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Möller K, Löwe A, Jenssen C, Bhutani MS, On W, Everett SM, Braden B, Hocke M, Healey A, Dong Y, Gerber M, Faiss S, Rimbas M, Ge N, Sun S, Taut H, Srivastava D, Burmester E, Dietrich CF. Comments and illustrations of the European Federation of Societies for Ultrasound in Medicine contrast-enhanced ultrasound guidelines. Rare pancreatic tumors, imaging features on transabdominal ultrasound and EUS with contrast enhancement: Rare epithelial pancreatic tumors: solid pseudopapillary neoplasm, acinar cell carcinoma, mixed neuroendocrine-non-neuroendocrine neoplasms, some rare subtypes of pancreatic adenocarcinoma and pancreatoblastoma. Endosc Ultrasound 2024; 13:129-144. [PMID: 39318646 PMCID: PMC11419495 DOI: 10.1097/eus.0000000000000056] [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: 11/15/2023] [Accepted: 12/13/2023] [Indexed: 09/26/2024] Open
Abstract
Rare malignant pancreatic lesions are systematically reported in this review. The focus is on the imaging appearance of the rare epithelial pancreatic tumors such as the solid pseudopapillary neoplasm, acinar cell carcinoma, rare subtypes of adenocarcinoma, and pancreatoblastoma as seen on ultrasound, EUS, and contrast-enhanced ultrasound or EUS. The present overview summarizes the data and shows that not every pancreatic tumor is likely to be the most common entities of ductal adenocarcinoma or neuroendocrine tumor.
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Affiliation(s)
- Kathleen Möller
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
| | - Axel Löwe
- Department Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch-Oderland, Strausberg, Germany
- Brandenburg Institute for Clinical Ultrasound (BICUS) at Medical University Brandenburg, Neuruppin, Germany
| | - Manoop S. Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Wei On
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Simon M. Everett
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, United Kingdom
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Germany
| | - Andrew Healey
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Michael Gerber
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
| | - Siegbert Faiss
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
| | - Mihai Rimbas
- Department of Gastroenterology, Clinic of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania
| | - Nan Ge
- Department of Endoscopy Center, Shengjing Hospital of China Medical University, Liaoning Province, China
| | - Siyu Sun
- Department of Endoscopy Center, Shengjing Hospital of China Medical University, Liaoning Province, China
| | - Heike Taut
- Children's Hospital, Universitätsklinikum Dresden, Technische Universität Dresden, Dresden, Germany
| | - David Srivastava
- Department Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
- University Hospital, Inselspital Bern, Switzerland
| | - Eike Burmester
- Medizinische Klinik I, Sana Kliniken Luebeck, Lübeck, Germany
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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Xu YC, Fu DL, Yang F. Unraveling the enigma: A comprehensive review of solid pseudopapillary tumor of the pancreas. World J Gastrointest Oncol 2024; 16:614-629. [PMID: 38577449 PMCID: PMC10989376 DOI: 10.4251/wjgo.v16.i3.614] [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: 11/09/2023] [Revised: 12/28/2023] [Accepted: 01/16/2024] [Indexed: 03/12/2024] Open
Abstract
Solid pseudopapillary tumor of the pancreas (SPTP) is a rare neoplasm predominantly observed in young females. Pathologically, CTNNB1 mutations, β-catenin nuclear accumulation, and subsequent Wnt-signaling pathway activation are the leading molecular features. Accurate preoperative diagnosis often relies on imaging techniques and endoscopic biopsies. Surgical resection remains the mainstay treatment. Risk models, such as the Fudan Prognostic Index, show promise as predictive tools for assessing the prognosis of SPTP. Establishing three types of metachronous liver metastasis can be beneficial in tailoring individualized treatment and follow-up strategies. Despite advancements, challenges persist in understanding its etiology, establishing standardized treatments for unresectable or metastatic diseases, and developing a widely recognized grading system. This comprehensive review aims to elucidate the enigma by consolidating current knowledge on the epidemiology, clinical presentation, pathology, molecular characteristics, diagnostic methods, treatment options, and prognostic factors.
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Affiliation(s)
- Ye-Cheng Xu
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - De-Liang Fu
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Feng Yang
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Fudan University, Shanghai 200040, China
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Fu C, Li X, Wang Y, Wang C, Jin H, Liu K, Xu H. Solid pseudopapillary neoplasm of the pancreas: a retrospective study of 195 cases. Front Oncol 2024; 14:1349282. [PMID: 38469229 PMCID: PMC10925641 DOI: 10.3389/fonc.2024.1349282] [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: 12/04/2023] [Accepted: 02/12/2024] [Indexed: 03/13/2024] Open
Abstract
Objective Solid pseudopapillary neoplasm of the pancreas (SPN) is a rare exocrine tumor of the pancreas. The aim of our study is to summarize the clinical features of SPN and to analyze the risk factors for malignant SPN. Methods From May 2013 to September 2022, patients who were pathologically confirmed to have SPN were retrospectively reviewed. Demographic data, clinical and pathological features, follow-up data were collected and analyzed. To investigate the factors influencing the benign or malignant nature of SPN, we employed logistic regression. Additionally, we utilized Kaplan-Meier curves to depict and analyze the overall prognosis. Results A total of 195 patients were included, 163 of whom were female and the average age of all patients was 31.7 years old. Among 195 patients, 101 patients (51.8%) had no obvious clinical symptoms and their pancreatic lesions were detected during routine examination. The primary symptom was abdominal pain and distension in 64 cases (32.8%). The maximum diameter of SPN tumors ranged from 1-17 cm (mean 6.19 cm). Forty-eight postoperative complications developed in 43 (22.1%) patients. After a median follow-up duration of 44.5 months, the overall 5-year survival rate was 98.8% and the recurrence rate was 1.5%. Furthermore, we observed a statistically significant difference in the completeness of the tumor capsule between benign and malignant SPN. Conclusion SPN is associated with a favorable long-term survival after surgery in our large sample size cohort. For malignant SPN, tumor capsule incompleteness is an independent risk factor.
