Abstract
A 33-year-old female was diagnosed with a solid pseudopapillary tumor (SPT) of the pancreas and multiple liver metastases at the Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital (Kanazawa, Japan). Distal pancreatectomy and postoperative systemic chemotherapy with gemcitabine (GEM) and S-1, an oral fluoropyrimidine derivative, was administered, however, liver metastases became enlarged and local recurrence occurred. Therefore, the patient was referred to the Department of Gastroenterologic Surgery at the Graduate School of Medicine (Kanazawa, Japan) for hepatic arterial infusion (HAI) chemotherapy. Oral S-1 (80 mg/m2) was administered as well as HAI chemotherapy with GEM (1,000 mg/standard liver volume). Following 18 cycles, tumor sizes were reduced and 18-fluorodeoxyglucose positron emission tomography (18FDG-PET) examination revealed obvious reduction of tumor FDG uptake. Transarterial tumor embolization (TAE) was performed for the previously unresectable right subphrenic liver tumor, and the other tumors were surgically resected. The resected tumors were diagnosed as liver metastases and a local recurrence of SPT in the postoperative pathological examination, which revealed that the resected tumors were composed of sheets of bland cells, which were positive for CD10, CD56, vimentin, neuron-specific enolase and α-antitrypsin. The postoperative course was uneventful, and the patient is currently under observation at an outpatient clinic; postoperative adjuvant chemotherapy with oral S-1 has continued, and additional TAE is planned. In the future, if the middle segment of the liver becomes enlarged, surgery for the residual right lobe tumor may be possible. This case demonstrates one method of SPT treatment: Preoperative HAI chemotherapy with GEM, plus oral S-1 and TAE. If complete resection can be achieved, the majority of patients with SPT have a favorable prognosis. In patients with unresectable metastases from SPT, it is crucial to conduct systematic multimodal treatment to maximize treatment success.
Highlights
Solid pseudopapillary tumor (SPT) is a rare, nonfunctional neoplasm of the pancreas that occurs most frequently in young females with a mean age of 25 years (90% of all cases occur in female patients) [1]
SPT is considered to be an indolent lesion with low malignant potential and a favorable prognosis following surgical resection, a number of cases of locally infiltrating and metastatic varieties, and post‐surgical recurrences have been reported [1]
The current study reports a case of SPT with multiple liver metastases and local recurrence following distal
Summary
Solid pseudopapillary tumor (SPT) is a rare, nonfunctional neoplasm of the pancreas that occurs most frequently in young females with a mean age of 25 years (90% of all cases occur in female patients) [1]. SPT is considered to be an indolent lesion with low malignant potential and a favorable prognosis following surgical resection, a number of cases of locally infiltrating and metastatic varieties, and post‐surgical recurrences have been reported [1]. The incidence of SPT is low, accounting for 1‐2% of exocrine pancreatic tumors and 5% of cystic pancreatic neoplasms. TAJIMA et al: METASTATIC SPT RESECTED FOLLOWING HAI CHEMOTHERAPY AND TAE pancreatectomy for the original lesion; the patient was treated with hepatic arterial infusion (HAI) chemotherapy, systemic chemotherapy, transarterial embolization (TAE), and surgical resection.
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