A case of spontaneous ruptured solid pseudopapillary tumor of pancreas resected by laparoscopic surgery

Abstract

Solid pseudopapillary tumor (SPT) is an uncommon neoplasm of the pancreas. A rare case of spontaneous rupture of SPT is reported. A 13-year-old female felt acute abdominal pain without blunt abdominal trauma. Enhanced computed tomography (CT) revealed a tumor in the pancreas tail with fluid collection around it. The tumor was diagnosed as SPT with hemoperitoneum associated with spontaneous rupture. The bleeding was stopped conservatively and she was referred for surgery at three months after the rupture. At that time, CT revealed a tumor 4 cm in diameter, which protruded from pancreas tail without distant metastases. Since peritoneal dissemination was not seen on intraoperative exploration, laparoscopic enucleation was performed. Pathologically, the tumor was diagnosed as SPT with rupture of the capsule of tumor, and complete resection was confirmed. The patient has been followed up for two years, and she is alive without recurrence.

Figure 1

Urgent CT of acute abdomen. A cystic tumor is shown (arrow) in the pancreatic tail and fluid collection (arrowhead) below it. CT also revealed fluid retention in the pelvis. These findings suggested the rupture of tumor and hemoperitoneum.

Figure 2

CT at three months after rupturing tumor. A cystic tumor is shown (arrow), protruding caudally from the pancreatic tail. The fluid around tumor had disappeared.

Figure 3

Intraoperative findings and surgical procedure. Above: tumor was grasped by forceps. Tumor was confirmed to be well demarcated and protruded from the pancreas tail. Peritoneal dissemination was not seen on laparoscopic exploration. Below: the tumor was resected with small amount of pancreatic parenchyma. Pancreatic parenchyma was divided by using laparoscopic coagulation shears. Arrow shows the cut surface of the pancreas.

Figure 4

Resected specimen. Above: macroscopically, the tumor contained the necrosis after bleeding. However, there was no apparent cystic part in the tumor. Below (Hematoxylin and Eosin stain ×400): showing solid part of the tumor composed of sheet of tumor cells with ovoid nuclei and with eosinophilic and clear vacuolar cytoplasm. Mitosis was seldom seen.