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Affiliation(s)
- Chang Fu
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xiaocong Li
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongxin Wang
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Chuangshi Wang
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hengwei Jin
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Kai Liu
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Hongji Xu
- Department of Abdominal Surgery, Guiqian International General Hospital, Guiyang, Guizhou, China
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Chen L, Yuan M, Wang M, Luo C, Gao M, Huang Q, Li Z, Zhou Z. Case report: Retroperitoneal solid pseudopapillary neoplasm associated with multiple hepatic metastases. Front Oncol 2024; 14:1335930. [PMID: 38352895 PMCID: PMC10861742 DOI: 10.3389/fonc.2024.1335930] [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: 11/09/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
Solid pseudopapillary neoplasm (SPN) is a rare tumor mostly occurring in the pancreas. They are low-grade malignant tumors of the exocrine pancreas that occasionally metastasize, usually to the liver or peritoneum. Additionally, multiple metastases of extrapancreatic SPN to the liver are extremely rare and have been reported before. This study presents a case of a 13-year-old male patient with retroperitoneal SPN and multiple hepatic metastases. The patient presented with abdominal trauma and underwent enhanced CT, which revealed upper pancreatic occupancy and three hypodense foci in the right lobe of the liver. Moreover, increased spleen size was noted. The patient's serum tumor marker CA125 was increased to 39.00 U/mL (N < 35.0 U/mL), and circulating tumor cells were elevated to 10.2 FU/3 mL (N < 8.7 FU/3 mL). The patient underwent retroperitoneal occupancy resection and splenectomy, followed by resection of liver metastases 7 months after the surgery. Furthermore, multiple liver metastases from retroperitoneal SPN were confirmed postoperatively. The patient recovered for 1 year without tumor recurrence. This case emphasizes the importance of evaluating serum tumor markers and medical imaging in young patients as well as the fact that surgery appears to be the preferred treatment option for multiple metastases in SPN.
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Affiliation(s)
- Lin Chen
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengchen Yuan
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng Wang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chenglong Luo
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengyu Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingbo Huang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhenqian Li
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhigang Zhou
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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The Role of MRI in the Diagnosis of Solid Pseudopapillary Neoplasm of the Pancreas and Its Mimickers: A Case-Based Review with Emphasis on Differential Diagnosis. Diagnostics (Basel) 2023; 13:diagnostics13061074. [PMID: 36980388 PMCID: PMC10046973 DOI: 10.3390/diagnostics13061074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/05/2023] [Accepted: 03/09/2023] [Indexed: 03/15/2023] Open
Abstract
Solid pseudopapillary neoplasm (SPN) is rare pancreatic tumor occurring most commonly in young females. The typical imaging appearance of SPN is of well-defined, encapsulated, and large heterogeneous tumors, consisting of solid and cystic components due to various degrees of intralesional hemorrhage and necrosis. However, atypical imaging presentation in the form of small solid tumors or uniformly cystic lesions might also be seen, which can be explained by specific pathological characteristics. Other imaging features such as a round shape, the absence of main pancreatic duct dilatation, and slow growth, in combination with vague symptoms, favor the diagnosis of SPNs. Nevertheless, the radiological findings of SPN might overlap with other solid and cystic pancreatic neoplasms, such as neuroendocrine tumors, serous and mucinous neoplasms, and even small pancreatic adenocarcinomas. In addition, a few benign non-tumorous conditions including walled-of-necrosis, and intrapancreatic accessory spleen may also pose diagnostic dilemmas simulating SPNs on imaging studies. The aim of this manuscript is to provide a comprehensive overview of the typical and atypical imaging features of SPNs and to describe useful tips for differential diagnosis with its potential mimickers.
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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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Rare Pseudopapillary Neoplasm of the Pancreas: A 10-Year Experience. Surg Res Pract 2021; 2021:7377991. [PMID: 34568545 PMCID: PMC8463183 DOI: 10.1155/2021/7377991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction The solid pseudopapillary epithelial neoplasm (SPN) is a rare form of pancreatic neoplasm with an incidence of 2-3% of all pancreatic tumours. The recent increase in incidence is attributed to the increasing use of imaging techniques for nonspecific abdominal complaints. We report our institutional experience in the management of this tumour over the last decade. Method We retrospectively analyzed from a prospectively maintained database of patients from January 2011 to December 2020 who were operated upon for SPN. All the patients were followed till date. Results Of 479 patients operated on for various types of pancreatic tumours during this period, 15 (3.1%) had SPN. The mean age of presentation was 28 years with a female preponderance (12/15, 80%). The most common location was the body and tail of the pancreas (66%), and the mean size was 6.4 cm (2–15 cm). The tumour extent was defined as ‘borderline resectable' in 20% of cases. Distal pancreatectomy was done in 11 patients with spleen preservation in 3. R0, R1, and R2 resection were done in 12, 2, and 1 patient(s), respectively. The operative mortality was 6.7%. All the patients are doing well on follow-up. Conclusion SPN is a low-grade malignant tumour with a strong female predilection. Clinical manifestations have no specificity, imaging examination only contributes tumour location, and the final diagnosis rests on pathology. Surgery is the main modality of treatment and carries a good prognosis.
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Abudalou M, Vega EA, Dhingra R, Holzwanger E, Krishnan S, Kondratiev S, Niakosari A, Conrad C, Stallwood CG. Solid pseudopapillary neoplasm-diagnostic approach and post-surgical follow up: Three case reports and review of literature. World J Clin Cases 2021; 9:1682-1695. [PMID: 33728313 PMCID: PMC7942041 DOI: 10.12998/wjcc.v9.i7.1682] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/23/2020] [Accepted: 01/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Solid pseudopapillary neoplasm (SPN) is a rare tumor that was first described by Frantz in 1959. Although this tumor is benign, some may have malignant potential that can be predicted based on demographics, imaging characteristics, and pathologic evaluation. This case series presents 3 SPN cases with discussion on gender differences, preoperative predictors of malignancy, and a suggested algorithm for diagnostic approach as well as post-surgical follow up.
CASE SUMMARY Three adult patients in a tertiary hospital found to have SPN, one elderly male and two young females. Each of the cases presented with abdominal pain and were discovered incidentally. Two cases underwent endoscopic ultrasound with fine needle aspiration and biopsy to assess tumor markers and immuno-histochemical staining (which were consistent with SPN before undergoing surgery), and one case underwent surgery directly after imaging. The average tumor size was 5 cm. Diagnosis was confirmed by histology. Two patients had post-surgical complications requiring intervention.
CONCLUSION Demographic and imaging characteristics can be sufficient to establish diagnosis for SPN, while malignant cases require pre-operative evaluation with endoscopic ultrasound fine needle aspiration/fine needle biopsy.
