Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2021; 9(7): 1682-1695
Published online Mar 6, 2021. doi: 10.12998/wjcc.v9.i7.1682
Solid pseudopapillary neoplasm-diagnostic approach and post-surgical follow up: Three case reports and review of literature
Mohammad Abudalou, Eduardo A Vega, Rohit Dhingra, Erik Holzwanger, Sandeep Krishnan, Svetlana Kondratiev, Ali Niakosari, Claudius Conrad, Christopher G Stallwood
Mohammad Abudalou, Department of Internal Medicine, St. Elizabeth Medical Center, Brighton, MA 02135, United States
Eduardo A Vega, Claudius Conrad, Department of General Surgery, St. Elizabeth Medical Center, Brighton, MA 02135, United States
Rohit Dhingra, Erik Holzwanger, Department of Gastroenterology, Tufts Medical Center, Boston, MA 02111, United States
Sandeep Krishnan, Christopher G Stallwood, Department of Gastroenterology, St. Elizabeth Medical Center, Brighton, MA 02135, United States
Svetlana Kondratiev, Department of Pathology, St. Elizabeth Medical Center, Brighton, MA 02135, United States
Ali Niakosari, Department of Radiology, St. Elizabeth Medical Center, Brighton, MA 02135, United States
Author contributions: All authors contributed to the content of manuscript and helped in editing.
Informed consent statement: All involved subjects gave their consent verbally.
Conflict-of-interest statement: Authors declare no conflict of interest in content of manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Christopher G Stallwood, MA, MD, Assistant Professor, Department of Gastroenterology, St. Elizabeth Medical Center, 736 Cambridge St, Brighton, MA 02135, United States.
Received: October 7, 2020
Peer-review started: October 7, 2020
First decision: November 8, 2020
Revised: November 23, 2020
Accepted: January 22, 2021
Article in press: January 22, 2021
Published online: March 6, 2021

Solid pseudopapillary neoplasm (SPN) is a rare tumor that was first described by Frantz in 1959. Although this tumor is benign, some may have malignant potential that can be predicted based on demographics, imaging characteristics, and pathologic evaluation. This case series presents 3 SPN cases with discussion on gender differences, preoperative predictors of malignancy, and a suggested algorithm for diagnostic approach as well as post-surgical follow up.


Three adult patients in a tertiary hospital found to have SPN, one elderly male and two young females. Each of the cases presented with abdominal pain and were discovered incidentally. Two cases underwent endoscopic ultrasound with fine needle aspiration and biopsy to assess tumor markers and immuno-histochemical staining (which were consistent with SPN before undergoing surgery), and one case underwent surgery directly after imaging. The average tumor size was 5 cm. Diagnosis was confirmed by histology. Two patients had post-surgical complications requiring intervention.


Demographic and imaging characteristics can be sufficient to establish diagnosis for SPN, while malignant cases require pre-operative evaluation with endoscopic ultrasound fine needle aspiration/fine needle biopsy.

Keywords: Pancreas, Pancreatic cyst, Pancreatic neoplasms, Solid pseudopapillary neoplasm, Pancreatectomy, Case report

Core Tip: Solid pseudopapillary neoplasm accounts for approximately 0.7% of pancreatic cystic tumors. It is benign in 85% of the cases, while 15% can have malignant behavior. The advancement of cross sectional imaging has led to increased detection. Demographic and characteristic imaging findings might be sufficient to make a diagnosis and predict malignant behavior, which can direct the need towards further testing or to proceed directly with surgery. Definitive treatment is surgical resection and the type of surgery depends on location and presence of peripancreatic invasion.