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Guo J, Zhao Q, Qin L, Xie S, Lu S, Li B, He M, Xie L, Yu S. Massive extrapancreatic solid pseudopapillary neoplasm misdiagnosed as hepatic tumor: a case report and literature review. Front Oncol 2024; 14:1342400. [PMID: 38380363 PMCID: PMC10877141 DOI: 10.3389/fonc.2024.1342400] [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: 11/21/2023] [Accepted: 01/16/2024] [Indexed: 02/22/2024] Open
Abstract
Background Solid pseudopapillary neoplasms (SPNs) of the pancreas are uncommon, low-malignancy neoplasms. Moreover, the occurrence of extrapancreatic SPNs is rarely encountered. Case summary A 45-year-old female presented with a right upper abdominal mass and abdominal pain for 3 and 1 months as chief complaints, respectively. Initially, the patient was misdiagnosed with hepatocellular carcinoma based on her symptoms and results of physical and imaging examinations. Following multidisciplinary discussion and ruling out surgical contraindications, a decision was taken to proceed with surgical intervention. Interestingly, the tumor was found to originate from the retroperitoneum and had invaded the right half of the liver and the right wall of the inferior vena cava. The operation was uneventful, and the pathological findings confirmed the tumor as an extrapancreatic SPN. The patient remained asymptomatic after 15 months of follow-up. Conclusion Surgical treatment remains the preferred option for extrapancreatic SPN. The preoperative misdiagnosis also highlights the importance of accurate diagnosis and the development of appropriate treatment strategies for liver masses.
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Affiliation(s)
- Jixu Guo
- Division of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qingjuan Zhao
- The First Clinical Medical College, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Liting Qin
- Division of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shengjie Xie
- Division of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shiliu Lu
- Division of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Baibei Li
- Division of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Meilin He
- The First Clinical Medical College, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Linhong Xie
- Division of Hepatobiliary Surgery, The Second People’s Hospital of Qinzhou, Qinzhou, China
| | - Shuiping Yu
- Division of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Fleming AM, Hendrick LE, Yakoub D, Abdelhafeez H, Deneve JL, Langham MR, Glazer ES, Davidoff AM, Merchant NB, Dickson PV, Murphy AJ. Malignant Solid Pseudopapillary Neoplasm of the Pancreas: An Orthogonal Analysis. Ann Surg Oncol 2024; 31:475-487. [PMID: 37768414 DOI: 10.1245/s10434-023-14343-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Pancreatic solid pseudopapillary neoplasms (SPN) are generally indolent; however, some patients present with "malignant" SPN. An orthogonal analysis of multiple datasets was performed to investigate the utility of complete surgical resection (CSR) for malignant SPN. METHODS A systematic review was performed for cases of malignant SPN, defined as T4, N1, and/or M1. Malignant SPN was analyzed within the National Cancer Database (NCDB) and compared with T1-3N0M0 SPN. Predictors of malignant SPN were assessed, and treatments were analyzed by using survival analysis. RESULTS The systematic review yielded 164 cases of malignant SPN. Of 31 children, only one died due to malignant SPN. Among adults, CSR was associated with improved disease-specific survival (DSS) (P = 0.0002). Chemotherapy did not improve malignant SPN DSS, whether resected (P = 0.8485) or not (P = 0.2219). Of 692 adults with SPN within the NCDB, 93 (13.4%) had malignant SPN. Pancreatic head location (odds ratio [OR] 2.174; 95% confidence interval [CI] 1.136-4.166; P = 0.0186) and tumor size (OR 1.154; 95% CI 1.079-1.235; P < 0.0001) associated with the malignant phenotype. Malignant SPN predicted decreased overall survival (OS) compared with T1-3N0M0 disease (P < 0.0001). Resected malignant SPN demonstrated improved OS (P < 0.0001), including resected stage IV malignant SPN (P = 0.0003). Chemotherapy did not improve OS for malignant SPN, whether resected (P = 0.8633) or not (P = 0.5734). Within a multivariable model, resection was associated with decreased hazard of death (hazard ratio 0.090; 95% CI 0.030-0.261; P < 0.0001). CONCLUSIONS Approximately 13% of patients with SPN present with a malignant phenotype. Pediatric cases may be less aggressive. Resection may improve survival for malignant SPN, which does not appear chemosensitive.
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Affiliation(s)
- Andrew M Fleming
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA.
