Solid pseudopapillary neoplasm of the pancreas in two male patients: gender does not matter

Solid pseudopapillary neoplasm of the pancreas in an adolescent: A case report and review of the literature

BACKGROUND

Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare epithelial tumor that primarily affects young women. Since the condition is often asymptomatic or presents with non-specific symptoms, its diagnosis can be difficult.

CASE SUMMARY

This report details the case of a 15-year-old girl who presented with a 2-year history of abdominal pain, with no significant findings during physical examination. Abdominal ultrasound revealed a well-defined heterogeneous solid-cystic mass in the epigastric region, likely originating from the tail of the pancreas. A subsequent contrast-enhanced computed tomography scan indicated a well-defined cystic lesion with an enhancing solid component and capsule in the tail of the pancreas, suggestive of a cystic neoplasm. The patient underwent an open distal pancreatectomy with splenectomy, and histopathological analysis confirmed the diagnosis of SPN of the pancreas.

CONCLUSION

This case highlights the risk of SPN in adolescent girls and the necessity of early diagnosis and intervention for better outcomes.

Solid pseudopapillary tumors of the pancreas in young women: Case report

INTRODUCTION AND IMPORTANCE

Solid pseudopapillary tumor of the pancreas (SPTP) is a rare tumor of the exocrine pancreas, with undetermined etiopathogeny, which most often affects young women. The clinical and physical signs are non-specific and despite the progress of complementary examinations, Confirmation is usually anatomopathological. Surgical resection is the only curative treatment.

CASE PRESENTATION

We report the case of a 17-year-old girl, consulted for a left hypochondrium mass which imaging concluded to be a corporal-caudal tumor mass of the pancreas for which a complete surgical excision was performed and whose anatomopathological study confirmed a pseudo-papillary and solid tumor of the pancreas. The positive diagnosis of SPTP remains difficult and is usually made on pathological analysis with immunohistochemical study.

DISCUSSION

Solid pseudopapillary tumor of the pancreas is a rare anatomic-clinical entity, first described by Frantz in 1959. The clinical manifestations of SPTP are not specific. Biologically, no signs are predictive of SPTP and imaging usually shows a well encapsulated mass with both solid and cystic components. The curative treatment of SPTP is exclusively surgical and consists of a complete removal of the tumor with its capsule because of its degenerative potential SPTP has a good prognosis with a recurrence rate of 10-15% and 95% survival at 5 years.

CONCLUSION

Solid pseudopapillary tumor of the pancreas is a rare tumor of the exocrine pancreas. Its evolution is slow. Preoperative diagnosis remains difficult despite the progress of complementary examinations. Surgical resection is the only curative treatment. Its prognosis remains excellent.

Pancreatic Solid Pseudopapillary Tumor Associated with Elevated DHEA and Testosterone

Solid pseudopapillary neoplasms (SPN) of the pancreas are extremely rare epithelial tumors with low malignant potential. They account for only 1-2% of pancreatic lesions. These masses often go unnoticed and when they become symptomatic it is often due to mass effect on neighboring structures. We encountered an unusual presentation in a healthy 34-year-old female who was found to have elevated dehydroepiandrosterone (DHEA) and testosterone levels during the evaluation of irregular menses. Subsequent abdominal imaging revealed an enhancing 2.7 cm pancreatic tail mass that was concerning for a pancreatic neoplasm. The patient underwent endoscopic ultrasound which confirmed the presence of a hypoechoic, 2.3 x 1.7 cm mass in the pancreatic tail. An intact interface was seen between the mass and adjacent structures, suggesting the absence of local invasion. Fine needle biopsy was performed and cytology was consistent with SPN. The patient later underwent curative distal pancreatectomy, with subsequent normalization of her menses. SPN are generally inactive on laboratory screening modalities (i.e., AFP, CEA, CA 19-9, and CA 125) and our patient showed no evidence of pancreatic insufficiency, pancreatic parenchymal injury, abnormal liver function, or cholestasis. Similarly to our patient, most SPN are asymptomatic. One retrospective study (spanning 15 years) reported vague abdominal pain in ~70% of patients, on initial presentation. Symptoms of tumor mass effect were the second most common. To our knowledge, this is the first reported presentation of elevated DHEA and testosterone levels associated with a solid pseudopapillary tumor in the absence of an underlying adrenal lesion or dysfunction. Despite extensive workup, no alternate etiology or correlatable medical condition could be elucidated for our patient's hormonal dysregulation. We, therefore, recommend further review and investigation into this potential correlative relationship in an effort to guide the future diagnosis and management of this unusual neoplasm.

Pancreatic Cytology

The diagnostic approach to pancreaticobiliary disease requires a multidisciplinary team in which the cytopathologist plays a crucial role. Fine-needle aspiration, obtained by endoscopic ultrasound, is the diagnostic test of choice for pancreatic lesions. Preoperative clinical management depends on many factors, many of which rely on accurate cytologic assessment. Pancreaticobiliary cytology is wrought with diagnostic pitfalls. Clinical history, imaging studies, cytology samples, and ancillary tests, including immunohistochemistry, biochemical analysis, and genetic sequencing, are integral to forming a complete diagnosis and guiding optimal patient management. This article reviews clinical aspects and the diagnostic work-up of commonly encountered diagnostic entities within the field of pancreatic cytology.