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Affiliation(s)
- Mohammad Abudalou
- Department of Internal Medicine, St. Elizabeth Medical Center, Brighton, MA 02135, United States
| | - Eduardo A Vega
- Department of General Surgery, St. Elizabeth Medical Center, Brighton, MA 02135, United States
| | - Rohit Dhingra
- Department of Gastroenterology, Tufts Medical Center, Boston, MA 02111, United States
| | - Erik Holzwanger
- Department of Gastroenterology, Tufts Medical Center, Boston, MA 02111, United States
| | - Sandeep Krishnan
- Department of Gastroenterology, St. Elizabeth Medical Center, Brighton, MA 02135, United States
| | - Svetlana Kondratiev
- Department of Pathology, St. Elizabeth Medical Center, Brighton, MA 02135, United States
| | - Ali Niakosari
- Department of Radiology, St. Elizabeth Medical Center, Brighton, MA 02135, United States
| | - Claudius Conrad
- Department of General Surgery, St. Elizabeth Medical Center, Brighton, MA 02135, United States
| | - Christopher G Stallwood
- Department of Gastroenterology, St. Elizabeth Medical Center, Brighton, MA 02135, United States
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Meriam S, Ines B, Fatma BF, Fatma K, Dhafer H, Imen H, Nawel B, Chiraz C, Dalila G. Atypical solid pseudopapillary tumor of the pancreas in a 14-year-old. Clin Case Rep 2021; 9:1716-1720. [PMID: 33768921 PMCID: PMC7981668 DOI: 10.1002/ccr3.3893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 12/04/2020] [Accepted: 01/14/2021] [Indexed: 11/17/2022] Open
Abstract
Diagnostic approach can be difficult in pediatric pancreatic masses. Our case shows that even though radiologic appearance was not conclusive, surgery remains the main treatment in resectable masses especially in children.
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Affiliation(s)
- Sabbah Meriam
- Department of GastroenterologyHabib Thameur HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Briki Ines
- Department of GastroenterologyHabib Thameur HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Ben Farhat Fatma
- Department of GastroenterologyHabib Thameur HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Khanchel Fatma
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Department of PathologyHabib Thameur HospitalTunisTunisia
| | - Haddad Dhafer
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Department of SurgeryHabib Thameur HospitalTunisTunisia
| | - Helal Imen
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Department of PathologyHabib Thameur HospitalTunisTunisia
| | - Bellil Nawel
- Department of GastroenterologyHabib Thameur HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Chammakhi Chiraz
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Department of RadiologyHabib Thameur HospitalTunisTunisia
| | - Gargouri Dalila
- Department of GastroenterologyHabib Thameur HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
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Niger M, Prisciandaro M, Antista M, Monica MAT, Cattaneo L, Prinzi N, Manglaviti S, Nichetti F, Brambilla M, Torchio M, Corti F, Pusceddu S, Coppa J, Mazzaferro V, de Braud F, Di Bartolomeo M. One size does not fit all for pancreatic cancers: A review on rare histologies and therapeutic approaches. World J Gastrointest Oncol 2020; 12:833-849. [PMID: 32879662 PMCID: PMC7443847 DOI: 10.4251/wjgo.v12.i8.833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/01/2020] [Accepted: 05/20/2020] [Indexed: 02/05/2023] Open
Abstract
Exocrine pancreatic neoplasms represent up to 95% of pancreatic cancers (PCs) and are widely recognized among the most lethal solid cancers, with a very poor 5-year survival rate of 5%-10%. The remaining < 5% of PCs are neuroendocrine tumors that are usually characterized by a better prognosis, with a median overall survival of 3.6 years. The most common type of PC is pancreatic ductal adenocarcinoma (PDAC), which accounts for roughly 85% of all exocrine PCs. However up to 10% of exocrine PCs have rare histotypes, which are still poorly understood. These subtypes can be distinguished from PDAC in terms of pathology, imaging, clinical presentation and prognosis. Additionally, due to their rarity, any knowledge regarding these specific histotypes is mostly based on case reports and a small series of retrospective analyses. Therefore, treatment strategies are generally deduced from those used for PDAC, even if these patients are often excluded or not clearly represented in clinical trials for PDAC. For these reasons, it is essential to collect as much information as possible on the management of PC, as assimilating it with PDAC may lead to the potential mistreatment of these patients. Here, we report the most significant literature regarding the epidemiology, typical presentation, possible treatment strategies, and prognosis of the most relevant histotypes among rare PCs.
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Affiliation(s)
- Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Michele Prisciandaro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Maria Antista
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Melissa Anna Teresa Monica
- First Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Laura Cattaneo
- First Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Natalie Prinzi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Sara Manglaviti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Federico Nichetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Marta Brambilla
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Martina Torchio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Francesca Corti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Sara Pusceddu
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Jorgelina Coppa
- Hepato-biliary-pancreatic Surgery and Liver Transplantation Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Vincenzo Mazzaferro
- Hepato-biliary-pancreatic Surgery and Liver Transplantation Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
- Università degli studi di Milano, Milan 20133, Italy
| | - Filippo de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
- Università degli studi di Milano, Milan 20133, Italy
| | - Maria Di Bartolomeo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
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Farhat W, Ammar H, Amine Said M, Mizouni A, Bouazzi A, Abdessaied N, Ben Mabrouk M, Ben Ali A. Solid pseudopapillary neoplasm of the pancreas: a report of 10 cases and literature review. ANZ J Surg 2020; 90:1683-1688. [PMID: 31989788 DOI: 10.1111/ans.15701] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/07/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Solid pseudopapillary tumour of the pancreas (SPTP) is a rare pancreatic tumour characterized by a non-specific clinical presentations and vague radiologic features. The aim of this study is to identify these tumours from other pancreatic neoplasms because complete resection is curative in most cases and provides long-term survival. METHODS A retrospective analysis of patients operated for SPTP between January 2000 and December 2018 was conducted. The collected data included age, gender, clinical findings, laboratory tests, radiological findings, anatomopathological examination, immunohistochemistry results, surgical treatment, mortality, morbidity and recurrence. RESULTS Ten cases of SPTP have been diagnosed between January 2000 and December 2018 representing 5.1% of all pancreatic tumours operated during this period (male/female: 2/8; median age 41.2 years; range 19-78 years). The most common symptom was abdominal pain and physical examination was normal in four of 10 cases. The most common tumour localization was the tail of the pancreas. The main tumour size was 7.2 cm (range 2-15 cm). One patient had abdominal disseminated disease. Surgical interventions were distal pancreatectomy in five cases, enucleation in one case, cephalic duodeno-pancreatectomy in two cases, central pancreatectomy in one case and pancreatic biopsy in one case. Only one patient received adjuvant chemotherapy. During follow-up, one patient died after 12 months and another developed unique hepatic metastasis that was resected. CONCLUSION Although it is delayed in diagnosis, the overall prognosis of these tumours remains good even with local recurrence and metastasis. Complete surgical resection is the treatment of choice even in cases of recurrence.