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Leah E Hendrick
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Danny Yakoub
- Department of Surgery, Augusta University Medical Center, Augusta, GA, USA
| | - Hafeez Abdelhafeez
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jeremiah L Deneve
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Max R Langham
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Evan S Glazer
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew M Davidoff
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nipun B Merchant
- Department of Surgery, University of Miami Health System, Miami, FL, USA
| | - Paxton V Dickson
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew J Murphy
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
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Ricardo VD, Marchetti G, de Almeida AF, Lopes CV, Reis JDS, Bonin EA, de Araújo WC, Machado MA, Romanini SG, Ardengh JC. Multicenter Study on the Performance of Imaging Tests Compared to Endosonography-Guided Fine-Needle Aspiration in the Diagnosis of Solid Pseudopapillary Neoplasms of the Pancreas. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:375-383. [PMID: 37868635 PMCID: PMC10586220 DOI: 10.1159/000525994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/07/2022] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Imaging diagnosis of pancreatic solid-pseudopapillary neoplasms (SPNs) is difficult. Preoperative diagnosis by endosonography-guided fine-needle aspiration (EUS-FNA) is possible and has been reported in the literature in pancreatic tumors. However, its usefulness is still controversial. The aim of this study was to determine the accuracy of the EUS-FNA in the diagnosis of patients with SPN and describe the findings in computerized tomography (CT), magnetic resonance cholangiopancreatography imaging (MRI/MRCP), and EUS therefore comparing the imaging methods alone to the findings of microhistology (McH) obtained by EUS-FNA. MATERIALS AND METHODS We retrospectively reviewed the medical records of patients undergoing EUS-FNA with suspected SPN in imaging studies in 5 Brazilian high-volume hospitals (two university hospitals and three private hospitals). The demographic data; findings in CT, MRI/MRCP, and EUS; and McH results obtained by EUS-FNA were noted prospectively. The final diagnosis was obtained after the anatomopathological examination of the surgical specimen in all patients (gold standard), and we compared the results of CT, MRI/MRCP, EUS, and the McH with the gold standard. RESULTS Fifty-four patients were included in the study, of which 49 (90.7%) were women with an average age of 33.4 (range 11-78) years. The most common symptom presented was abdominal pain, present in 35.2% patients. SPN was detected incidentally in 32 (59%) patients. The average size of the tumors was 3.8 cm (SD: 2.26). The most common finding at EUS was a solid, solid/cystic, and cystic lesion in 52.9%, 41.1%, and 7.8% patients, respectively. The final diagnosis was 51 patients with SPN and 3 with nonfunctioning pancreatic neuroendocrine tumors (NF-NET). The correct diagnosis was made by CT, MRI/MRCP, EUS isolated, and EUS-FNA in 21.9%, 28.88%, 64.71%, and 88.24%, respectively. EUS-FNA associated with CT and MRI increased diagnostic performance from 22.72% to 94.11% and from 29.16% to 94.11%, respectively. CONCLUSIONS SPN are rare, incidentally identified in most cases, and affect young women. Differential diagnosis between SPN, NF-NET, and other types of tumors with imaging tests can be difficult. EUS-FNA increases preoperative diagnosis in case of diagnostic doubt and should be used whenever necessary to rule out NF-NET or other type of solid/cystic nodular lesion of the pancreas.
