was completely atrophied, and no pancreaticojejunostomy was performed. Histological examination revealed typical features of SPN. This case demonstrates that even with relatively large lesions in a male patient over an extended duration, SPNs can still exhibit favorable features, highlighting the absence of specific preoperative markers for aggressive tumors. Therefore, unless there is an absolute contraindication, complete resection of all SPNs remains advisable.
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Affiliation(s)
- Alexis L Carmona
- Medicine, University of California (UC) Riverside School of Medicine, Riverside, USA
| | - Sameh A Fayek
- Surgery, University of North Texas Health Science Center, Fort Worth, USA
- Surgery, Faculty of Medicine, Cairo, EGY
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Ku PY, Cheng SB, Chen YJ, Lai CY, Liu HT, Chen WH. Surgical Outcomes of Pancreatic Solid Pseudopapillary Neoplasm: Experiences of 24 Patients in a Single Institute. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:889. [PMID: 38929506 PMCID: PMC11205590 DOI: 10.3390/medicina60060889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/22/2024] [Accepted: 05/25/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: The pancreatic solid pseudopapillary neoplasm (SPN), a rare tumor predominantly affecting young women, has seen an increased incidence due to improved imaging and epidemiological knowledge. This study aimed to understand the outcomes of different interventions, possible complications, and associated risk factors. Materials and Methods: This study retrospectively analyzed 24 patients who underwent pancreatic surgery for SPNs between September 1998 and July 2020. Results: Surgical intervention, typically required for symptomatic cases or pathological confirmation, yielded favorable outcomes with a 5-year survival rate of up to 97%. Despite challenges in standardizing preoperative evaluation and follow-up protocols, aggressive complete resection showed promising long-term survival and good oncological outcomes. Notably, no significant differences were found between conventional and minimally invasive (MI) surgery in perioperative outcomes. Histopathological correlations were lacking in prognosis and locations. Among the patients, one developed diffuse liver metastases 41 months postoperatively but responded well to chemotherapy and transcatheter arterial chemoembolization, with disease stability observed at 159 postoperative months. Another patient developed nonalcoholic steatohepatitis after surgery and underwent liver transplantation, succumbing to poor medication adherence 115 months after surgery. Conclusions: These findings underscore the importance of surgical intervention in managing SPNs and suggest the MI approach as a viable option with comparable outcomes to conventional surgery.
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Affiliation(s)
- Peng-Yu Ku
- Division of General Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (P.-Y.K.)
| | - Shao-Bin Cheng
- Division of General Surgery, Department of Surgery, Taichung Tzu Chi Hospital, Taichung 427213, Taiwan
| | - Yi-Ju Chen
- Division of General Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (P.-Y.K.)
| | - Chia-Yu Lai
- Division of General Surgery, Department of Surgery, Taichung Tzu Chi Hospital, Taichung 427213, Taiwan
| | - Hsiao-Tien Liu
- Division of General Surgery, Department of Surgery, Taichung Tzu Chi Hospital, Taichung 427213, Taiwan
| | - Wei-Hsin Chen
- Division of General Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (P.-Y.K.)
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Gil J, Suh M, Choi H, Paeng JC, Cheon GJ, Kang KW. [ 18F]FDOPA PET/CT in Solid Pseudopapillary Tumor of the Pancreas: a Recurred Tumor Mimicking Splenosis. Nucl Med Mol Imaging 2024; 58:81-85. [PMID: 38510822 PMCID: PMC10948710 DOI: 10.1007/s13139-023-00826-1] [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: 09/14/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 03/22/2024] Open
Abstract
Solid pseudopapillary tumor (SPT) of the pancreas is a neoplasm with low malignant potential. It is often challenging to diagnose SPT due to its nonspecific clinical and radiological features, and [18F]FDOPA is effective in diagnosing SPT, particularly in differentiating SPT from benign conditions such as splenosis. A 55-year-old woman underwent distal pancreatectomy and splenectomy for histologically confirmed SPT. She was also initially diagnosed with splenosis. During follow-up, sizes of multiple nodular lesions were increased, raising the possibility of peritoneal seeding of SPT. For diagnosis, a spleen scan and SPECT/CT were performed using 99mTc-labeled damaged red blood cells, which showed no uptake in the peritoneal nodules. Subsequent [18F]FDOPA PET/CT revealed [18F]FDOPA-avidity of the nodules. The patient underwent tumor resection surgery, and the nodules were pathologically confirmed as SPT.
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Affiliation(s)
- Joonhyung Gil
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Minseok Suh
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Hongyoon Choi
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Keon Wook Kang
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
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Lu X, Chen H, Zhang T. Solid pseudopapillary neoplasm (SPN) of the pancreas: current understanding on its malignant potential and management. Discov Oncol 2024; 15:77. [PMID: 38498246 PMCID: PMC10948659 DOI: 10.1007/s12672-024-00905-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024] Open
Abstract
Solid pseudopapillary neoplasms (SPN) of the pancreas are presently recognized as low-grade malignant tumors that are frequently observed in young females. This tumor has a low incidence and is associated with an excellent prognosis following surgical resection. Typical SPNs primarily affect the pancreas and tend to have moderate or asymptomatic manifestations. Based on retrospective research, it is anticipated that patients with SPN can achieve disease-free survival, even in cases when metastasis is detected during inspection. However, the incidence of malignant SPN has been consistently underestimated, as evidenced by recent research findings. Malignancy of SPN primarily encompasses invasion and infiltration, metastasis, and recurrence after R0 resection. Imaging technologies such as Ultrasound, Computed Tomography, Magnetic Resonance Imaging, and Position Emission Tomography are capable of preliminarily identifying malignant SPN, which is primarily based on its invasive clinical features. Research on risk factors of malignant SPN revealed that larger tumor size, Ki-67 index, and several other parameters had significant correlations with invasive tumor behavior. Pathologic features of malignant SPNs overlay other pancreatic tumors, nevertheless they can provide valuable assistance in the process of diagnosis. Several confirmed specific pathologic biomarkers are related to its cellular origin, characteristic gene mutation, and cell proliferation. Considering the invasiveness of malignant SPN, it is imperative to enhance the comprehensiveness of its therapy. Tumor resection remains a suggested course of action in line with typical SPN, and additional lymph node dissection is seen as reasonable. Compared to benign SPNs, malignant SPNs have worse prognosis, underscoring the necessity of early identification and treatment in comprehensive medical centers to get improved clinical outcomes.
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Affiliation(s)
- Xiaoyue Lu
- Peking Union Medical College, Beijing, China
| | - Hao Chen
- Department of General Surgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Taiping Zhang
- Department of General Surgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
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ALGhabra Y, Hamdi M, Alhomsi M, Alusef A, Qatleesh S, Ousta MA. Solid pseudopapillary neoplasm of the pancreas: A case report with a brief literature review. Int J Surg Case Rep 2024; 115:109234. [PMID: 38245948 PMCID: PMC10831808 DOI: 10.1016/j.ijscr.2024.109234] [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: 11/19/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Solid pseudopapillary neoplasm (SPN) of the pancreas, representing only 1 % of pancreatic cancers, was identified by Virginia Frantz in 1959. Predominantly affecting young females, it often remains asymptomatic, posing diagnostic challenges due to slow growth. This paper emphasizes SPN's rarity and associated diagnostic complexities. CASE PRESENTATION In a specific case, a 17-year-old female with post-traumatic right flank pain underwent an enhanced CT scan, revealing a well-defined, hypodense mass in the pancreatic head. With normal laboratory results, a diagnostic laparotomy exposed a sizable solid cystic mass. A Whipple procedure unveiled a predominantly cystic mass enveloped by a well-developed capsule. DISCUSSION SPN appears as a distinct mixed solid and cystic lesion on imaging, necessitating confirmation through core biopsy. Surgical resection, the primary treatment, ensures a positive overall prognosis, despite rare recurrence and metastases. Microscopic examination reveals pseudopapillae, and immunohistochemistry aids diagnosis with positive staining for estrogen receptor, progesterone receptor, CD10, and CD99. CONCLUSION SPN, a rare pancreatic neoplasm predominantly affecting young females, may present with abdominal pain or palpable mass despite its usual asymptomatic nature. Diagnosis involves imaging and biopsy confirmation, with surgical resection as the curative treatment. While prognosis is generally favorable, comprehensive understanding and improved management require further research for this uncommon pancreatic neoplasm.