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Affiliation(s)
- Waad Farhat
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Houssem Ammar
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Mohamed Amine Said
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Abdelkader Mizouni
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Amal Bouazzi
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Nihed Abdessaied
- Department of Pathology, Farhat Hached Hospital, University of Sousse, Sousse, Tunisia
| | | | - Ali Ben Ali
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
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12
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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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Singla T, Ahluwalia C, Singla G, Kolte S, Singla S, Arora R. Solid pseudopapillary neoplasm of pancreas metastasizing to spleen in a post menopausal female. INDIAN J PATHOL MICR 2019; 62:624-626. [PMID: 31611457 DOI: 10.4103/ijpm.ijpm_43_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Tanisha Singla
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Charanjeet Ahluwalia
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Gaurav Singla
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sachin Kolte
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Swati Singla
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rashmi Arora
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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14
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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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15
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You L, Yang F, Fu DL. Prediction of malignancy and adverse outcome of solid pseudopapillary tumor of the pancreas. World J Gastrointest Oncol 2018; 10:184-193. [PMID: 30079144 PMCID: PMC6068856 DOI: 10.4251/wjgo.v10.i7.184] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/23/2018] [Accepted: 05/23/2018] [Indexed: 02/05/2023] Open
Abstract
Since solid pseudopapillary tumor of the pancreas (SPTP) was officially classified by the World Health Organization in 1996, SPTP has recently received special attention in the literature. Studies have shown that SPTP is a heterogeneous tumor, with a small percentage of patients harboring aggressive behaviors. However, criteria for malignancy grade in SPTP have not been well established. The prognosis of SPTP is generally good, with cases having a chance for long-term survival even with recurrence and/or metastasis after surgical resection. The current American Joint Committee on Cancer/Union for International Cancer Control tumor, node, metastasis staging system is not specific to SPTP. The lack of a predictive staging classification that accurately describes the heterogeneity of this disease hinders meaningful research into optimal individualized therapy. Here we summarize and discuss the associated factors proposed for appraisal of the malignant potential and adverse outcome of SPTP.
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Affiliation(s)
- Li You
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Feng Yang
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - De-Liang Fu
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
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16
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McCluney S, Wijesuriya N, Sheshappanavar V, Chin-Aleong J, Feakins R, Hutchins R, Abraham A, Bhattacharya S, Valente R, Kocher H. Solid pseudopapillary tumour of the pancreas: clinicopathological analysis. ANZ J Surg 2018; 88:891-895. [DOI: 10.1111/ans.14362] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 11/20/2017] [Accepted: 11/23/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Simon McCluney
- Barts and the London HPB Centre, Department of Surgery; The Royal London Hospital, Barts Health NHS Trust; London UK
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Nilukshi Wijesuriya
- Barts and the London HPB Centre, Department of Surgery; The Royal London Hospital, Barts Health NHS Trust; London UK
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Vinayata Sheshappanavar
- Barts and the London HPB Centre, Department of Surgery; The Royal London Hospital, Barts Health NHS Trust; London UK
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Joanne Chin-Aleong
- Barts and the London HPB Centre, Department of Surgery; The Royal London Hospital, Barts Health NHS Trust; London UK
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Roger Feakins
- Barts and the London HPB Centre, Department of Surgery; The Royal London Hospital, Barts Health NHS Trust; London UK
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Robert Hutchins
- Barts and the London HPB Centre, Department of Surgery; The Royal London Hospital, Barts Health NHS Trust; London UK
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Ajit Abraham
- Barts and the London HPB Centre, Department of Surgery; The Royal London Hospital, Barts Health NHS Trust; London UK
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Satyajit Bhattacharya
- Barts and the London HPB Centre, Department of Surgery; The Royal London Hospital, Barts Health NHS Trust; London UK
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Roberto Valente
- Barts and the London HPB Centre, Department of Surgery; The Royal London Hospital, Barts Health NHS Trust; London UK
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Hemant Kocher
- Barts and the London HPB Centre, Department of Surgery; The Royal London Hospital, Barts Health NHS Trust; London UK
- Barts Cancer Institute; Queen Mary University of London; London UK
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17
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Gremida A, Altaee A, Darji K, Rustagi T, McCarthy D. Acute Pancreatitis: Nothing to SPiT At. Dig Dis Sci 2017; 62:583-587. [PMID: 28108891 DOI: 10.1007/s10620-017-4457-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/11/2017] [Indexed: 12/09/2022]
Affiliation(s)
- Anas Gremida
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
| | - Ahmad Altaee
- Department of Internal Medicine, Saint Louis University, Saint Louis, MO, USA
| | - Kavita Darji
- Department of Internal Medicine, Saint Louis University, Saint Louis, MO, USA
| | - Tarun Rustagi
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Denis McCarthy
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
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18
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Shrimal PK, Agarwal J, Nageshwar Reddy D. A Child With a Pancreatic Mass. Gastroenterology 2015; 149:e5-6. [PMID: 26515489 DOI: 10.1053/j.gastro.2015.04.052] [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: 01/15/2015] [Revised: 03/12/2015] [Accepted: 04/06/2015] [Indexed: 12/02/2022]
Affiliation(s)
| | - Jaya Agarwal
- Asian Institute of Gastroenterology, Hyderabad, India
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19
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Guerrache Y, Soyer P, Dohan A, Faraoun SA, Laurent V, Tasu JP, Aubé C, Cazejust J, Boudiaf M, Hoeffel C. Solid-pseudopapillary tumor of the pancreas: MR imaging findings in 21 patients. Clin Imaging 2014; 38:475-482. [PMID: 24629792 DOI: 10.1016/j.clinimag.2014.01.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 01/17/2014] [Accepted: 01/19/2014] [Indexed: 12/27/2022]
Abstract
PURPOSE Solid-pseudopapillary tumor (SPT) of the pancreas is a rare, low-grade malignancy, which mostly occurs in adolescent and young adult females. The goal of this study was to retrospectively analyze the magnetic resonance (MR) imaging presentation of SPT of the pancreas. METHODS We retrospectively reviewed the preoperative MR imaging examinations and the medical, surgical and histopathological records of 21 patients who underwent surgery for SPT of the pancreas. MR imaging included T1-weighted, T2-weighted, and gadolinium chelate-enhanced MR imaging. In addition, 10 patients had diffusion-weighted (DW) MR imaging. MR examinations were retrospectively reviewed for location, size, morphological features and signal intensity of the tumors. RESULTS Nineteen women and 2 men (median age, 23 years; range, 14-59) were included. Seven patients (7/21; 33%) presented with abdominal symptoms. The median largest tumor diameter was 53mm (range, 32-141 mm). SPTs were located in the pancreatic head, body, and tail in 9 (9/21; 43%), 5 (5/21; 24%) and 7 (7/21, 33%) patients, respectively. All patients (21/21; 100%) had a single SPT. SPTs were more frequently oval (12/21; 57%), predominantly solid (12/21; 57%), fully encapsulated (16/21; 76%), larger than 30 mm (21/21; 100%), hypointense on T1-weighted MR images (21/21, 100%), hyperintense on T2-weighted MR images (21/21; 100%) and with an enhancing capsule after gadolinium-chelate administration (21/21; 100%). CONCLUSIONS There is trend of appearance for SPT of the pancreas on MR imaging but that variations may be observed in a number of cases. SPT uniformly presents as a single, well-demarcated and encapsulated pancreatic mass.