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Affiliation(s)
| | - Giulia Marchetti
- Santa Casa de São Paulo Medical School (FCMSCSP), São Paulo, Brazil
| | | | - César Vivian Lopes
- Endoscopy Service of Santa Casa do Rio Grande do Sul, Rio Grande, Brazil
| | - Jerusa dos Santos Reis
- Endoscopy Section of the Presidente Dutra Hospital, Federal University of Maranhão, São Luís, Brazil
| | | | | | | | | | - José Celso Ardengh
- Endoscopy Department of Hospital Moriah, São Paulo, Brazil
- Digestive Endoscopy Section of Hospital das Clínicas de Ribeirão Preto Medical School, University of São Paulo (HCFMRP-USP), São Paulo, Brazil
- Department of Diagnostic Imaging of the Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Jayapal L, Kumar SR, Jebakumar GS, Tasgaonkar SS, Swain SK, Munikrishnan V, Balachandar TG. Solid Pseudopapillary Neoplasm of the Pancreas: Unraveling Insights from a Single Institutional Study Emphasizing Preoperative Diagnosis of a Rare Tumor. Euroasian J Hepatogastroenterol 2023; 13:50-54. [PMID: 38222960 PMCID: PMC10785128 DOI: 10.5005/jp-journals-10018-1394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/04/2023] [Indexed: 01/16/2024] Open
Abstract
Aim Solid pseudopapillary neoplasm (SPN), a slow-growing pancreatic tumor with a vague clinical presentation and non-specific radiological features, is rather uncommon. We share our experience emphasizing on preoperative diagnosis and the correlation with final histopathological examination. Materials and methods This is a retrospective analysis of the 468 patients who underwent pancreas-related surgery at our institution between January 2013 and July 2022. Demographic characteristics, symptoms at presentation, preoperative serum calcium carbohydrate antigen (CA 19-9), lesion characteristics on cross-sectional diagnostic imaging, surgical technique, complications in postoperative period, length of stay, histopathological features, and 3-year follow-up findings of the patients with SPN of pancreas were evaluated. Results The male-to-female ratio was 1:11 and the mean age at presentation was 33.3 ± 9.5 years. Upper abdomen discomfort was the most common presenting complaint (91%). And five patients had findings suggestive of SPN on preoperative CECT abdomen, and the remaining six individuals were diagnosed solely based on final histological examination. The tumor's median diameter was 5.6 cm (range, 4.1-7.9). The distal body and tail of pancreas was the most common location (63%), followed by the head (36%), and was managed with distal pancreatectomy with or without spleen preservation and Whipple's procedure, respectively. One patient developed grade III Clavien-Dindo complication. The average length of in-hospital stay was 8.27±2.72 days. None of the patients had recurrence on follow-up. Conclusion Solid pseudopapillary neoplasm of the pancreas is often misdiagnosed preoperatively. Endoscopic ultrasound-guided FNA with IHC will be beneficial to diagnose it preoperatively especially in small-sized tumors with atypical features. Complete surgical resection with adequate margins without routine lymphadenectomy is curative in resectable tumors. How to cite this article Jayapal L, Kumar SR, Jebakumar GS, et al. Solid Pseudopapillary Neoplasm of the Pancreas: Unraveling Insights from a Single Institutional Study Emphasizing Preoperative Diagnosis of a Rare Tumor. Euroasian J Hepato-Gastroenterol 2023;13(2):50-54.
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Affiliation(s)
- Loganathan Jayapal
- Department of Surgical Gastroenterology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Santhosh R Kumar
- Department of Surgical Gastroenterology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | | | - Siddesh S Tasgaonkar
- Department of Surgical Gastroenterology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Sudeepta Kumar Swain
- Department of Surgical Gastroenterology, Apollo Hospitals, Chennai, Tamil Nadu, India
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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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Wang R, Li J, Tan CL, Liu XB, Chen YH. Prospects and applications of enucleation in solid pseudopapillary neoplasms of the pancreas. World J Gastrointest Oncol 2022; 14:1227-1238. [PMID: 36051095 PMCID: PMC9305568 DOI: 10.4251/wjgo.v14.i7.1227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/30/2022] [Accepted: 06/21/2022] [Indexed: 02/06/2023] Open
Abstract
Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare, low-grade, malignant neoplasms that are mostly seen in young women in the second and third decades of life and are quite uncommon in children. Standard resection for benign and borderline neoplasms of the pancreas is associated with a substantial risk of postoperative morbidity and long-term functional impairment, whereas enucleation leads to less morbidity and preserves healthy parenchyma as well as exocrine and endocrine function. Enucleation of SPNs has been increasingly reported to be feasible and safe for preserving the normal physiological function of the pancreas, especially in teenagers and children. This review summarizes findings published in recent years on the enucleation of SPNs as well as potential future developments and directions. Enucleation has undoubtedly come to stay as an alternative surgical procedure for SPNs. However, many questions remain unresolved, and future directions toward the best surgical indication, the prevention and intervention of complications, especially pancreatic fistula, intraoperative resection margin safety assessment, and long-term oncology prognosis remain to be evaluated and should be explored in future clinical trials.
