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Review
. 2018 Sep 16;10(9):145-155.
doi: 10.4253/wjge.v10.i9.145.

Clinical update on the management of pseudopapillary tumor of pancreas

Gandhi Lanke  1 , Faisal S Ali  1 , Jeffrey H Lee  2
Affiliations
Review

Clinical update on the management of pseudopapillary tumor of pancreas

Gandhi Lanke et al. World J Gastrointest Endosc. .

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.

Keywords: Beta-catenin; E-cadherin; Endoscopic ultrasound-fine needle aspiration; Immunohistochemistry; Pancreatectomy; Pancreatic cysts.

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Conflict of interest statement

Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.

Figures

Figure 1
Figure 1
Pathogenesis of solid pseudopapillary neoplasm.
Figure 2
Figure 2
Histological appearance of solid pseudopapillary neoplasm. A hematoxylin and eosin (H and E) stain of a solid pseudopapillary neoplasm demonstrating eosinophilic neoplastic cells with vacuolated cytoplasm and pseudopapillary appearance.
Figure 3
Figure 3
Cytoplasmic and nuclear staining of beta-catenin.
Figure 4
Figure 4
Computed tomography appearances. A: A pancreatic tail solid pseudopapillary neoplasm. Note the characteristic enhancing solid spaces at the periphery of an encapsulated SPN, accompanied by centrally located cystic space; B: Pancreatic tail solid pseudopapillary neoplasm with septation. The cystic component of SPN with degeneration is characterized by a heterogenous hypoattenuation on CT; C: Abdominal metastatic lesions of SPN. SPN: Solid pseudopapillary neoplasm; CT: Computed tomography.
Figure 5
Figure 5
F-18 fluorodeoxy glucose avid solid pseudopapillary neoplasm metastases and metastatic solid pseudopapillary neoplasm to mesentery. A: FDG avid SPN metastases to mesentery; B: FDG avid metastatic SPN to mesentery; C: CT appearance of the FDG avid lesion. SPN: Solid pseudopapillary neoplasm; CT: Computed tomography; FDG: F-18 fluorodeoxy glucose.
Figure 6
Figure 6
Endoscopic ultrasound appearances. A: SPN adjacent to the gastric wall. SPN demonstrates heterogenous echogenicity on EUS, with hyperechoic foci representing solid areas with surrounding hypoechoic cystic spaces; B: A pancreatic head SPN. EUS: Endoscopic ultrasound; SPN: Solid pseudopapillary neoplasm.
Figure 7
Figure 7
Endoscopic ultrasound guided fine needle aspiration of solid pseudopapillary neoplasm located in body/tail pancreas (Transgastric approach).
Figure 8
Figure 8
Proposed algorithm for the diagnosis and management of solid pseudopapillary neoplasm.CT: Computed tomography; MIR: Magnetic resonance imaging; SPN: Solid pseudopapillary neoplasm; EUS-FNA: Endoscopic ultrasound-fine needle aspiration.
See this image and copyright information in PMC

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