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Affiliation(s)
- Youcef Guerrache
- Department of Radiology, Centre Pierre et Marie Curie, Place du 1er Mai, 16016 Alger, Algeria.
| | - Philippe Soyer
- Department of Abdominal Imaging, Hôpital Lariboisière-APHP, 2, rue Ambroise Paré, 75010 Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, 10 Avenue de Verdun, 75010 Paris, France.
| | - Anthony Dohan
- Department of Abdominal Imaging, Hôpital Lariboisière-APHP, 2, rue Ambroise Paré, 75010 Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, 10 Avenue de Verdun, 75010 Paris, France.
| | - Sid Ahmed Faraoun
- Department of Radiology, Centre Pierre et Marie Curie, Place du 1er Mai, 16016 Alger, Algeria.
| | - Valérie Laurent
- Department of Radiology, CHU Nancy-Brabois, Allée du Morvan, 54511 Nancy cedex, France.
| | - Jean-Pierre Tasu
- Department of Radiology, CHU Poitiers, 2 rue de la Milétrie, 86000 Poitiers, France.
| | - Christophe Aubé
- Department of Radiology, CHU d'Angers, 4 rue Larrey, 49933 Angers Cedex 9, France.
| | - Julien Cazejust
- Department of Radiology, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France.
| | - Mourad Boudiaf
- Department of Radiology, Centre Pierre et Marie Curie, Place du 1er Mai, 16016 Alger, Algeria.
| | - Christine Hoeffel
- Department of Radiology, Hôpital Robert Debré, 11 Boulevard Pasteur, 51092 Reims, France.
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20
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FDG PET/CT findings of solid pseudopapillary tumor of the pancreas with CT and MRI correlation. Clin Nucl Med 2013; 38:e118-24. [PMID: 23354028 DOI: 10.1097/rlu.0b013e318270868a] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this study was to evaluate retrospectively (18)F-FDG PET/CT findings of solid pseudopapillary tumor of the pancreas (SPTP). PATIENTS AND METHODS FDG PET/CT findings were reviewed in 8 patients with SPTP confirmed by pathology. Early PET/CT scans were performed 1 hour after FDG injection in all 8 patients. After an interval of 1 hour, delayed PET/CT scans were performed in 6 patients. All patients underwent enhanced CT and 4 patients underwent MRI. RESULTS A total of 8 tumors were detected in all 8 patients. CT and MRI findings included encapsulation (n = 2), solid and cystic components (n = 4), focal calcification (n = 7), and weak enhancement during the arterial phase on enhanced CT or MRI and increasing enhancement during the portal venous phase (n = 8). All the tumors showed increased FDG uptake. The mean SUVmax of all tumors was 8.9, with a high variability of SUVmax among lesions ranging from 2.5 to 29.1. The tumors (n = 6) with high cellularity had stronger FDG uptake, whereas the tumors (n = 2) with low cellularity had relatively low FDG uptake. The tumors (n = 6) with pancreatic parenchymal, vascular, or perineural invasions had intense FDG uptake, whereas the tumors (n = 2) without invasions had slight-to-moderate FDG uptake. Two tumors with relatively high proliferative index had very strong FDG uptake, whereas those (n = 6) with low proliferative index or negative Ki-67 staining result had relatively lower FDG uptake. On delayed FDG PET/CT images, The SUVmax of SPTP increased in 4 patients and slightly decreased in 2 patients. CONCLUSIONS CT or MRI demonstrated morphological features of SPTP and FDG PET/CT that reflected the histopathological composition of the tumors. FDG uptake of SPTP may be related to tumor cellularity, proliferative index, or histological malignancy. Familiarity with the morphological and functional imaging findings of SPTP may be helpful for correct diagnosis and appropriate treatment.
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21
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Solid pseudopapillary tumour of the pancreas: Incidence, prognosis and outcome of surgery (single center experience). Int J Surg 2013; 11:447-57. [PMID: 23619333 DOI: 10.1016/j.ijsu.2013.04.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 04/15/2013] [Accepted: 04/16/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Solid pseudopapillary tumour (SPT) of the pancreas is a rare neoplasm of low malignant potential. The pathogenesis and guidelines for its treatment remain unclear. This study was designed to evaluate the diagnosis, surgical treatment and prognosis of SPT. STUDY DESIGN A retrospective study during the period between January 1995 to October 2012. PATIENTS AND METHOD Cases with SPTs treated at our institution were reviewed. Demographic data, clinical manifestations, radiological, surgical, and pathological records were reviewed for patients with SPT. RESULTS Twenty four patients with SPT were identified (22 women and 2 men with a mean age 24.83 ± 8.66 (12-52 years). The tumour was located in the head in (50%) and in the body (8.3%) and in the tail (41.7%). The mean size was 9.2 ± 5.3 (3-25 cm). The main clinical presentation was abdominal pain in (83.3%). All 24 patients had curative resection including pancreaticoduodenectomy (50%), central pancreatectomy (8.3%) and distal pancreatectomy (41.7%). Sex, age, symptoms, tumour size, CT image and tumour markers were not significant clinical factors to predict SPT with malignant behavior. The recurrence rate was (8.3%) after 5 years postoperatively. No hospital mortality, all patients except 2 patients (8.3%) were alive at follow up period. The estimated 1, 3, and 5 year survival rate was 95%, 95%, and 88%. CONCLUSION SPT are rare neoplasms with malignant potential. Aggressive surgical resection is needed even in presence of local invasion, and also for recurrence as patients had a good long term survival.