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Affiliation(s)
- Rui Wang
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu 610037, Sichuan Province, China
| | - Jing Li
- Department of Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610037, Sichuan Province, China
| | - Chun-Lu Tan
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu 610037, Sichuan Province, China
| | - Xu-Bao Liu
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu 610037, Sichuan Province, China
| | - Yong-Hua Chen
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu 610037, Sichuan Province, China
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Naoi D, Koinuma K, Sasanuma H, Sakuma Y, Horie H, Lefor AK, Sugano K, Ushiama M, Yoshida T, Sata N. Solid-pseudopapillary neoplasm of the pancreas in a patient with familial adenomatous polyposis: a case report. Surg Case Rep 2021; 7:35. [PMID: 33511474 PMCID: PMC7843828 DOI: 10.1186/s40792-021-01121-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Familial adenomatous polyposis (FAP) is characterized by the presence of hundreds to thousands of colonic polyps, and extracolonic manifestations are likely to occur. Pancreatic tumors are rare extracolonic manifestations in patients with FAP, among which solid-pseudopapillary neoplasm (SPN) are extremely rare. We report here a patient with an SPN of the pancreas found during the follow-up of FAP. Case presentation A 20-year-old woman was diagnosed with FAP 3 years previously by colonoscopy which revealed less than 100 colonic polyps within the entire colon. She complained of left upper abdominal pain and a 10-cm solid and cystic pancreatic tumor was found by computed tomography scan. Solid and cystic components within the tumor were seen on abdominal magnetic resonance imaging. Simultaneous laparoscopic resection of the distal pancreas and subtotal colectomy was performed. Histopathological findings confirmed the pancreatic tumor as an SPN without malignancy. Abnormal staining of beta-catenin was observed by immunohistochemical study. Multiple polyps in the colorectum were not malignant. Molecular biological analysis from peripheral blood samples revealed a decrease in the copy number of the promoter 1A and 1B region of the APC gene, which resulted in decreased expression of the APC gene. Conclusions A rare association of SPN with FAP is reported. The genetic background with relation to beta-catenin abnormalities is interesting to consider tumor development. So far, there are few reports of SPN in a patient with FAP. Both lesions were treated simultaneously by laparoscopic resection.
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Affiliation(s)
- Daishi Naoi
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University School of Medicine, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Koji Koinuma
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University School of Medicine, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hideki Sasanuma
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University School of Medicine, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yasunaru Sakuma
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University School of Medicine, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hisanaga Horie
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University School of Medicine, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Alan Kawarai Lefor
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University School of Medicine, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kokichi Sugano
- Genome Center, Genetic Counseling Clinic, Tochigi Cancer Center Research Institute, Tochigi, Japan
| | - Mineko Ushiama
- Department of Genetic Medicine and Services, National Cancer Center Hospital, Tokyo, Japan
| | - Teruhiko Yoshida
- Department of Genetic Medicine and Services, National Cancer Center Hospital, Tokyo, Japan
| | - Naohiro Sata
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University School of Medicine, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
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Safety of Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Pancreatic Solid Pseudopapillary Neoplasm Before Surgical Resection: A European Multicenter Registry-Based Study on 149 Patients. Pancreas 2020; 49:34-38. [PMID: 31856077 DOI: 10.1097/mpa.0000000000001460] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The results of only a few endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic solid pseudopapillary neoplasm (SPN) have been published, and the safety of the procedure has never been investigated. Our study compared the recurrence rate in patients with and without preoperative EUS-FNA. METHODS This European multicenter registry-based study was conducted in 22 digestive units, and retrospectively included all patients who underwent complete resection of a pancreatic SPN from 2000 to 2018. Patients with and without initial EUS-FNA were compared, and postsurgery recurrence and the associated risk factors were evaluated. RESULTS A complete resection of a pancreatic SPN was performed in 149 patients (133 women, 89%), with a mean age of 34 (standard deviation, 14) years. There were no significant differences between the with (78 patients) and without (71 patients) EUS-FNA groups, except for age and tumor size and location.Preoperative EUS-FNA allowed pancreatic SPN diagnosis in 63/78 cases (81%). After a mean follow-up of 43 (standard deviation, 36) months, recurrence was noted in 4 patients (2.7%). Preoperative EUS-FNA was not correlated with recurrence, but an older age (P = 0.005) was significant. CONCLUSIONS Preoperative EUS-FNA does not affect pancreatic SPN recurrence. In this series, old age was significantly correlated with recurrence.