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Affiliation(s)
- Yasser ALGhabra
- Al-Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Mohammad Hamdi
- Al-Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria; M.D, Faculty of Medicine, Aleppo University, Aleppo, Syria.
| | - Malath Alhomsi
- Al-Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Ahmad Alusef
- Al-Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria; M.D, Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Safaa Qatleesh
- Al-Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Mhd Ali Ousta
- Al-Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
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Marshall G, Byrne M, Wirth K, Liao X, Linehan DC, Wilson NA. Middle-Preserving Pancreatectomy for Multicentric Solid Pseudopapillary Neoplasm in a 10-Year-Old Female. European J Pediatr Surg Rep 2024; 12:e58-e62. [PMID: 39421548 PMCID: PMC11486527 DOI: 10.1055/s-0044-1791812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/17/2024] [Indexed: 10/19/2024] Open
Abstract
Solid pseudopapillary neoplasm (SPN) is a rare low-grade malignant tumor of the pancreas that occurs predominantly in young females. This tumor is occasionally multicentric, posing a unique surgical conundrum for resection. We present a case of a 10-year-old female with a history of multicystic dysplastic left kidney and persistent urogenital sinus who was diagnosed with biopsy-proven multicentric SPN of the pancreatic head and tail and underwent middle-preserving pancreatectomy. The patient tolerated the surgery very well. Our case is one of the few reported cases of multicentric SPN in a pediatric patient, and the only case treated with middle-preserving pancreatectomy, which is a novel surgical option for protecting pediatric patients from total endocrine and exocrine pancreatic insufficiency. With the increase in the incidence of SPN, there is an increasing need for pancreas-preserving surgical options, particularly in pediatric patients.
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Affiliation(s)
- Grace Marshall
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Matthew Byrne
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Korry Wirth
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Xiaoyan Liao
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York
| | - David C. Linehan
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Nicole A. Wilson
- Departments of Surgery, Pediatrics, and Biomedical Engineering, University of Rochester Medical Center, Rochester, New York
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Wang HT, Wang YT, Yu ZH, Tu C, Lu B, Yu L, Feng D, Wang TG. CT target scanning in the diagnosis of solid pseudopapillary tumor of the pancreas. BMC Med Imaging 2023; 23:214. [PMID: 38102549 PMCID: PMC10722792 DOI: 10.1186/s12880-023-01175-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE To discuss the value of computed tomography (CT) iterative reconstruction technique combined with target scanning in the diagnosis of solid pseudopapillary tumor of the pancreas (SPTP). METHODS The clinical information and CT examination data of 27 patients with SPTP were retrospectively analyzed, and the general condition and CT performance of the patients were observed. The CT image reconstruction algorithm of all patients used iterative reconstruction technique combined with the application of target scanning technique. RESULTS A total of 27 patients were included in this study, including 6 males and 21 females, aged 14-72 years with a mean age of 39.6 ± 13.6 years. SPTP was more common in young and middle-aged females, with a low level of tumor markers, dominated by cystic-solid tumors. The combination of CT iterative reconstruction technology and targeted scanning revealed the following: the capsule of SPTP was clear and complete, where calcifications were visible, solid components were progressively enhanced, and rare pancreatic and bile duct dilation was seen. Tumors were cystic-solid in 18 of 27 patients with SPTP, of which the solid components showed isodensity or slightly low-density, with calcifications. The solid components and cyst walls were mildly enhanced during the arterial phase, and were progressively enhanced during the parenchymal phase, portal vein phase, and delayed phase, with their enhancement degree lower than that of normal pancreatic parenchyma, and pancreatic and bile duct dilation was rare. There were no statistical differences in tumor location, morphology, growth pattern, integrity of capsule, cystic or solid, calcifications, and enhancement features between the male group and the female group (P > 0.05). CONCLUSION The iterative reconstruction combined with target scanning clearly displayed the CT features of tumors, helping the diagnosis and clinical treatment of the disease.
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Affiliation(s)
- Hai-Tao Wang
- Department of Radiology, The First Affiliated Hospital of Ningbo University, No.247 Renmin Road, Jiangbei District, Ningbo, 315020, China
| | - Yu-Tao Wang
- Department of Radiology, Ningbo Ninth Hospital, No.68 Xiangbei Road, Jiangbei District, Ningbo, 315020, China.
| | - Zhi-Hai Yu
- Department of Radiology, The First Affiliated Hospital of Ningbo University, No.247 Renmin Road, Jiangbei District, Ningbo, 315020, China
| | - Can Tu
- Department of Radiology, The First Affiliated Hospital of Ningbo University, No.247 Renmin Road, Jiangbei District, Ningbo, 315020, China
| | - Bin Lu
- Department of Radiology, The First Affiliated Hospital of Ningbo University, No.247 Renmin Road, Jiangbei District, Ningbo, 315020, China
| | - Liang Yu
- Department of Radiology, The First Affiliated Hospital of Ningbo University, No.247 Renmin Road, Jiangbei District, Ningbo, 315020, China
| | - Di Feng
- Department of Radiology, The First Affiliated Hospital of Ningbo University, No.247 Renmin Road, Jiangbei District, Ningbo, 315020, China
| | - Tie-Gong Wang
- Department of Radiology, Changhai Hostipal, Naval Medical University, No.168 Changhai Road, Yangpu District, Shanghai, 200433, China.
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Baskaran S, Lodha M, Kumar RR, Elhence P. Spontaneous rupture of solid pseudopapillary epithelial neoplasm of pancreas with intraperitoneal haemorrhage. BMJ Case Rep 2023; 16:e257398. [PMID: 38081741 PMCID: PMC10728932 DOI: 10.1136/bcr-2023-257398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Affiliation(s)
- Suruthi Baskaran
- General Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mahendra Lodha
- General Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ravi Ranjan Kumar
- General Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Poonam Elhence
- Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Gandhe S, Patil R, Yasam VR, Nagarkar R. Solid Pseudopapillary Epithelial Neoplasm of the Pancreas: A Rare Entity with Diagnostic Dilemma. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2023. [DOI: 10.1055/s-0042-1760354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
AbstractThe solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas is a relatively uncommon entity. The aim of the present study was to summarize our experiences with regard to diagnostic dilemma, surgery, postoperative follow-up, and management. This retrospective data were collected during the period from January 1, 2018 to December 31, 2020. A total of four patients (three females and one male) were identified within an age range of 13 to 25 years. All the patients were presented with nonspecific symptoms such as abdomen lumps, swelling in the abdomen, and abdominal pain. To reach a definite diagnosis, imaging studies were conducted along with endoscopic ultrasound fine-needle aspiration (EUS-FNA) and biopsy. After confirmation of SPEN on biopsy, all the patients underwent surgery without any complications. Patients are on follow-up, and to date, no metastasis has been detected. SPEN is a rare pancreatic tumor with unusual pathological features leading to a diagnostic dilemma. The pathologist should be familiar with SPEN and its salient histological characteristics that differentiate it from other look-alike pancreatic tumors and can help in timely surgery and management.
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Affiliation(s)
- Sucheta Gandhe
- Department of Pathology, HCG Manavata Cancer Centre, Nashik, Maharashtra, India
| | - Rahul Patil
- Department of Pathology, HCG Manavata Cancer Centre, Nashik, Maharashtra, India
| | | | - Raj Nagarkar
- Department of Surgical Oncology, HCG Manavata Cancer Centre, Nashik, Maharashtra, India
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Liang J, Jiang Y, Abboud Y, Gaddam S. Role of Endoscopy in Management of Upper Gastrointestinal Cancers. Diseases 2022; 11:diseases11010003. [PMID: 36648868 PMCID: PMC9844461 DOI: 10.3390/diseases11010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Upper gastrointestinal (GI) malignancy is a leading cause of cancer-related morbidity and mortality. Upper endoscopy has an established role in diagnosing and staging upper GI cancers, screening for pre-malignant lesions, and providing palliation in cases of advanced malignancy. New advances in endoscopic techniques and technology have improved diagnostic accuracy and increased the therapeutic potential of upper endoscopy. We aim to describe the different types of endoscopic technology used in cancer diagnosis, summarize the current guidelines for endoscopic diagnosis and treatment of malignant and pre-malignant lesions, and explore new potential roles for endoscopy in cancer therapy.
