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Review
. 2005 Mar 7;11(9):1403-9.
doi: 10.3748/wjg.v11.i9.1403.

Solid-pseudopapillary tumor of the pancreas: clinical experience and literature review

Hsueh-Lien Huang  1 , Shou-Chuan Shih, Wen-Hsiung Chang, Tsang-En Wang, Ming-Jen Chen, Yu-Jan Chan
Affiliations
Review

Solid-pseudopapillary tumor of the pancreas: clinical experience and literature review

Hsueh-Lien Huang et al. World J Gastroenterol. .

Abstract

Aim: To evaluate the clinical presentations of solid-pseudopapillary tumor of the pancreas (SPT) and examine the diagnosis, treatment, low grade malignant potential of this rare disease.

Methods: We retrospectively reviewed a series of seven patients with SPT managed in our hospital between July 1990 and October 2003. Six females and one male with mean age of 31 years (range 13 to 50 years) were diagnosed with SPT at our institution.

Results: Clinical presentation included a palpable abdominal mass in two patients and vague abdominal discomfort in another two. Two patients were asymptomatic; their tumors were found incidentally on abdominal sonographic examination for other reasons. The final patient was admitted with hemoperitoneum secondary to tumor rupture. The mean diameter of the tumors in the seven patients was 10.5 cm (range 5 to 20 cm). The lesions were located in the body and tail in five cases and in the head of the pancreas in two. Surgical procedures included distal pancreatectomy (3), distal pancreatectomy with splenectomy (2), pancreaticoduodenectomy (1) and a pylorus-preserving Whipple procedure (1). There were gross adhesions or histological evidence of infiltration to the adjacent pancreas and/or splenic capsule in four cases. None of the patients received adjuvant therapy. The mean follow up was 7 years (range 0.5 to 14 years). One patient developed multiple liver metastases after 14 years of follow up.

Conclusion: SPT is a rare tumor that behaves less aggressively than other pancreatic tumor. However, in cases with local invasion, long-term follow up is advisable.

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Figures

Figure 1
Figure 1
Computed tomographic (CT) scan of SPT. A: Encapsulated complex, solid and cystic mass in tail of the pancreas with some internal enhancement after contrast injection shows hemorrhagic degeneration (arrow) (Case 4); B: Calcification in the mass in the body of the pancreas (arrow) (Case 6).
Figure 2
Figure 2
A huge complex mass with a well-defined capsule (straight arrow) and disrupted area (curved arrow) with hemoperitoneum secondary to blunt abdominal trauma (Case 2).
Figure 3
Figure 3
Superior mesenteric artery angiogram in case 3 showing avascular soft tissue lesion with displacement of nearby vessels (arrows).
Figure 4
Figure 4
Gross appearance of SPT (Case 3) shows A: well encapsulated tumor with old blood clots aspirated from the lesion; B: cut section of the tumor reveals hematoma with a solid gray-white area at the periphery.
Figure 5
Figure 5
Tumor with pseudopapillary clusters (curved arrow), cystic spaces (straight arrow), and solid portion (arrow head) (HE, original magnification ×20).
Figure 6
Figure 6
The tumor comprised A: branching pseudopapillary structures (HE, original magnification ×200); B: solid sheets of fairly uniform cells with cytoplasmic hyaline globules (arrows) (HE, original magnification ×200).
Figure 7
Figure 7
CT showing varying sized masses of mixed density in both lobes of the liver (straight arrow) and one similar lesion in the enlarged spleen (curved arrow) in case 1.
Figure 8
Figure 8
Metastatic tumor in liver (case 1) showing small tumor cells (straight arrow) compared to the normal liver cells with abundant cytoplasm (curved arrow) (HE, original magnification ×200).
See this image and copyright information in PMC

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