Solid pseudopapillary tumor of the pancreas: A difficult presentation of an uncommon tumor

Abstract

We present a case of a solid pseudopapillary tumor of the pancreas incidentally discovered in a child who presented following sports-related abdominal trauma. This case is a unique presentation of an uncommon pancreatic tumor that posed a diagnostic dilemma to radiologists as it appeared as a hematoma by imaging and initial image-guided aspiration. Ultimately, MRI and core biopsy were needed to make the final diagnosis. This entity posed a problem during the differential diagnosis given the appearance and extenuating circumstances.

Keywords: Hemorrhage; Pancreas; Solid Pseudopapillary Tumor; Teenager.

Fig. 1

Axial contrast enhanced CT image obtained at an outside hospital shows a well-circumscribed low density mass (red arrow) in the right upper quadrant. (Color version of figure is available online.)

Fig. 2

Initial US image shows a complex echogenic lesion in the right upper quadrant with areas suggesting calcification (red arrow). (Color version of figure is available online.)

Fig. 3

Axial contrast enhanced LAVA (left) and Axial T2 SSFSE fat saturated (right) MRI abdomen images (red arrows) show a heterogeneous enhancing mass with areas suggesting cystic change and hemorrhage in the right upper quadrant. (Color version of figure is available online.)

Fig. 4

(A) Gross picture of the specimen including a segment of duodenum (on the left side of the picture; solid arrow indicating proximal resection end and dashed arrow indicating distal duodenum), and pancreatic head containing the tumor (on the right side of the picture; the tumor is highlighted by a dashed circle). (B) Gross picture of the cut section of tumor. The tumor has a solid and cystic appearance with hemorrhage. The tumor measures 6.5 × 4.5 × 4.3 cm and it is highlighted by the dashed circle. The duodenum is located on the left side of the specimen and its luminal surface is highlighted by arrows. (C) Microscopic picture of tumor (H&E stain): the tumor shows pseudopapillae with hyalinized fibrovascular cores lined by several layers of bland epithelial cells with eosinophilic cytoplasm and clusters of hyaline globules. The arrows highlight one of the pseudopapillae. (D) Microscopic picture of tumor (H&E stain): the tumor contains multiple cystic structures filled by blood content (representative cysts are highlighted by black stars). The yellow star highlights the solid portion of the tumor. (Color version of figure is available online.)