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Liang X, He W, Huang C, Feng Z, Guan X, Liu Y, Sun Z, Li Z. Preoperative prediction of invasive behavior of pancreatic solid pseudopapillary neoplasm by MRI-based multiparametric radiomics models. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3782-3791. [PMID: 35976419 DOI: 10.1007/s00261-022-03639-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE A log-combined model was developed to predict the invasive behavior of pancreatic solid pseudopapillary neoplasm (pSPN) based on clinical and radiomic features extracted from multiparametric magnetic resonance imaging (MRI). MATERIALS AND METHODS A total of 111 patients with pathologically confirmed pSPN who underwent preoperative plain and contrast-enhanced MRI were included, and divided into an invasive group (n = 34) and non-invasive group (n = 77). Clinical features and laboratory data related to pSPN invasive behavior were analyzed. Regions of interest were delineated based on T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and contrast-enhanced T1WI (CE-T1WI) to extract radiomic features. Correlation analysis was performed for these features, followed by L1_based feature selection (C = 0.15). A logistic regression algorithm was used to construct models based on each of the four sequences and a log-combined model was used to integrate the sequences. A receiver operating characteristic (ROC) curve was plotted to evaluate the model performance, and the Brier score was used to assess the overall accuracy of the model predictions. RESULTS The area under the ROC curve was 0.68, 0.73, 0.71, and 0.49 for Log-T1WI, Log-T2WI, Log-DWI, and Log-CE models, respectively, and 0.81 for the log-combined model. The accuracy, precision, sensitivity, and specificity of the log-combined model were 0.77, 0.88, 0.75, and 0.78, respectively. The best performance was obtained with the log-combined model with a Brier score of 0.18. Tumor location was identified as a significant clinical feature in comparison between the two groups (p < 0.05), and invasive pSPN was more frequent in the tail of the pancreas. CONCLUSION The log-combined model based on multiparametric MRI and clinical features can be used as a non-invasive diagnostic tool for preoperative prediction of pSPN invasive behavior and to facilitate the development of individualized treatment strategies and monitoring management plans.
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Affiliation(s)
- Xiuqun Liang
- Department of Radiology, The People's Hospital of Guangxi Zhuang Autonomous Region & Research Center of Radiology, Guangxi Academy of Medical Sciences, Nanning, 530021, Guangxi, China
| | - Wenguang He
- Department of Radiology, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310007, Zhejiang, China
| | - Chencui Huang
- Department of Research Collaboration, R&D center, Beijing Deepwise & League of PHD Technology Co, Ltd, Beijing, 100080, China
| | - Zhan Feng
- Department of Radiology, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310007, Zhejiang, China
| | - Xiaohui Guan
- Department of Radiology, The People's Hospital of Guangxi Zhuang Autonomous Region & Research Center of Radiology, Guangxi Academy of Medical Sciences, Nanning, 530021, Guangxi, China
| | - Ying Liu
- Department of Radiology, The People's Hospital of Guangxi Zhuang Autonomous Region & Research Center of Radiology, Guangxi Academy of Medical Sciences, Nanning, 530021, Guangxi, China
| | - Zeyong Sun
- Department of Radionuclide, The People's Hospital of Guangxi Zhuang Autonomous Region & Research Center of Radionuclide, Guangxi Academy of Medical Sciences, Nanning, 530021, Guangxi, China
| | - Zhi Li
- Department of Radiology, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310007, Zhejiang, China.
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Diagnostic and Therapeutic Indications for Endoscopic Ultrasound (EUS) in Patients with Pancreatic and Biliary Disease—Novel Interventional Procedures. Curr Oncol 2022; 29:6211-6225. [PMID: 36135057 PMCID: PMC9497766 DOI: 10.3390/curroncol29090488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 11/20/2022] Open
Abstract
There is growing evidence supporting the substantial, essential and indispensable role of endoscopic ultrasound (EUS) as a key diagnostic armamentarium for upper GI oncologic surgery. Well described in countless publications, EUS holds that position in gastroenterological expert centers all over Europe. Despite its undisputable contributions to oncologic upper GI surgery, the availability of this technique at the expert level shows up in an irregular spread pattern. Endoscopic ultrasound’s primary use during the first few years after its creation was the detection of pancreatic cancer. From then on, EUS developed in different directions, becoming a diagnostic tool that increasingly better defines its status as a method of minimally invasive therapeutic applications and a useful addition to surgical options. As a result, several surgical interventions could even be replaced by ultrasound-targeted interventions. This process took place in just a few years and was made possible by technical development that sensibly combined high-resolution ultrasound with therapeutic endoscopy. The present article will serve to cover the most prevalent uses with supporting data considering the growing list of suggested indications for EUS while also examining cutting-edge initiatives that might soon become the standard of clinical practice. Endoscopic centers with high expertise are needed to train future experts in the growing field of EUS interventions.
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Park S, Park MG, Roh YH, Kim DK. Solid Pseudopapillary Neoplasm of the Pancreas with Lymph Node Metastasis in a Young Male Patient. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2022; 79:77-82. [PMID: 35232923 DOI: 10.4166/kjg.2021.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 11/03/2022]
Abstract
Solid pseudopapillary pancreatic neoplasms are rare. The male-to-female ratio is 1:9, and metastasis occurs only in a few cases. A 39-year-old male with a solid pseudopapillary neoplasm (SPN) with lymph node metastasis underwent ultrasonography, CT, and MRI, which revealed a mass (8 cm) in the pancreatic head. Fluorodeoxyglucose (FDG)-PET showed a hypermetabolic lymph node in the root area of the superior mesenteric artery (SMA). The patient underwent pylorus-preserving pancreaticoduodenectomy, which confirmed a peripancreatic lymph node metastasis. The lymph node of the SMA root area remained because of the encasing of the superior mesenteric artery. After 14 months of follow-up (with no adjuvant therapy initiated), the residual metastatic lymph nodes showed no change and no recurrence. In conclusion, surgery of the primary tumor for patients with SPN is recommended, even in cases with metastatic lymph nodes remaining.
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Affiliation(s)
- Seyeon Park
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Min Gyoung Park
- Department of Pathology, Dong-A University College of Medicine, Busan, Korea
| | - Young Hoon Roh
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Dong Kyun Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
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17
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Tanoue K, Mataki Y, Kurahara H, Idichi T, Kawasaki Y, Yamasaki Y, Kita Y, Hozaka Y, Oi H, Nakajo A, Arigami T, Maemura K, Ohtsuka T. Multidisciplinary treatment of advanced or recurrent solid pseudopapillary neoplasm of the pancreas: three case reports. Surg Case Rep 2022; 8:7. [PMID: 35001187 PMCID: PMC8743312 DOI: 10.1186/s40792-022-01358-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022] Open
Abstract
Background Solid pseudopapillary neoplasm (SPN) is a rare pancreatic tumor that predominantly affects young females. Prognosis is excellent; however, 10–15% of patients show metastasis at the time of surgery or develop tumor recurrence after pancreatectomy. Case presentation We reviewed the clinical course of three patients with advanced or recurrent SPN and subsequently underwent multidisciplinary treatment at our institution between 2002 and 2019. The primary tumor was resected in all three patients, and metastases were also resected if indicated. Intensive combined therapy, including re-resection, chemotherapy, ablation, arterial chemoembolization, and radiation therapy, allowed all patients to survive for a long time. The literature review showed that resection seems to be more effective than other treatments for metastatic SPN. Conclusions Multidisciplinary treatment, including resection, may improve the prognosis of patients with SPN with recurrence or metastasis.