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22
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Huang Y, Feng JF. Clinicopathologic characteristics and surgical treatment of solid pseudopapillary tumor of the pancreas. Hippokratia 2013; 17:68-72. [PMID: 23935348 PMCID: PMC3738282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND AIM Solid pseudopapillary tumor (SPT) of the pancreas is a very rare neoplasm of low malignant potential that mostly affects young women. The aim of the present study is to report our experience in surgical treatment of SPT and review of the literature. MATERIAL AND METHODS A retrospective review of three cases of SPT who were treated at our department during the last two years was performed. The clinicopathologic characteristics, surgical treatment, and prognosis are described in detail. RESULTS Case 1 described an asymptomatic SPT in a pregnant woman. To the best of our knowledge, only one case of SPT in pregnancy has been reported in the literature. Case 2 described an SPT in the pancreatic tail causing splenic infarction, and a distal pancreatectomy combined with splenectomy was performed. Case 3 described an SPT in the pancreatic head, for which a pancreatoduodenectomy was successfully performed. All of the three patients were followed up for 10-22 months without recurrence or metastases after the initial surgery at the time of reporting. CONCLUSIONS At present, radical resection is the treatment of choice for SPT. Enucleation can be performed for tumors with complete amicula. Distal pancreatectomy combined with or without splenectomy can be performed for pancreatic body and/or tail tumor, and pancreatoduodenectomy for pancreatic head tumor. The prognosis of SPT is good.
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Affiliation(s)
- Y Huang
- Nursing Department, Zhejiang Cancer Hospital, Hangzhou, China
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23
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Cai H, Zhou M, Hu Y, He H, Chen J, Tian W, Deng Y. Solid-pseudopapillary neoplasms of the pancreas: clinical and pathological features of 33 cases. Surg Today 2012; 43:148-54. [PMID: 22825652 DOI: 10.1007/s00595-012-0260-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 12/15/2011] [Indexed: 02/06/2023]
Abstract
PURPOSE Solid-pseudopapillary neoplasms (SPNs) are rare pancreatic tumors, with a low potential for malignancy. The clinical and pathological features of 33 SPNs were reviewed. METHODS This study conducted a retrospective analysis of 33 patients who underwent surgery for a pathologically confirmed SPN from 2000 to 2011. RESULTS Thirty of the 33 patients (91 %) were female, and the median age at diagnosis was 29.2 years (range 12-59). The most common symptom was abdominal discomfort with dull pain (58 %). Others included asymptomatic lesions that were only detected incidentally during imaging (21 %), a palpable abdominal mass (15 %) and indigestion (6 %). All 33 patients underwent surgery with a curative intent and 3 (9 %) underwent laparoscopic surgery. The mean diameter of the tumors was 4.9 cm (range 2-15 cm), and they occurred in the head (9, 27 %), neck (5, 15 %), body or tail (19, 58 %) of the pancreas. One patient had lymph node metastases, one patient had portal venous invasion and 8 patients had perineural invasion. The patient follow-up ranged from 4 to 118 months, and 32 patients were alive and well without recurrence. One patient relapsed 10 months after distal pancreatectomy with splenectomy and underwent a second surgery via laparotomy. Unfortunately, the patient died of multiple organ failure 12 days after the second surgery. CONCLUSION SPNs are rare neoplasms with malignant potential but excellent prognosis. Adequate surgical resection, including laparoscopic surgery, may therefore be performed safely and is associated with a long-term survival, even in invasive cases.
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Affiliation(s)
- Hongke Cai
- Department of Surgical Oncology, Second Affiliated Hospital, Zhejiang University College of Medicine, No. 88 Jiefang Road, Zhejiang, People's Republic of China
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Navarro S, Ferrer J, Bombí JA, López-Boado MA, Ayuso JR, Ginés A, Fernández-Esparrach G, Vaquero E, Cuatrecasas M, Fernández-Cruz L. [Pseudopapillary solid tumor of the pancreas: report of 6 cases]. Med Clin (Barc) 2012; 138:114-8. [PMID: 22036462 DOI: 10.1016/j.medcli.2011.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 09/06/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Solid pseudopapillary neoplasms (SPNs) are rare tumours of the exocrine pancreas. Although they can develop metastasis, the prognosis is good. The aim of this study was to describe the characteristics of these tumours attended in our hospital. PATIENTS AND METHOD All cases of SPN in the database of the Pathology Department between 1991 and 2010 were included. Age, sex, symptoms, type of surgery, pathologic and immunohistochemical characteristics, and clinical evolution were analyzed. RESULTS Six cases were identified; all of them were women with a median age of 27.5 years. One patient presented haemoperitoneum, 2 abdominal pain and 3 were diagnosed incidentally. The most frequent localization was the pancreatic tail (n=4) and the median size was 7.7 cm. Four tumours were benign and 2 carcinomas. One of them had liver and lymph node metastases. Ki-67 proliferation index was low (1-3%). After a median follow-up of 33.5 months, all patients were alive and without evidence of relapse. CONCLUSION SPNs occur in young women. In most cases surgical resection is curative. A low mitotic index confers a good prognosis and a long survival.
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Affiliation(s)
- Salvador Navarro
- Servicio de Gastroenterología, Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBERehd, Barcelona, España.
