Endoscopic Ultrasound in Solid Pseudopapillary Tumor of the Pancreas: About two Clinical Cases

Abstract

Background: Solid pseudopapillary tumor of the pancreas (SPPT) or Frantz's tumor is a rare exocrine pancreatic tumor, it generally occurs among females within the second or third decade of life. The clinical symptomatology is non-specific, frequently presenting as a slowly growing abdominal mass without any biological abnormalities. The imaging usually shows a well-limited mass with little vascularity. Endoscopic ultrasound (EUS) with fine needle aspiration (FNA) helps the diagnosis. The treatment of these tumors is surgical, and the prognosis is excellent after complete resection. We report two new cases of Frantz tumor, detailing the clinicopathological features of this rare neoplasm. Case presentation: Case 1: A 19-year-old woman presented with middle upper abdominal pain. Computed tomography (CT) scan showed a solitary encapsulated mass in the pancreatic body. Endoscopic ultrasound showed a regular, well-defined, heterogenous lesion, measuring 50 × 46 cm, in the pancreatic body. endoscopic ultrasound fine-needle aspiration was then performed with cytopathological analysis compatible with SPPT. Body computed tomography confirmed the absence of metastases and she underwent a central pancreatectomy. 12 months after the diagnosis, she remains asymptomatic, continuing regular follow-up. Case 2: A 22-year-old woman presented with epigastric pain and weight loss. CT scan revealed a single 5 cm well defined mass in the pancreatic head. EUS showed a well-defined heterogenous hypoechoic encapsulated mass in the pancreatic head, measuring 64 × 44 mm; EUS-FNA was performed and cytopathological analysis was suggestive of SPPT. She underwent conventional cephalic duodenopancreatectomy. She presented septic postoperative complications, with a favorable outcome after medical and surgical therapy. she remains asymptomatic, after 6 months follow-up. Conclusion: Solid pseudo papillary pancreatic tumor is a rare exocrine low-grade neoplasm. EUS is a sensitive tool in the diagnosis of SPPT, identifying and characterizing the pathologic lesions, and allowing EUS-FNA with cytomorphological recognition, making it an invaluable tool for establishing diagnosis, helping clinical management and surgical planning.