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Affiliation(s)
- Kiyonori Tanoue
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Yuko Mataki
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Hiroshi Kurahara
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
| | - Tetsuya Idichi
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Yota Kawasaki
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Yoichi Yamasaki
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Yoshiaki Kita
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Yuto Hozaka
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Hideyuki Oi
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Akihiro Nakajo
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Takaaki Arigami
- Department of Onco-Biological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kosei Maemura
- Department of Digestive Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Takao Ohtsuka
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
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18
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Kotb M, Fawzy O, Aboelela A, Aziz MA, Zaki I, Soliman M, Abouheba M. Solid pseudopapillary neoplasm of pancreas in a 14-year-old girl. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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19
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Diaconescu S, Gîlcă-Blanariu GE, Poamaneagra S, Marginean O, Paduraru G, Stefanescu G. Could the burden of pancreatic cancer originate in childhood? World J Gastroenterol 2021; 27:5322-5340. [PMID: 34539135 PMCID: PMC8409163 DOI: 10.3748/wjg.v27.i32.5322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/08/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023] Open
Abstract
The presence of pancreatic cancer during childhood is extremely rare, and physicians may be tempted to overlook this diagnosis based on age criteria. However, there are primary malignant pancreatic tumors encountered in pediatric patients, such as pancreatoblastoma, and tumors considered benign in general but may present a malignant potential, such as the solid pseudo-papillary tumor, insulinoma, gastrinoma, and vasoactive intestinal peptide secreting tumor. Their early diagnosis and management are of paramount importance since the survival rates tend to differ for various types of these conditions. Many pediatric cancers may present pancreatic metastases, such as renal cell carcinoma, which may evolve with pancreatic metastatic disease even after two or more decades. Several childhood diseases may create a predisposition for the development of pancreatic cancer during adulthood; hence, there is a need for extensive screening strategies and complex programs to facilitate the transition from pediatric to adult healthcare. Nevertheless, genetic studies highlight the fact the specific gene mutations and family aggregations may be correlated with a special predisposition towards pancreatic cancer. This review aims to report the main pancreatic cancers diagnosed during childhood, the most important childhood diseases predisposing to the development of pancreatic malignancies, and the gene mutations associates with pancreatic malignant tumors.
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Affiliation(s)
- Smaranda Diaconescu
- Department of Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
- Department of Pediatric Gastroenterology, St Mary Emergency Children's Hospital, Iasi 700309, Romania
| | - Georgiana Emmanuela Gîlcă-Blanariu
- Department of Gastroenterology and Hepatology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi 700115, Romania
- Department of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, Iasi 700111, Romania
| | - Silvia Poamaneagra
- Department of Pediatric Gastroenterology, St Mary Emergency Children's Hospital, Iasi 700309, Romania
- Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures 540142, Romania
| | - Otilia Marginean
- Department of Pediatrics, Research Center of Disturbance of Growth and Development on Children-Belive, University of Medicine and Pharmacy “Victor Babes” Timisoara, Timisoara 300041, Romania
- First Clinic of Pediatrics, "Louis Turcanu" Emergency Childen's Hospital, Timisoara 300011, Romania
| | - Gabriela Paduraru
- Department of Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
- Department of Pediatric Gastroenterology, St Mary Emergency Children's Hospital, Iasi 700309, Romania
| | - Gabriela Stefanescu
- Department of Gastroenterology and Hepatology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi 700115, Romania
- Department of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, Iasi 700111, Romania
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20
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Silano F, de Melo Amaral RB, Santana RC, Neves VC, Ardengh JC, do Amaral PCG. Yield of surgery in solid pseudopapillary neoplasms of the pancreas: A case series and literature review. World J Gastrointest Oncol 2021; 13:589-599. [PMID: 34163575 PMCID: PMC8204350 DOI: 10.4251/wjgo.v13.i6.589] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/24/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Solid pseudopapillary neoplasms (SPN) of the pancreas represents approximately 2% of non-endocrine tumors of the pancreas. It is described in the literature as a rare and predominant tumor in young women. AIM To report a case series with SPN and analyzing clinical, surgical, anatomopathological characteristics, as well as the prognosis and review of literature. METHODS Retrospective analysis of patients undergoing surgery, with histological diagnosis of SPN between 1998 and 2018, using standardized and prospectively completed forms, performed at the Surgery Service of the Upper Digestive System at Hospital São Rafael/Rede D'Or in Salvador - BA. Review of literature through a database search in MEDLINE/PubMed of retrospective articles. RESULTS Fourteen female patients with the average age of 31.6 years (range min-max) were selected. Twelve patients (85.7%) were asymptomatic, being an incidental diagnosis or due to screening for other reasons. One patient had abdominal pain due to gastric compression and another patient had jaundice. The 14 patients were staged with computerized tomography or magnetic resonance imaging. None had evidence of metastasis. In 8 patients (57.1%), the tumor was in the tail and body. The average size was 6.7 cm (range min-18). The type of surgery was according to the anatomical location of the tumor. There was no lymph node involvement. In two cases, vascular resection with the use of a prosthesis was required for reconstruction. The surgical margins were free. In all cases, postoperative immunohistochemistry confirmed that it was a solid pseudo-papillary neoplasia of the pancreas. There has been no disease recurrence in any case so far. CONCLUSION The tumors had a benign, indolent and histopathological behavior compatible with the literature. Curative surgery is recommended in all cases.
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Affiliation(s)
- Flávio Silano
- Digestive Surgery, Hospital São Rafael/Rede D’Or, Salvador 40285000, Bahia, Brazil
| | - Ricardo Bandeira de Melo Amaral
- Department of Surgery of the Upper Digestive System, São Rafael Hospital/Rede D’Or Hospital Group, Salvador 41253-190, Bahia, Brazil
| | - Rodolfo Carvalho Santana
- Department of Surgery of the Upper Digestive System, São Rafael Hospital/Rede D’Or Hospital Group, Salvador 41253-190, Bahia, Brazil
| | - Vanessa Costa Neves
- Department of Surgery of the Upper Digestive System, São Rafael Hospital/Rede D’Or Hospital Group, Salvador 41253-190, Bahia, Brazil
| | - José Celso Ardengh
- Surgery and Anatomy, Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, São Paulo 04611-000, São Paulo, Brazil
- Endoscopy Service, Hospital 9 de Julho, São Paulo 04611-000, São Paulo, Brazil
- Imaging and Diagnosis, Escola Paulista de Medicina - São Paulo Federal University, São Paulo 04611-000, SP, Brazil
| | - Paulo Cezar Galvão do Amaral
- Department of Surgery of the Upper Digestive System, São Rafael Hospital/Rede D’Or Hospital Group, Salvador 41253-190, Bahia, Brazil
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21
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Gandhi D, Sharma P, Parashar K, Kochar PS, Ahuja K, Sawhney H, Sharma S. Solid pseudopapillary Tumor of the Pancreas: Radiological and surgical review. Clin Imaging 2020; 67:101-107. [PMID: 32559679 DOI: 10.1016/j.clinimag.2020.06.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/27/2020] [Accepted: 06/07/2020] [Indexed: 12/13/2022]
Abstract
Solid Pseudopapillary Neoplasms of the pancreas are rare pancreatic tumors with low-grade malignant potential, typically affecting young females. In this review, we discuss the surgical anatomy; the imaging characteristics, and image reporting essentials for proper surgical planning along with the atypical features which should caution the physician regarding the risk of malignancy. We also discuss the common surgical procedures and organ preservation surgeries along with a comprehensive review of the literature.
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Affiliation(s)
- Darshan Gandhi
- St Vincent's Medical Center, Hartford Healthcare, CT, USA
| | - Pranav Sharma
- Yale New Haven Health Bridgeport Hospital, Radiology Department, 267 Grant Street, Bridgeport, CT 06610, USA.
| | | | - Puneet S Kochar
- Yale New Haven Health Bridgeport Hospital, Radiology Department, 267 Grant Street, Bridgeport, CT 06610, USA
| | | | - Harpreet Sawhney
- Yale New Haven Health Bridgeport Hospital, Radiology Department, 267 Grant Street, Bridgeport, CT 06610, USA
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22
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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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23
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Pant SR, Pokhrel NB, Chapagain P, Kansakar P. Different Methods of Resection of Solid Pseudopapillary Neoplasm of the Pancreas: A Case Series of Three Patients. Cureus 2020; 12:e7346. [PMID: 32328359 PMCID: PMC7170022 DOI: 10.7759/cureus.7346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Solid pseudopapillary neoplasm of the pancreas is one of the rarest forms of pancreatic neoplasm. It was also known as Franz's tumor or Hamoudi tumor until the World Health Organization (WHO) labeled it as a solid pseudopapillary tumor in 1996. It typically affects young non-Caucasian females in their second or third decade of life. Treatment involves complete excision of the tumor which results in a complete cure in most of the cases. Three cases of solid pseudopapillary neoplasm (diagnosis confirmed by cytology) in young females, each presenting with different symptoms were studied. Each of the three cases was found to have the neoplasm at different sites of the pancreas and was subjected to different resection procedures. The cases were followed up for at least a year and evaluated for recurrences/metastases. Solid pseudopapillary neoplasm remains one of the most misdiagnosed tumors. The diagnosis depends on radiology and cytology. With a very high five-year survival rate, surgical resection remains the treatment of choice. The type of surgical procedure depends on the site, size and local invasion of the tumor.
