Analysis of diagnosis and treatment of solid pseudopapillary neoplasm of pancreas in 12 children

Abstract

Objective To analyze the experience in diagnosis and surgical treatment for solid pseudopapillary neoplasm(SPN) of pancreas in children. Methods A retrospective study was performed in 12 pediatric patients with SPN who had been admitted to Affiliated Cancer Hospital of Zhengzhou University during January 2004 to December 2016, and their general data, demographic data, types of operations, postoperative complications and follow-up were analyzed. Results Among the 12 patients, 3 cases were male and 8 cases were female, with average age 14.3 years old(11-17 years old). The main clinical manifestations included abdominal pain(4/12 cases, 33.3%), abdominal mass(2/12 cases, 16.7%) and trauma(2/12 cases, 16.7%). In those 12 patients, 33.3%(4/12 cases) SPN was located at the head of the pancreas, and 66.7%(8/12 cases) at the body and tail of it.The tumors were usually large, the largest diameter ranged from 4.0 to 15.3 cm(average largest diameter, 8.2 cm). The color ultrasonography indicated heterogeneous echogenic mass and clear boundary.CT scanning indicated that the tumor was a low-density cystic mass with a clear boundary, with enhanced tumor real component and irregular reinforcement.No calcification was found in the patients.Dynamic enhanced magnetic resonance imaging scan revealed gradual strengthening solid components in tumor.All the patients received surgical resection, with distal pancreatectomy in 4 patients, pancreaticoduodenectomy in 4 patients, spleen-preserving distal pancreatectomy in 2 patients, Enucleation in 1 patient, and distal pancreatectomy and self-splenic slices transplantation in 1 patient.Lymphadenectomy was performed in 4 patients, and all the 21 removed lymph nodes were all negative.Pathological diagnosis confirmed the SPN in all the patients, among them 3 cases were malignant SPN, and one of them with tumor rupture and hemorrhage.The mean follow-up duration was 57.7 months(19-156 months) and no recurrence was found. Conclusion SPN is a rare neoplasm in children who go to see doctors because of clinical symptoms.Surgical resection, especially organs-preserving resection, may improve the long-term results. Key words: Solid pseudopapillary neoplasm; Child; Surgical resection