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Zhan H, Cheng Y, Wang L, Su P, Zhong N, Zhang Z, Zhi X, Hu S. Clinicopathological Features and Treatment Outcomes of Solid Pseudopapillary Neoplasms of the Pancreas: A 10-Year Case Series from a Single Center. J Laparoendosc Adv Surg Tech A 2019; 29:600-607. [PMID: 30741591 DOI: 10.1089/lap.2018.0704] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare pancreatic tumors. This study summarizes the clinicopathological characteristics and treatment outcomes of SPN patients through a 10-year single-center case series. Materials and Methods: Medical records of patients diagnosed with SPNs and who underwent surgery between August 2007 and July 2017 at Qilu Hospital, Shandong University, were retrospectively analyzed. Results: This study included 91 patients: 13 males/78 females, mean age 28.8 ± 11.5 years. Among the cases, 38.5% were incidentally confirmed without specific symptoms, while the others displayed various abdominal symptoms. All patients had single pancreatic lesions, and 1 patient presented with liver metastasis. Abdominal enhanced computed tomography, magnetic resonance imaging, and endoscopic ultrasound were the diagnostic imaging techniques used to identify SPNs. All patients had successful surgical removal of their tumors; 28 patients underwent laparoscopy. During the 2-121-month follow-up period, 1 patient died of lung metastasis and multiple organ failure at 35 months postoperatively, but no other tumor recurrence or metastasis was found. Conclusions: SPN usually occurs in the young female population and presents with various clinical characteristics. Mixed solid-cystic masses with calcification or hemorrhage are typical morphological tumor features. Minimally invasive organ-/function-preserving operations are advocated for benign cases, while aggressive radical resection should be performed in patients with local invasion or distant metastasis.
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Affiliation(s)
- Hanxiang Zhan
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Yugang Cheng
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Lei Wang
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Peng Su
- Department of Pathology, Qilu Hospital, Shandong University, Jinan, China
| | - Ning Zhong
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Zongli Zhang
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Xuting Zhi
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Sanyuan Hu
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
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Tan HL, Syn N, Goh BKP. Systematic Review and Meta-analysis of Minimally Invasive Pancreatectomies for Solid Pseudopapillary Neoplasms of the Pancreas. Pancreas 2019; 48:1334-1342. [PMID: 31688598 DOI: 10.1097/mpa.0000000000001426] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We report the first systematic review and meta-analysis on minimally invasive pancreatectomy (MIP) for solid pseudopapillary neoplasms (SPPN) of the pancreas. METHODS A systematic review of all studies reporting patient characteristics and outcomes of MIP for SPPN was conducted. RESULTS We reviewed 27 studies comprising 149 patients with SPPN managed via MIP. Five were comparative retrospective cohort studies, comprising 46 and 60 patients in the minimally-invasive and open groups, respectively. Tumor size was smaller in the minimally-invasive group (mean difference, -2.20; 95% confidence interval (CI), -3.09 to -1.32; P < 0.001). The MI group had lower intraoperative blood loss (mean difference, -180.19; 95% CI, -344.28 to -16.09; P = 0.03) and transfusion requirement (relative risk, 0.24; 95% CI, 0.06-0.94; P = 0.04), and a shorter time to diet (mean difference, -2.99; 95% CI, -3.96 to -2.03; P < 0.001) and length of stay (mean difference, -3.61; 95% CI, -6.98 to -0.24; P = 0.04). There was no significant difference in operating time, margin positivity, postoperative morbidity, and postoperative pancreatic fistula rates. CONCLUSIONS Minimally invasive pancreatectomy for SPPN is associated with decreased intraoperative blood loss and transfusion requirements and a shorter postoperative time to diet and hospital stay.
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Affiliation(s)
- Hwee Leong Tan
- From the Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Nicholas Syn
- From the Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Brian K P Goh
- From the Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
- Duke-NUS Graduate Medical School Singapore, Singapore
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11
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Lanke G, Ali FS, Lee JH. Clinical update on the management of pseudopapillary tumor of pancreas. World J Gastrointest Endosc 2018; 10:145-155. [PMID: 30283597 PMCID: PMC6162250 DOI: 10.4253/wjge.v10.i9.145] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/28/2018] [Accepted: 06/08/2018] [Indexed: 02/06/2023] Open
Abstract
Solid pseudopapillary neoplasm (SPN) is a rare tumor with malignant potential which is generally located in the tail of pancreas. The prevalence of SPN has increased with widespread use of cross sectional imaging. SPN is often misdiagnosed due to nonspecific clinical presentation and accurate diagnosis is essential for optimal management. Endoscopic ultrasound-FNA with immunohistochemistry can help in preoperative diagnosis. Surgery is the treatment of choice and a successful R0 resection is curative. Overall, SPN has a good prognosis. This review article focuses on pathogenesis, diagnosis and management of SPN.