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Affiliation(s)
- Samriddha R Pant
- Surgery, Tribhuvan University Institute of Medicine, Kathmandu, NPL
| | - Nishan B Pokhrel
- Internal Medicine, Tribhuvan University Institute of Medicine, Kathmandu, NPL
| | | | - Prasan Kansakar
- Surgery, Tribhuvan University Institute of Medicine, Kathmandu, NPL
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Guo T, Wang L, Xie P, Zhang Z, Yu Y. Diagnosis and Surgical Treatment and Pathological Findings of Solid Pseudopapillary Tumor of the Pancreas: A Single-Institution Experience. Cancer Manag Res 2020; 12:581-588. [PMID: 32158262 PMCID: PMC6986403 DOI: 10.2147/cmar.s238527] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/14/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose To investigate the diagnosis, surgical treatment, and pathology of solid pseudopapillary tumors of the pancreas in our institution. Patients and Methods We retrospectively analyzed the demographic details, clinical features, imaging findings, and pathological findings of 87 patients with a confirmed diagnosis of solid pseudopapillary tumors of the pancreas (SPTP) and underwent surgery in Tongji Hospital of Tongji Medical College, over a period of 8 years from 2011 to 2018. Results Our study involved a total of 87 patients (16 males and 71 females) with a mean age of 31.3±13.1 years (range: 10–61 years). The main compliant was abdominal pain or discomfort (n=49) and the median tumor size was 58.6±31.7 mm (range: 16–156mm). Tumors were located in the head (27 patients, 31%), the neck (13 patients, 15%), and the body and tail (47 patients, 54%). There were no significant differences between the patients in terms of sex, age, or tumor location. Partial pancreatectomy was performed in 79 patients, enucleation in six patients, and total pancreatectomy in two patients. R0 resection was achieved in 86 patients. The postoperative morbidity was 36.8%, and the main complication was pancreatic fistula. Pathological examination and immunohistochemical markers were used to provide a final diagnosis. The main follow-up period was 46 months (range: 13–97 months). At the end of the follow-up period, 86 patients were alive and had not experienced recurrence; one patient was lost to follow-up. Conclusion The accurate diagnosis of SPTP is vital. Our data showed that surgical resection is safe and associated with low morbidity and mortality rates. Pathological findings can play an important role in diagnosis and long-term survival.
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Affiliation(s)
- Tong Guo
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, People's Republic of China
| | - Lu Wang
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, People's Republic of China
| | - Peng Xie
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, People's Republic of China
| | - Zhiwei Zhang
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, People's Republic of China
| | - Yahong Yu
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, People's Republic of China
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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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Martin M, Downie P. Paediatric stage III classical Hodgkins lymphoma: An unexpected finding in a sub-diaphragmatic positron emission tomography-avid lesion. J Paediatr Child Health 2019; 55:715-717. [PMID: 30623513 DOI: 10.1111/jpc.14367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/07/2018] [Accepted: 12/13/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Michelle Martin
- Centre for Children's Cancer and Blood Diseases, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Peter Downie
- Centre for Children's Cancer and Blood Diseases, Monash Children's Hospital, Melbourne, Victoria, Australia
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Yalçın B, Yağcı‐Küpeli B, Ekinci S, Orhan D, Oğuz B, Varan A, Kutluk T, Akyüz C. Solid pseudopapillary neoplasm of the pancreas in children: Hacettepe experience. ANZ J Surg 2019; 89:E236-E240. [DOI: 10.1111/ans.15111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/15/2018] [Accepted: 01/25/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Bilgehan Yalçın
- Department of Pediatric OncologyHacettepe University Faculty of Medicine Ankara Turkey
| | - Begül Yağcı‐Küpeli
- Department of Pediatric OncologyHacettepe University Faculty of Medicine Ankara Turkey
- Department of Pediatric Hematology/OncologyAdana City Education and Research Hospital, Sağlık Bilimleri University Adana Turkey
| | - Saniye Ekinci
- Department of Pediatric SurgeryHacettepe University Faculty of Medicine Ankara Turkey
| | - Diclehan Orhan
- Department of PathologyHacettepe University Faculty of Medicine Ankara Turkey
| | - Berna Oğuz
- Department of RadiologyHacettepe University Faculty of Medicine Ankara Turkey
| | - Ali Varan
- Department of Pediatric OncologyHacettepe University Faculty of Medicine Ankara Turkey
| | - Tezer Kutluk
- Department of Pediatric OncologyHacettepe University Faculty of Medicine Ankara Turkey
| | - Canan Akyüz
- Department of Pediatric OncologyHacettepe University Faculty of Medicine Ankara Turkey
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Mohammed AA, Rasheed FM, Arif SH, Salih AM, Kakamad FH, Mohammed SH. Solid pseudopapillary tumor of the pancreas in a 17-year-old girl. Int J Surg Case Rep 2019; 56:86-88. [PMID: 30852373 PMCID: PMC6409429 DOI: 10.1016/j.ijscr.2019.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/09/2019] [Accepted: 02/13/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Solid pseudopapillary tumor of the pancreas is a rare tumor of low malignant potential. The aim of this paper is to present and discuss a case of solid pseudopapillary tumor of the pancreas occurring in a 17-year-old female. A 17-year-old girl presented with dull aching poorly localized left hypochondrial pain for two years, she had no clinical findings on physical examination. Ultrasound of the abdomen showed well-defined 9 cm * 7 cm heterogeneous lesion with cystic contents in the region of the tail of the pancreas. Computed tomography scan (CT scan) of the abdomen showed a mass of 8 cm * 7 cm in the region of the tail of the pancreas; that could be pancreatic mass, left suprarenal mass, or lymphoma. Resection of the mass and histopathological examination confirmed the diagnosis of pseudopapillary tumor of the pancreas. CONCLUSION Pseudopapillary neoplasm of the pancreas is a rare condition, which needs surgical intervention. Close follow up is necessary to early detection of the recurrence and metastasis.
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Affiliation(s)
- Ayad Ahmad Mohammed
- University of Duhok, College of Medicine, Department of Surgery, Duhok, Kurdistan Region, Iraq
| | - Ferhad Mohammed Rasheed
- University of Duhok, College of Medicine, Department of Surgery, Duhok, Kurdistan Region, Iraq
| | - Sardar Hassan Arif
- University of Duhok, College of Medicine, Department of Surgery, Duhok, Kurdistan Region, Iraq
| | - Abdulwahid M Salih
- University of Sulaimani, College of Medicine, Department of Surgery, Sulaimani, Kurdistan Region, Iraq
| | - Fahmi H Kakamad
- University of Sulaimani, College of Medicine, Department of Surgery, Sulaimani, Kurdistan Region, Iraq; Kscien Organization, Hamdi Str. Azadi Mall, Sulaimani, Kurdistan Region, Iraq.
| | - Shvan H Mohammed
- Kscien Organization, Hamdi Str. Azadi Mall, Sulaimani, Kurdistan Region, Iraq; Chara Laboratory, Shahedan Street, Kalar, Kurdistan, Iraq
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Clinical and Pathological Features of Solid Pseudopapillary Neoplasms of the Pancreas: A Nationwide Multicenter Study in Japan. Pancreas 2018; 47:1019-1026. [PMID: 30059473 DOI: 10.1097/mpa.0000000000001114] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinicopathological features of solid pseudopapillary neoplasms (SPNs). METHODS In this retrospective study, 288 SPNs were analyzed. RESULTS Overall, 214 patients (74%) were female. Distant metastases occurred in 4 patients, and splenic vein tumor thrombus occurred in 1 patient. Although imaging findings showed large (>2.0 cm) SPNs with clear, regular border, and heterogeneous internal structure, small SPNs appeared as almost entirely solid. Surgical resection was performed in 278 cases. The 5-year survival rate was 98.8%. Six patients had tumor recurrence after the initial resection. The detection rate in typical pathological findings was low for small SPNs. Tumor extension to the pancreatic parenchyma was detected in greater than 70% of the cases. Tumor invasion to adjacent organs was detected in 13 cases. One was given a diagnosis of apparent high-grade malignant transformation. CONCLUSIONS The proportion of male cases was higher than that in previous studies, and there were statistically significant differences in the onset age and tumor diameter between male and female patients. Therefore, women seemed to have an early occurrence of SPNs, suggesting a difference in the developmental stage between men and women. Images and pathological findings of SPNs varied according to tumor size. Our findings indicated that SPN patients have excellent survival after margin-negative surgical resection.