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Zampieri N, Schiavo N, Capelli P, Scarpa A, Bassi C, Camoglio FS. Pseudopapillary tumor in pediatric age: clinical and surgical management. Pediatr Surg Int 2011; 27:1271-5. [PMID: 21789668 DOI: 10.1007/s00383-011-2947-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2011] [Indexed: 01/22/2023]
Abstract
BACKGROUND Solid pseudopapillary tumors of the pancreas are rare exocrine pancreatic tumors. Through a review of pediatric cases in a single Institution, we present the clinical and surgical management of this neoplasm. METHODS We retrospectively reviewed the clinical charts of patients treated at our unit between 1995 and 2009 for SPT. Clinical and surgical management were analyzed and reported. RESULTS During the study period 11 patients underwent surgery for pseudopapillary tumor. Five patients were treated with duodenum-preserving pancreatic head resection and six patients with splenopancreasectomy with a Roux-en-Y pancreatic jejunostomy. Patients did not show recurrence and are currently disease free. Blood tests, Ultrasound, Computed tomography and Magnetic Resonance Imaging were not useful to preoperatively identify the nature of the pancreatic masses. CONCLUSION Solid pseudopapillary tumor is a rare condition that should be taken into account for the differential diagnosis of pancreatic masses in pediatric age. Due to its favourable prognosis, surgical removal should be planned and done following the intraoperative findings.
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Affiliation(s)
- Nicola Zampieri
- Department of Surgical Sciences, Pediatric Surgical Unit, Policlinico G. B.Rossi, University of Verona, piazzale Scuro n. 1, Piazzale L. A. Scuro, 37134, Verona, Italy.
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Carreño Toro L, Smok Sahid G, Villarroel Perez MA, Sanhueza Linares V. [Solid pseudopapillary pancreatic neoplasm: report of five cases]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:266-70. [PMID: 21477890 DOI: 10.1016/j.gastrohep.2011.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Revised: 01/24/2011] [Accepted: 01/25/2011] [Indexed: 12/31/2022]
Abstract
Solid pseudopapillary pancreatic neoplasms (SPPN) are rare entities mainly diagnosed in young women. Prognosis is generally relatively favorable. Histological evaluation usually reveals papillary as well as solid areas of low malignant potential, as the name implies. A retrospective review of five cases, diagnosed and treated in our institution, is presented with the corresponding clinical and pathological data and follow-up. All SPPN occurred in women, with an average age of 19 years (13 to 27 years), who consulted for abdominal pain. In all patients, the tumors were > 4cm, distributed in several pancreatic segments. The histopathologic report confirmed papillary as well solid areas and low mitotic count. In two patients, neural and angioinvasion were found.
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Affiliation(s)
- Laura Carreño Toro
- Servicio de Anatomía Patológica, Hospital Clínico Universidad de Chile, Chile
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Nguyen NQ, Johns AL, Gill AJ, Ring N, Chang DK, Clarkson A, Merrett ND, Kench JG, Colvin EK, Scarlett CJ, Biankin AV. Clinical and immunohistochemical features of 34 solid pseudopapillary tumors of the pancreas. J Gastroenterol Hepatol 2011; 26:267-274. [PMID: 21261715 DOI: 10.1111/j.1440-1746.2010.06466.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIM Clinicopathological data regarding pancreatic solid pseudopapillary tumors (SPT) in a multiethnic country are limited. The aim of the present study was to characterize pancreatic SPT in Australia. METHODS Clinicopathological features, treatment, immunohistochemical findings and outcome data of 34 patients (79% Caucasian, 12% Asian, 6% South Pacific Islander and 3% African) with pancreatic SPT were reviewed. RESULTS The most presenting complaint was abdominal pain. Median diameter of tumors was 60 mm (range: 20-220); predominantly located in the pancreatic tail (tail : body : head = 23:3:8). All tumors were resected and patients underwent surgery, including a liver resection for metastasis, all patients were alive after a median follow up of 70 months (IQR: 48-178). Two patients underwent repeated surgery for local recurrences with liver metastases after 8 and 18 months, which were successfully managed by surgical resection. Completeness of excision, perineural spread, vascular space invasion, mitotic rate and cellular atypia did not predict recurrence. In all cases, there was aberrant nuclear staining of beta-catenin and a loss of membranous expression of E-cadherin with aberrant nuclear localization of the cytoplasmic domain. Most pancreatic SPT were also strongly positive for CD10 (96%), progesterone receptor (79%), cytokeratin (28%), synapthophysin (26%) and chromogranin (15%). CONCLUSIONS Pancreatic SPT occur in all races and are uniformly indolent. Given complete resection of a pancreatic SPT is usually curative and recurrences can be treated with re-operation, correct diagnosis is important.
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Affiliation(s)
- Nam Q Nguyen
- Department of Gastroenterology, Bankstown Hospital, New South Wales, Australia
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Chang H, Gong Y, Xu J, Su Z, Qin C, Zhang Z. Clinical strategy for the management of solid pseudopapillary tumor of the pancreas: aggressive or less? Int J Med Sci 2010; 7:309-13. [PMID: 20827431 PMCID: PMC2934730 DOI: 10.7150/ijms.7.309] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 08/27/2010] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To further delineate the clinicopathological and radiological features of solid pseudopapillary tumor (SPT) of the pancreas and summarize the surgical therapy strategy for this tumor. METHODS A retrospective review of 18 pathologically confirmed cases of SPT was performed and the clinical and pathological features, radiological findings and surgical interventions were analyzed. RESULTS The patients included 17 females and 1 male with a median age of 23 years. The median diameter of the lesions was 8.0 cm. Abdominal pain was the predominant complaint (8/18). The rest of the patients were asymptomatic and presented with a pancreatic mass detected incidentally. Radiological study revealed a well-demarcated mass which was composed of a solid-cystic portion. On post-contrast CT, the solid portions could be enhanced whereas the cystic parts remained unenhanced. With the preoperative diagnosis of SPT in 11 patients and pancreatic cyst, benign or malignant pancreatic tumor in the rest, pancreatic tumor resection was successfully completed. Surgical exploration findings, pathological characteristics and good prognosis of the patients with SPT, indicated its low-grade malignant potential. CONCLUSION In combination with clinical findings, radiological features of SPT may help to make the correct diagnosis and differentiation from other pancreatic neoplasms. Once diagnosed, given the excellent prognosis and low-grade malignancy, less aggressive surgical resection of the primary lesion is proposed.
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Affiliation(s)
- Hong Chang
- Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan Shandong, China.
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D'Onofrio M, Gallotti A, Pozzi Mucelli R. Imaging techniques in pancreatic tumors. Expert Rev Med Devices 2010; 7:257-73. [PMID: 20214430 DOI: 10.1586/erd.09.67] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Conventional ultrasonography represents the first diagnostic imaging modality for the study of pancreatic tumors. Contrast-enhanced ultrasound has significantly improved the accuracy of first-line examination and may influence the choice of second-line investigations: multidetector computed tomography is considered the gold standard for studying pancreatic solid lesions and tumor staging, while MRI with magnetic resonance cholangiopancreatography allows better study of pancreatic cystic lesions and the ductal system. To definitely diagnose a pancreatic lesion, image-guided fine-needle-aspiration or biopsy are very often required. PET with 18-fluorodeoxyglucose, endoscopic ultrasound and intraoperative ultrasonography remain techniques often employed in the third line. This article reviews the imaging techniques generally used for diagnosing the main pancreatic tumors, and a work-up algorithm is finally proposed.