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Affiliation(s)
- Gandhi Lanke
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Faisal S Ali
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Jeffrey H Lee
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
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12
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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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13
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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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14
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Naar L, Spanomichou DA, Mastoraki A, Smyrniotis V, Arkadopoulos N. Solid Pseudopapillary Neoplasms of the Pancreas: A Surgical and Genetic Enigma. World J Surg 2018; 41:1871-1881. [PMID: 28251269 DOI: 10.1007/s00268-017-3921-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Solid pseudopapillary neoplasms of the pancreas are rare tumors accounting for 1-2% of pancreatic exocrine neoplasms. This entity was first described by Dr. Frantz in 1959 and was defined by the World Health Organization in 1996 as "solid pseudopapillary tumor." It is most often a benign neoplasm, but 10-15% of the cases are malignant. Over the past decades, the incidence of this tumor is increasing. However, many surgeons are still unfamiliar with this neoplasm and its unique characteristics, which can lead to pitfalls in the diagnosis and treatment. The correct diagnosis of SPNP is of utmost importance since it has a low malignant potential and with the appropriate treatment, patients have a long life expectancy. There are many genetic alterations, involving various signaling pathways that have been associated with SPNP and are very important in diagnosing the tumor. The cornerstone of SPNP treatment includes surgical excision of the tumor, preserving as much pancreatic tissue as possible. We review the information in the literature regarding more organ-preserving techniques and possible clinical features that might indicate a malignant potential, thus demanding a more radical intraoperative excision.
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Affiliation(s)
- Leon Naar
- 4th Department of Surgery, Athens University Medical School, ATTIKON University Hospital, 1 Rimini Street, Chaidari, 12462, Athens, Greece
| | - Despoina-Amalia Spanomichou
- 4th Department of Surgery, Athens University Medical School, ATTIKON University Hospital, 1 Rimini Street, Chaidari, 12462, Athens, Greece
| | - Aikaterini Mastoraki
- 4th Department of Surgery, Athens University Medical School, ATTIKON University Hospital, 1 Rimini Street, Chaidari, 12462, Athens, Greece.
| | - Vassilios Smyrniotis
- 4th Department of Surgery, Athens University Medical School, ATTIKON University Hospital, 1 Rimini Street, Chaidari, 12462, Athens, Greece
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, Athens University Medical School, ATTIKON University Hospital, 1 Rimini Street, Chaidari, 12462, Athens, Greece
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15
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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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16
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Ridtitid W, Al-Haddad MA. Endoscopic Ultrasound Imaging for Diagnosing and Treating Pancreatic Cysts. Gastrointest Endosc Clin N Am 2017; 27:615-642. [PMID: 28918802 DOI: 10.1016/j.giec.2017.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cystic pancreatic lesions are increasingly diagnosed owing to the abundant use of cross-sectional imaging. Given their malignant potential, true pancreatic cysts should be considered for resection or periodic follow-up. Cystic lesions of the pancreas (CLPs) require further evaluation and management. Therefore, it is important to establish a solid diagnosis at the time of detection. Endoscopic ultrasound examination is the imaging modality of choice. Fine needle aspiration provides fluid for cytologic, biochemical, and molecular assays to classify lesions and predict biological behavior. This review provides an overview of the diagnosis and management of various types of commonly encountered true CLPs.
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Affiliation(s)
- Wiriyaporn Ridtitid
- Division of Gastroenterology and Hepatology, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Mohammad A Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 550 North University Boulevard, Suite 4100, Indianapolis, IN 46202, USA.
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17
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Solid Pseudopapillary Neoplasm of the Pancreas: Clinicopathologic Feature, Risk Factors of Malignancy, and Survival Analysis of 53 Cases from a Single Center. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5465261. [PMID: 29094047 PMCID: PMC5637868 DOI: 10.1155/2017/5465261] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/09/2017] [Accepted: 07/31/2017] [Indexed: 12/16/2022]
Abstract
Introduction Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor of low malignant potential. The aim of this study was designed to evaluate the clinicopathologic feature, predictive factors of malignancy, and survival from experience of a single center. Methods 53 consecutive patients who underwent surgery for a pathologically definitive SPN were retrospectively reviewed. Results A total of 53 cases included 7 male cases and 46 female cases with the median age of 35.4 years (14-67). Abdominal pain and mass were the most common clinical presentations. The radiological presentations were consistent with solid and cystic pattern in 18 cases, solid pattern in 25 cases, and cystic pattern in 10 cases. The predominant location of tumor was pancreatic body and tail. The mean size of the tumors was 6.4 cm. Aggressive en bloc resection combined with organ-preserving should be indicated whenever feasible. Follow-up information was available for 48 patients with a median follow-up time of 48 months. The 5-year disease-specific survival was 95.7%. Incomplete capsule was not only the predictive factor of malignancy but also the significant predictor of disease-specific survival. Conclusion Incomplete capsule may suggest a malignant SPN and a prognostic indicator of disease-specific survival. We recommend that surgeons consider a more radical resection with an incomplete capsule of tumor.