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Toumi N, Harbi H, Abdeljelil K, Mellouli M, Krichene J, Abid H, Amar MB, Mahfoudh KB. [An epigastric mass in a 31year-old woman]. Presse Med 2018; 47:713-718. [PMID: 30075947 DOI: 10.1016/j.lpm.2018.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Nozha Toumi
- Habib-Bourguiba Hospital, Radiology Department, Sfax, Tunisia.
| | - Houssem Harbi
- Habib-Bourguiba Hospital, General Surgery Department, Sfax, Tunisia
| | | | - Manel Mellouli
- Habib-Bourguiba Hospital, Pathology Department, Sfax, Tunisia
| | - Jihene Krichene
- Habib-Bourguiba Hospital, General Surgery Department, Sfax, Tunisia
| | - Hanene Abid
- Habib-Bourguiba Hospital, Radiology Department, Sfax, Tunisia
| | - Mohamed Ben Amar
- Habib-Bourguiba Hospital, General Surgery Department, Sfax, Tunisia
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Tipmanee V, Pattaranggoon NC, Kanjanapradit K, Saetang J, Sangkhathat S. Molecular dynamic simulation of mutated β-catenin in solid pseudopapillary neoplasia of the pancreas. Oncol Lett 2018; 15:9167-9173. [PMID: 29805647 PMCID: PMC5958693 DOI: 10.3892/ol.2018.8490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/22/2018] [Indexed: 02/07/2023] Open
Abstract
Solid pseudopapillary neoplasia of the pancreas (SPN) is a rare pancreatic neoplasm that frequently harbors mutations in catenin β1 (CTNNB1, encoding β-catenin) as a part of its molecular pathogenesis. Mutations to CTNNB1 reported in SPN usually occur at the serine/threonine phosphorylation sites, including codons 33, 37 and 41, and the flanking residues of codon 33. On analysis of 3 cases of SPN, mutations to CTNNB1 were detected in codon 32 (D32A and D32Y). As this residue, aspartic acid, is not a direct phosphorylation site of the protein, molecular modeling tools were used to predict the influence of these mutations on the protein structure of β-catenin. A total of three MD simulations (wild-type, D32A, and D32Y) were performed to visualize the conformations of β-catenin under in vivo, aqueous-phase conditions at 37°C. In the wild-type protein, the secondary structure of residues P16-H28 remained helical; we therefore hypothesized that the helical structure of this protein fragment (residues M11-G50) was necessary for phosphorylation of S33 phosphorylation. The loss of the secondary structure in P16-H28 was observed in D32A, losing its helical structure and becoming a turn; however, in the D32Y mutant, the helical structure remained. The present demonstrated that structural changes in the mutated β-catenin protein at D32 could potentially explain the mechanism behind its defective phosphorylation in the pathogenesis of SPN.
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Affiliation(s)
- Varomyalin Tipmanee
- Department of Biomedical Science, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Nawanwat C. Pattaranggoon
- Department of Biomedical Science, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Kanet Kanjanapradit
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Jirakrit Saetang
- Department of Biomedical Science, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Surasak Sangkhathat
- Department of Biomedical Science, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
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Wang P, Wei J, Wu J, Xu W, Chen Q, Gao W, Jiang K, Miao Y. Diagnosis and treatment of solid-pseudopapillary tumors of the pancreas: A single institution experience with 97 cases. Pancreatology 2018; 18:415-419. [PMID: 29548800 DOI: 10.1016/j.pan.2017.12.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES We evaluated the diagnoses and surgical management of solid pseudopapillary tumors of the pancreas (SPTP) in a single center setting. METHODS Demographic details, clinical presentations, imaging features, surgical strategies, and pathological findings of 97 consecutive patients who underwent surgery for pathologically confirmed SPTP between 2008 and 2016 were analyzed retrospectively. RESULTS A total of 97 patients with SPTP accounted for 2.15% of total pancreatic surgeries (N = 4508). The mean age at diagnosis was 31.6 ± 13.92 years (range: 7-83 years), and males:females were 85:12. Chief complaints were abdominal pain or discomfort (n = 50). The mean transverse tumor diameter was 53.2 ± 2.76 mm (range: 14-170 mm). Tumors were localized to the pancreatic head (38.1%; 37/97), neck (12.4%; 12/97), body and tail (49.5%; 48/97). There were no significant differences in age of onset, presenting symptoms, and sites between males and females. A significant difference was found in the maximum diameter of SPTP across different age groups. Partial pancreatectomy was performed for patient with tumor ≥ 5 cm, and enucleation was performed when tumor was smaller than 5 cm. Pancreatic fistula was the main complication. Immunohistochemical markers for endocrine, exocrine and epithelial factors were used for a final diagnosis. During a median follow-up of 54 months (range: 7-121 months), 84 patients were alive without evidence of recurrence, and 13 patients were lost to follow-up. CONCLUSION SPTP surgical resection is a safe procedure with low morbidity and mortality, which is also effective even in the presence of invasiveness and metastases. Accurate initial diagnoses and follow up are essential.
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Affiliation(s)
- Peng Wang
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jishu Wei
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Junli Wu
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wenbin Xu
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Qiuyang Chen
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wentao Gao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Kuirong Jiang
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yi Miao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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Solid Pseudopapillary Neoplasm of the Pancreas in Children and Adults: A National Study of 369 Patients. J Pediatr Hematol Oncol 2018; 40:e233-e236. [PMID: 29240036 DOI: 10.1097/mph.0000000000001049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor in children, with current evidence limited to single-center studies. We examined treatment and clinical outcomes for pediatric and adult SPN with a national data set. METHODS The 2004 to 2013 National Cancer Data Base was queried to identify all patients diagnosed with SPN. The cohort was stratified by age (pediatric and adult) defined as below 18 years and 18 years and above, respectively. Baseline characteristics and unadjusted outcomes were compared. RESULTS We identified 21 pediatric and 348 adult patients with SPN. Both groups displayed similar demographic composition. Patients were commonly female (90.5% [pediatric] vs. 85.9% [adult], P=0.56) and white (66.7% vs. 68.3%, P=0.74). Tumor location was similar between adults and children. Median tumor size was similar between children and adults (5.9 vs. 4.9 cm, P=0.41). Treatment strategies did not vary between groups. Partial pancreatectomy was the most common resection strategy (71.4% vs. 53.1%, P=0.80). Both groups experienced low mortality (0.0% vs. 0.7% at 5 y, P=0.31). CONCLUSIONS This study provides the largest comparison of pediatric and adult SPN to date. Children with SPN have similar disease severity at presentation, receive similar treatments, and demonstrate equivalent postoperative outcomes compared with their adult counterparts.
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Rastogi A, Assing M, Taggart M, Rao Korivi Jia Sun B, Elsayes K, Tamm E, Bhosale P. Does Computed Tomography Have the Ability to Differentiate Aggressive From Nonaggressive Solid Pseudopapillary Neoplasm? J Comput Assist Tomogr 2018; 42:405-411. [PMID: 29287021 PMCID: PMC5951735 DOI: 10.1097/rct.0000000000000698] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of the study was to assess the ability of contrast-enhanced computed tomography (CECT) to differentiate aggressive from nonaggressive solid pseudopapillary neoplasms (SPNs). MATERIALS AND METHODS Forty treatment-naive patients with pathologically proven pancreatic SPNs were included. Imaging characteristics were determined by consensus of 3 radiologists blinded to histopathologic aggressiveness. All patients underwent 4-phase CECT using a pancreatic protocol. The regions of interest of the tumor and the normal pancreas were documented on all phases. Lymph nodes were considered metastatic if greater than 1.0 cm in short-axis diameter.Fisher exact and Wilcoxon rank-sum tests were used to compare between aggressive and nonaggressive tumors. RESULTS No significant difference was noted between imaging covariates, such as internal hemorrhage, calcification, wall thickness perceptibility, vascular invasion, margins, cystic component, and pancreatic and biliary ductal dilation. Tumors with greater than 62.5 Hounsfield units and progressive enhancement during the delayed phase had aggressive characteristics (P = 0.03). CONCLUSIONS On delayed phase CECT, pathologically aggressive SPNs may show greater enhancement than nonaggressive SPNs.