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Affiliation(s)
- Mirko D'Onofrio
- Department of Radiology, GB Rossi University Hospital, University of Verona, Verona, Italy.
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Yu PF, Hu ZH, Wang XB, Guo JM, Cheng XD, Zhang YL, Xu Q. Solid pseudopapillary tumor of the pancreas: a review of 553 cases in Chinese literature. World J Gastroenterol 2010; 16:1209-1214. [PMID: 20222163 PMCID: PMC2839172 DOI: 10.3748/wjg.v16.i10.1209] [Citation(s) in RCA: 172] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 12/17/2009] [Accepted: 12/24/2009] [Indexed: 02/06/2023] Open
Abstract
AIM To sum up the clinical and pathological characteristics of solid pseudopapillary tumor (SPT) and the experience with it. METHODS A total of 553 SPT patients reported in Chinese literature between January 1996 and January 2009 were retrospectively reviewed and analyzed. RESULTS The mean age of the 553 SPT patients included in this review was 27.2 years, and the male to female ratio was 1:8.37. Their symptoms were non-specific, and nearly one third of the patients were asymptomatic. Computed tomography and ultrasonography were performed to show the nature and location of SPT. Most of the tumors were distributed in the pancreatic head (39.8%), tail (24.1%), body and tail (19.5%). Forty-five patients (9.2%) were diagnosed as malignant SPT with metastasis or invasion. None of the clinical factors was closely related to the malignant potential of SPT. Surgery was the main therapeutic modality for SPT. Local resection, distal pancreatectomy and pancreatoduodenectomy were the most common surgical procedures. Local recurrence and hepatic metastasis were found in 11 and 2 patients, respectively, after radical resection. Four patients died of tumor progression within 4 years after palliative resection of SPT. The prognosis of SPT patients was good with a 5-year survival rate of 96.9%. CONCLUSION SPT of the pancreas is a rare indolent neoplasm that typically occurs in young females. It is a low-grade malignancy and can be cured with extended resection. The prognosis of such patients is good although the tumor may recur and metastasize.
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Romics L, Oláh A, Belágyi T, Hajdú N, Gyűrűs P, Ruszinkó V. Solid pseudopapillary neoplasm of the pancreas—proposed algorithms for diagnosis and surgical treatment. Langenbecks Arch Surg 2010; 395:747-55. [DOI: 10.1007/s00423-010-0599-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 01/20/2010] [Indexed: 02/06/2023]
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Nejmeddine A, Salah KB, Mahfoud KB, Zagden O, Beyrouti MI. Solid pseudopapillary tumor of the pancreas in a 14-year-old girl. Presse Med 2009; 38:1712-4. [PMID: 19299106 DOI: 10.1016/j.lpm.2008.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 08/05/2008] [Accepted: 09/15/2008] [Indexed: 11/19/2022] Open
Affiliation(s)
- Affes Nejmeddine
- Department of general surgery, Habib Bourguiba Hospital, Sfax 3003, Tunisia.
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Wang DB, Wang QB, Chai WM, Chen KM, Deng XX. Imaging features of solid pseudopapillary tumor of the pancreas on multi-detector row computed tomography. World J Gastroenterol 2009; 15:829-35. [PMID: 19230043 PMCID: PMC2653382 DOI: 10.3748/wjg.15.829] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To retrospectively analyze the imaging features of solid-pseudopapillary tumors (SPTs) of the pancreas on multi-detector row computed tomography (MDCT) and define the imaging findings suggestive of malignant potential.
METHODS: A total of 24 consecutive cases with surgically and pathologically confirmed SPTs of the pancreas underwent preoperative abdominal MDCT studies in our hospital. All axial CT images, CT angiographic images, and coronally and sagittally reformed images were obtained. The images were retrospectively reviewed at interactive picture archiving and communication system workstations.
RESULTS: Of the 24 cases of SPTs, 11 cases (45.8%) occurred in the pancreatic head and seven (29.1%) in the tail. Eighteen were pathologically diagnosed as benign and six as malignant. MDCT diagnosis of SPTs was well correlated with the surgical and pathological results (Kappa = 0.6, P < 0.05). The size of SPTs ranged from 3 to 15 cm (mean, 5.8 cm). When the size of the tumor was greater than 6 cm (including 6 cm), the possibilities of vascular (8 vs 1) and capsular invasion (9 vs 0) increased significantly (P < 0.05). Two pathologically benign cases with vascular invasion and disrupted capsule on MDCT presented with local recurrence and hepatic metastases during follow-up about 1 year after the resection of the primary tumors.
CONCLUSION: Vascular and capsular invasion with superimposed spread into the adjacent pancreatic parenchyma and nearby structures in SPTs of the pancreas can be accurately revealed by MDCT preoperatively. These imaging findings are predictive of the malignant potential associated with the aggressive behavior of the tumor, even in the pathologically benign cases.
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Abstract
Solid pseudopapillary neoplasms (SPN) of the pancreas are rare tumours with low malignant potential, usually affecting young women. Due to its relatively low incidence, there are no international guidelines published on diagnosis or treatment. The aims of our study were to summarize our clinical experience of SPN in a Hungarian Surgical Centre and to discuss the relevant international literature. The clinical data of four patients treated between 2004 and 2007 in the Petz Aladár County Teaching Hospital (Gyôr, Hungary) were analyzed retrospectively. All patients were women with age of 17-49 years. In all cases SPN was diagnosed preoperatively on the basis of CT-findings and the diagnosis was confirmed by postoperative histology. After an organ-preserving radical resection of the tumour, all patients have remained disease free with an acceptable quality of life so far. Our data suggest that CT-scan is adequate to establish the preoperative diagnosis of SPN. Surgical resection should be carried out with the required radicality, but organ preservation is advised in order to provide a relatively good quality of life.
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Affiliation(s)
- Nóra Hajdú
- Petz Aladár Megyei Oktató Kórház Sebészeti Centrum, Gyor, Hungary.
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