EUS-FNA of Solid Pseudopapillary Tumors of the Pancreas: A Single Center Experience

Abstract

Background: Solid pseudopapillary tumors (SPT) are rare epithelial neoplasms of the pancreas. They occur predominantly in young women and are usually discovered incidentally. Little data exists regarding the role of EUS-FNA in diagnosing SPTs and guiding surgical management, therefore we describe our single center experience. Methods: A retrospective review was performed to identify patients with a diagnosis of solid pseudopapillary tumor over a two year period at the University of Pittsburgh Medical Center. Clinical history, diagnostic studies, EUS findings, cytology, pathology, operative records and surgical pathology were reviewed. Results: Seven patients were found to have pathologically proven SPT. All were young women (mean age 35, range 15-52) with incidentally discovered lesions. EUS-FNA was performed in all cases. All lesions were well defined; mean size 34 × 31 mm. The pancreatic locations were: 1 head, 4 body, 2 tail. Three lesions appeared solid, 3 were mixed solid and cystic, and 1 was cystic. Based on EUS-FNA cytology and immunostains, a pre-operative diagnosis of SPT was made in all but one case. The lesion was cystic in the non-diagnostic case; cytology revealed debris and macrophages. All patients underwent surgical resection; 5/7 patients underwent laparoscopic distal pancreatectomy. The patient with the head lesion underwent Whipple resection; one patient with a body lesion underwent open distal pancreatectomy given body habitus. There has been no evidence of recurrent disease assessed by computed tomography at 14 months mean follow-up. Conclusions: Accurate preoperative diagnosis of SPT is possible via EUS-FNA. This can guide surgical management in appropriate cases.