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Affiliation(s)
- Ashita Rastogi
- Department of Radiodiagnosis, Tata Memorial Centre Mumbai, Maharashtra – 400 012. India Nepal
| | - Mathew Assing
- Radiology Fellow, Stanford Hospital, Palo Alto, California
| | - Mellisa Taggart
- Department of Pathology Administration, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brinda Rao Korivi Jia Sun
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Khaled Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eric Tamm
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Priya Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Solid pseudopapillary neoplasm-Case report of a rare pancreatic tumor. Int J Surg Case Rep 2017; 33:148-150. [PMID: 28327418 PMCID: PMC5358903 DOI: 10.1016/j.ijscr.2017.02.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 02/26/2017] [Accepted: 02/27/2017] [Indexed: 01/08/2023] Open
Abstract
Solid pseudopapillary neoplasm is a rare pancreatic tumor. Most patients are female and within the second or third decade of life. The radiologic features are crucial for an accurate diagnosis. Tumor size has not been shown to be a predictor of resectability. Surgical resection is the treatment of choice with an excellent long-term prognosis. Introduction Solid pseudopapillary neoplasm (SPN) is a rare pancreatic tumor. Most patients are female within the second or third decade of life with only a small minority concerning children. Frequently described as low malignant potential tumors, surgical resection remains the main treatment. Presentation of case The authors present a case of a SPN diagnosed in a 17-year-old Caucasian girl with vomiting and abdominal pain localized to the right upper quadrant. CT scans and MRI scans showed the presence of a well-defined tumor arising from the pancreatic head with 14 cm of greater diameter. Pylorus-preserving pancreatoduodenectomy was performed and histopathology confirmed a SPN with complete resection and no evidence of malignancy. Discussion SPN are usually found incidentally hence the importance of an accurate radiologic diagnosis. Symptoms may be present such as abdominal pain or vomiting due to compression, namely in large tumors. A surgical approach is usually indicated aiming complete resection, with tumor size not predicting resectability. Conclusion Solid pseudopapillary tumors of the pancreas are extremely rare and usually have an excellent long-term prognosis after surgical resection.
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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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Mirminachi B, Farrokhzad S, Sharifi AH, Nikfam S, Nikmanesh A, Malekzadeh R, Pourshams A. Solid Pseudopapillary Neoplasm of Pancreas; A Case Series and Review Literature. Middle East J Dig Dis 2016; 8:102-8. [PMID: 27252816 PMCID: PMC4885608 DOI: 10.15171/mejdd.2016.14] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND
Information regarding solid pseudopapillary neoplasm (SPN) of the pancreas
is limited in Iran. We aimed to review the clinicocytopathological features and
follow-up of patients with SPN of pancreas who were diagnosed in a single
center in Iran.
METHODS
Seven patients with SPN of the pancreas were diagnosed during January
2010 to March 2015 at the Digestive Disease Research Institute of Tehran University
of Medical Sciences. The patients were reviewed prospectively.
RESULTS
Six out of the 7 patients were female and the mean age of all the patients
was 29.4 years ranging from 15 to 61 years. The most common clinical presentation
was nonspecific abdominal pain (N=6). The tumors were located
mostly in head and neck of the pancreas. SPN was diagnosed in all patients
by fine needle aspiration through endosonography (EUS-FNA). All patients
underwent surgery. Histological findings of surgical tissues were consistent
with EUS-FNA. The postoperative follow-up period of about 14 months was
uneventful.
CONCLUSION
SPN of the pancreas is a rare pancreatic tumor which affects primarily
young women. EUS-guided FNA could play an important role in preoperative
diagnosis of SPN of the pancreas.
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Affiliation(s)
- Babak Mirminachi
- Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Solmaz Farrokhzad
- Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran ; Qazvin Health Center, Qazvin University of Medical Science, Qazvin, Iran
| | - Amir Houshang Sharifi
- Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Nikfam
- Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Pourshams
- Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Haque S, Dietz R, Perez MCN. Recognizing the distinct cytomorphologic features of solid pseudopapillary neoplasm of the pancreas. J Gastrointest Oncol 2016; 7:E13-6. [PMID: 27034801 DOI: 10.3978/j.issn.2078-6891.2015.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare low-grade malignant tumor with an indolent clinical course and a favorable prognosis that is most commonly seen in young women of reproductive age. We present a case of SPN in a middle-aged man, diagnosed on a limited cytology specimen. Interestingly, this tumor has unique cytomorphologic findings in fine needle aspiration cytology smears, which help distinguish it from other pancreatic lesions. The presence of fibrovascular cores lined by loosely cohesive monomorphic neoplastic cells is a reliable cytomorphologic feature on aspiration cytology. Recognition of this characteristic finding is crucial for the diagnosis of this entity, especially when it presents in unexpected patient populations or when faced with scant cytology specimens. This report focuses on the distinguishing characteristics of SPN and how they compare and contrast with other pancreatic lesions that are in the differential diagnosis of SPN.
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Affiliation(s)
- Saadiya Haque
- 1 Affiliated Pathologists Medical Group, Rancho Dominguez, CA, USA ; 2 Department of Pathology and Laboratory Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Robin Dietz
- 1 Affiliated Pathologists Medical Group, Rancho Dominguez, CA, USA ; 2 Department of Pathology and Laboratory Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Mia C N Perez
- 1 Affiliated Pathologists Medical Group, Rancho Dominguez, CA, USA ; 2 Department of Pathology and Laboratory Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
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Recurrence of Solid Pseudopapillary Tumor: A Rare Pancreatic Tumor. Case Rep Oncol Med 2016; 2016:7523742. [PMID: 27994898 PMCID: PMC5138469 DOI: 10.1155/2016/7523742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/03/2016] [Indexed: 12/13/2022] Open
Abstract
Solid pseudopapillary tumor of the pancreas (SPTP) is a rare disease of young females that does not usually recur after resection. Here we report a case of an elderly female with history of SPTP ten years ago who presented with anorexia and a palpable left lower quadrant abdominal mass. Imaging revealed metastatic disease and US-guided biopsy of the liver confirmed the diagnosis of SPTP. Due to her advanced age and comorbidities, she elected to undergo hospice care. The objective of this case report is to increase awareness of this tumor and its possibility of recurrence, necessitating further guidelines for follow-up.
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Tumor seudopapilar sólido del páncreas: presentación de un caso y revisión del tema. Cir Esp 2015; 93:e37-40. [DOI: 10.1016/j.ciresp.2013.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 03/28/2013] [Accepted: 04/08/2013] [Indexed: 11/19/2022]
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Mahida JB, Thakkar RK, Walker J, Shen R, Kenney BD, Prasad V, Aldrink JH. Solid pseudopapillary neoplasm of the pancreas in pediatric patients: A case report and institutional case series. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Suzuki S, Hatori T, Furukawa T, Shiratori K, Yamamoto M. Clinical and pathological features of solid pseudopapillary neoplasms of the pancreas at a single institution. Dig Surg 2014; 31:143-50. [PMID: 24970563 DOI: 10.1159/000363420] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 05/05/2014] [Indexed: 12/13/2022]
Abstract
AIMS The aim of this study was to determine the clinicopathological features and surgical management of solid pseudopapillary neoplasms (SPNs) of the pancreas at a single institution. METHODS We investigated 34 patients (5 males and 29 females) who underwent surgery for pathologically confirmed SPNs between 1994 and 2012. RESULTS Clinical symptoms were absent in 58.8% of the patients. The median tumor diameter was 42.7 mm. All tumors were successfully removed by R0 resection. Pathologically, 5.9% had duodenum invasion and 2.9% had pancreatic serosal invasion, but there was no lymph node metastasis. Radiological findings showed calcification in 39.4% of the patients, capsule formation in 51.5%, cystic components in 69.7%, solid components in 93.9% and internal bleeding in 36.4%. Immunohistochemically, neuron-specific enolase was positive in 100% of the patients, nuclear accumulation of β-catenin in 100% and CD10 in 78.8%. There were no recurrences reported at the median follow-up (67 months). Regarding gender differences, the cystic component in radiological imaging was the only significant finding among the features studied (p = 0.01). CONCLUSIONS R0 resection with appropriate procedures appears to be sufficient for patients with SPNs, even for locally invasive tumors. There were no significant differences between genders except for the cystic component on radiological imaging.