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18
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Namur GN, Ribeiro TC, Souto MM, Figueira ERR, Bacchella T, Jureidini R. MINIMALLY INVASIVE SURGERY FOR PSEUDOPAPILLARY NEOPLASM OF THE PANCREAS. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 29:97-101. [PMID: 27438035 PMCID: PMC4944744 DOI: 10.1590/0102-6720201600020008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/08/2016] [Indexed: 01/04/2023]
Abstract
Background: Solid pseudopapillary pancreatic neoplasia is usually a large well-circumscribed
pancreatic mass, with cystic and solid areas more frequently found in young women.
It is a benign pancreatic neoplasia in most cases, therefore minimally invasive
surgery could be an interesting approach. Aim: Evaluate the results of minimally invasive surgery for this neoplasia. Methods: Patients with this tumor who underwent minimally invasive pancreatectomies
between 2009 and 2015 in a single institution, were analyzed regarding
demographic, clinical-pathological futures, post-operative morbidity and
disease-free survival. Results: All were women, and their median age was 39 (18-54) years. Two patients with
tumor in the head of the pancreas underwent laparoscopic pancreaticoduodenectomy,
and another one underwent laparoscopic enucleation. Two patients with tumor in the
neck underwent central pancreatectomy. Distal pancreatectomies were performed in
the other five, one with splenic preservation. None required blood transfusion or
conversion to open surgery. Two (20%) developed clinical relevant pancreatic
fistulas, requiring readmission. Median length of postoperative hospital stay was
five days (2-8). All resection margins were negative. Patients were followed for a
median of 38 months (14-71), and there was no recurrence. Conclusions: Minimally invasive surgery for solid pseudopapillary pancreatic neoplasia is
feasible for tumors in different locations in the pancreas. It was associated with
acceptable morbidity and respected the oncologic principles for treatment.
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Affiliation(s)
| | - Thiago Costa Ribeiro
- Hospital de Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Marcelo M Souto
- Hospital de Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - Telesforo Bacchella
- Hospital de Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Ricardo Jureidini
- Hospital de Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
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19
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Lee HS, Kim HK, Shin BK, Choi JH, Choi YJ, Kim HY. A Rare Case of Recurrent Metastatic Solid Pseudopapillary Neoplasm of the Pancreas. J Pathol Transl Med 2016; 51:87-91. [PMID: 27498546 PMCID: PMC5267534 DOI: 10.4132/jptm.2016.06.16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/21/2016] [Accepted: 06/16/2016] [Indexed: 11/30/2022] Open
Abstract
A 61-year-old woman visited our hospital for bilateral multiple lung nodules and a mass in her thorax. She had a long history of multiple metastatic recurrences of solid pseudopapillary neoplasm (SPN); 24 years previously, the patient had undergone pylorus-preserving pancreaticoduodenectomy for a 9.9 × 8.6 cm mass in the pancreatic head. The tumor was diagnosed as an SPN. Nine years later, metastatic nodules were found on computed tomography in the patient’s liver and peritoneum and were excised. She subsequently underwent an additional eight metastatectomy procedures in diverse organs. For the presented event, the lung nodules were removed. The prevalence of malignant SPN in the general population is 5%–15%. However, multiple metastatic recurrence of malignant SPN is rare; the lung is a particularly rare site of metastasis, found in only three cases in the literature. Here, we describe this exceptional case and provide a literature review.
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Affiliation(s)
- Hye Seung Lee
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Han Kyeom Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Bong Kyung Shin
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Jin Hyuk Choi
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Yoo Jin Choi
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Ha Yeon Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
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20
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Yang F, Yu X, Bao Y, Du Z, Jin C, Fu D. Prognostic value of Ki-67 in solid pseudopapillary tumor of the pancreas: Huashan experience and systematic review of the literature. Surgery 2016; 159:1023-1031. [PMID: 26619927 DOI: 10.1016/j.surg.2015.10.018] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 10/13/2015] [Accepted: 10/13/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Solid pseudopapillary tumor of the pancreas (SPTP) is considered to have a low Ki-67 proliferation index, which may explain the generally good clinical outcome. The aim of our study was to evaluate whether Ki-67 has prognostic value in SPTP. METHODS A case series study of patients with SPTP treated in our institution from June 2002 to April 2014 was conducted. Prognostic factors for clinical outcomes were analyzed by the use of clinical decision and survival analysis. In addition, we performed a systematic review and pooled analysis to evaluate our results. RESULTS The institutional data included 71 patients (13 male and 58 female) ranging in age from 12 to 64 years (median, 31 years). Three patients developed local recurrence and/or liver metastasis after initial surgery. The 5-year recurrence-free survival rate was 93.6%. One patient died of disease, with the 5-year disease-specific survival rate of 98.5%. Ki-67 index ≥ 4% was found significantly associated with the survival of SPTP. Twenty-six studies comprising 163 patients were included in the pooled analysis based on our inclusion criteria. A total of 15 cases showed a Ki-67 index ≥ 4%. Kaplan-Meier survival analysis confirmed that Ki-67 index ≥ 4% was significantly associated with poorer recurrence-free survival and disease-specific survival (both P < .001). CONCLUSION This study highlighted a potential role of Ki-67 in predicting adverse outcome of patients with SPTP and should be considered as part of routine histological reporting of SPTP.
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Affiliation(s)
- Feng Yang
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital affiliated to Fudan University, Shanghai, China
| | - Xinzhe Yu
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital affiliated to Fudan University, Shanghai, China
| | - Yun Bao
- Department of Pathology, Huashan Hospital affiliated to Fudan University, Shanghai, China
| | - Zunguo Du
- Department of Pathology, Huashan Hospital affiliated to Fudan University, Shanghai, China
| | - Chen Jin
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital affiliated to Fudan University, Shanghai, China
| | - Deliang Fu
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital affiliated to Fudan University, Shanghai, China.
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21
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Nakamura Y, Matsushita A, Katsuno A, Yamahatsu K, Sumiyoshi H, Mizuguchi Y, Uchida E. Clinical outcomes for 14 consecutive patients with solid pseudopapillary neoplasms who underwent laparoscopic distal pancreatectomy. Asian J Endosc Surg 2016; 9:32-6. [PMID: 26567867 DOI: 10.1111/ases.12256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 10/08/2015] [Accepted: 10/12/2015] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The postoperative results of laparoscopic distal pancreatectomy for solid pseudopapillary neoplasm of the pancreas (SPN), including the effects of spleen-preserving resection, are still to be elucidated. METHODS Of the 139 patients who underwent laparoscopic pancreatectomy for non-cancerous tumors, 14 consecutive patients (average age, 29.6 years; 1 man, 13 women) with solitary SPN who underwent laparoscopic distal pancreatectomy between March 2004 and June 2015 were enrolled. The tumors had a mean diameter of 4.8 cm. Laparoscopic spleen-preserving distal pancreatectomy was performed in eight patients (spleen-preserving group), including two cases involving pancreatic tail preservation, and laparoscopic spleno-distal pancreatectomy was performed in six patients (standard resection group). RESULTS The median operating time was 317 min, and the median blood loss was 50 mL. Postoperatively, grade B pancreatic fistulas appeared in two patients (14.3%) but resolved with conservative treatment. No patients had postoperative complications, other than pancreatic fistulas, or required reoperation. The median postoperative hospital stay was 11 days, and the postoperative mortality was zero.None of the patients had positive surgical margins or lymph nodes with metastasis. The median follow-up period did not significantly differ between the two groups (20 vs 39 months, P = 0.1368). All of the patients are alive and free from recurrent tumors without major late-phase complications. CONCLUSION Laparoscopic distal pancreatectomy might be a suitable treatment for patients with SPN. A spleen-preserving operation is preferable for younger patients with SPN, and this study demonstrated the non-inferiority of the procedure compared to spleno-distal pancreatectomy.
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Affiliation(s)
- Yoshiharu Nakamura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Akira Matsushita
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Akira Katsuno
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Kazuya Yamahatsu
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Hiroki Sumiyoshi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Yoshiaki Mizuguchi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Eiji Uchida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
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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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