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Affiliation(s)
- Shuji Suzuki
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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Abstract
AbstractPancreatic cysts involve a wide spectrum of pathologies from post-inflammatory cysts to malignant neoplasms. Pancreatic pseudocysts, serous cystadenomas, mucinous cystadenomas, intraductal papillary mucinous neoplasms (IPMNs) and solid pseudopapillary tumors occur most frequently. Differential diagnosis involves the following imaging investigations: transabdominal ultrasonography (TUS), contrast enhanced ultrasonography (CEUS) and endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance (MR) and magnetic resonance cholangiopancretography (MRCP), endoscopic retrograde cholangiopancretography (ERCP). The cyst fluid cytology is performed in difficult differential diagnosis between pseudocysts and benign and potentially malignant or malignant tumors. Most frequently, viscosity, amylase, CEA and CA 19-9 levels are determined. Imaging findings should be correlated with cytology. The management depends on the cyst type and size. Small asymptomatic pseudocysts, serous cystadenomas and branchduct IPMNs should be carefully observed, whereas symptomatic large or uncertain serous cystadenomas and cystadenocarcinomas, mucinous cystadenomas and cystadenocarcinomas, main-duct IPMNs and large branch-duct IPMNs with malignant features, serous and mucinous cystadenocarcinomas, and solid pseudopapillary tumors require surgery. Pseudocysts are usually drained. Percutaneous / EUS-guided or surgical cyst drainage can be performed. Complicated and uncertain pseudocysts and cystic tumors need surgical resection. The type of surgery depends on cyst location and size and includes proximal, central, distal, total pancreatectomies and enucleation.
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Saligram S, Fan F, Oropeza-Vail M, Gholami P, Olyaee M. Accuracy of Endoscopic Ultrasound-guided Fine Needle Aspiration in Diagnosing Solid Pseudopapillary Tumor. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 5:716-20. [PMID: 24404556 PMCID: PMC3877535 DOI: 10.4103/1947-2714.123270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: Solid pseudopapillary tumors are rare pancreatic tumors. Accurate preoperative diagnosis helps in planning of the surgery. Aim: This study was to evaluate accuracy of endoscopic ultrasound-guided fine needle aspiration and immunohistochemistry in diagnosing solid pseudopapillary tumors. Materials and Methods: A retrospective review was performed by reviewing medical records to identify patients treated for solid pseudopapillary tumors over a 5-year period. Patients who were noted to have pancreatic lesions by computer tomography abdomen underwent endoscopic ultrasound. Fine needle aspiration was obtained from each of these lesions and subjected to immunohistochemistry. Results: Five patients were identified. Endoscopic ultrasound was able to identify the pancreatic lesions in all five patients noted in computer tomography abdomen. Solid pseudopapillary tumors were diagnosed by immunohistochemistry. All five patients underwent surgery and the resected lesions confirmed solid pseudopapillary tumors in 80% patients. Conclusion: Endoscopic ultrasound-guided fine needle aspiration has a higher degree of accuracy in diagnosing solid pseudopapillary tumors.
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Affiliation(s)
- Shreyas Saligram
- Department of Gastroenterology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS-66106, USA
| | - Fang Fan
- Department of Gastroenterology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS-66106, USA
| | - Melissa Oropeza-Vail
- Department of Gastroenterology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS-66106, USA
| | - Parviz Gholami
- Department of Gastroenterology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS-66106, USA
| | - Mojtaba Olyaee
- Department of Gastroenterology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS-66106, USA
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Lakhtakia R, Al-Wahaibi K, Zahid KF, Malik KA, Burney IA. Solid pseudopapillary neoplasm of the pancreas: a case report with review of the diagnostic dilemmas and tumor behavior. Oman Med J 2013; 28:441-4. [PMID: 24223249 DOI: 10.5001/omj.2013.122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 09/14/2013] [Indexed: 12/14/2022] Open
Abstract
Solid pseudopapillary neoplasm of the pancreas is a rare tumor of the pancreas often detected initially on imaging. Of uncertain histogenesis, it has a low-grade malignant potential with excellent post-surgical curative rates and rare metastasis. Despite advances in imaging, pseudocysts and other cystic neoplasms feature in the differential diagnosis. Pathological and/or cytological evaluation remains the gold standard in reaching a definitive diagnosis. On morphology alone, other primary pancreatic tumors and metastatic tumors pose a diagnostic challenge. Recent advances in immunohistochemical characterization have made the histopathologic diagnosis more specific and, in turn, shed light on the likely histogenesis of this rare tumor. We report a case of solid pseudopapillary neoplasm of the pancreas that was suspected on radiology and diagnosed intraoperatively on imprint cytology guiding definitive surgery. The diagnostic dilemmas are reviewed.
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Affiliation(s)
- Ritu Lakhtakia
- Head of Department, Department of Pathology, College of Medicine & Health Sciences, Sultan Qaboos University, Al Khoud, PO Box 35 P.C 123, Sultanate of Oman
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Bouassida M, Mighri MM, Bacha D, Chtourou MF, Touinsi H, Azzouz MM, Sassi S. Solid pseudopapillary neoplasm of the pancreas in an old man: age does not matter. Pan Afr Med J 2012; 13:8. [PMID: 23308315 PMCID: PMC3527018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 05/19/2012] [Indexed: 10/28/2022] Open
Abstract
Solid pseudopapillary tumor (SPN) of the pancreas is a rare tumor, but has favorable prognosis. It is typically observed in young women. Only few cases have been reported in young men. We report the observation of a 73-year-old man presented with a palpable mass in the left upper abdomen. CT scan showed 10 cm mass at the tail of the pancreas. This mass had mixed cystic and solid components. The patient underwent a distal pancreatectomy and splenectomy. SPN of the pancreas was diagnosed based on histopathological features. The patient recovered uneventfully and didn't receive adjuvant therapy. A CT scan performed 16 months postoperatively showed no evidence of disease recurrence. Although SPN of the pancreas is typically observed in young women, the diagnosis should not be discounted in old male patients. Male patients and those with old age, atypical histopathology and incomplete resection may have a higher risk of recurrence and death, deserving particular attention.
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Affiliation(s)
- Mahdi Bouassida
- Department of Surgery, Mohamed Tahar Maamouri Hospital, 8000 Mrazga, Nabeul, Tunisia,Corresponding author: Mahdi Bouassida, Department of Surgery, Mohamed Tahar Maamouri Hospital, 8000 Mrazga, Nabeul, Tunisia
| | - Mohamed Monji Mighri
- Department of Surgery, Mohamed Tahar Maamouri Hospital, 8000 Mrazga, Nabeul, Tunisia
| | - Dhouha Bacha
- Department of Pathology, Mohamed Tahar Maamouri Hospital, 8000 Mrazga, Nabeul,Tunisia
| | | | - Hassen Touinsi
- Department of Surgery, Mohamed Tahar Maamouri Hospital, 8000 Mrazga, Nabeul, Tunisia
| | - Mohamed Msaddak Azzouz
- Department of Gastroenterology, Mohamed Tahar Maamouri Hospital, 8000 Mrazga, Nabeul, Tunisia
| | - Sadok Sassi
- Department of Surgery, Mohamed Tahar Maamouri Hospital, 8000 Mrazga, Nabeul, Tunisia
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Akhavan A, Binesh F, Navabii H. Solid pseudopapillary tumour of the pancreas in an 11-year-old Iranian girl. BMJ Case Rep 2012; 2012:bcr.02.2012.5866. [PMID: 22729335 DOI: 10.1136/bcr.02.2012.5866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Solid pseudopapillary tumour (SPT) of the pancreas is a low-malignancy-potential tumour of the pancreas. It mostly occurs in young female adults. It is uncommon in childhood. Here, we present the case of an 11-year-old girl with SPT.
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Affiliation(s)
- Ali Akhavan
- Department of Radiotherapy, Shahid Sadoghi University, Yazd, Iran.
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