Abstract
Introduction The solid pseudopapillary epithelial neoplasm (SPN) is a rare form of pancreatic neoplasm with an incidence of 2-3% of all pancreatic tumours. The recent increase in incidence is attributed to the increasing use of imaging techniques for nonspecific abdominal complaints. We report our institutional experience in the management of this tumour over the last decade. Method We retrospectively analyzed from a prospectively maintained database of patients from January 2011 to December 2020 who were operated upon for SPN. All the patients were followed till date. Results Of 479 patients operated on for various types of pancreatic tumours during this period, 15 (3.1%) had SPN. The mean age of presentation was 28 years with a female preponderance (12/15, 80%). The most common location was the body and tail of the pancreas (66%), and the mean size was 6.4 cm (2–15 cm). The tumour extent was defined as ‘borderline resectable' in 20% of cases. Distal pancreatectomy was done in 11 patients with spleen preservation in 3. R0, R1, and R2 resection were done in 12, 2, and 1 patient(s), respectively. The operative mortality was 6.7%. All the patients are doing well on follow-up. Conclusion SPN is a low-grade malignant tumour with a strong female predilection. Clinical manifestations have no specificity, imaging examination only contributes tumour location, and the final diagnosis rests on pathology. Surgery is the main modality of treatment and carries a good prognosis.
Highlights
Solid pseudopapillary neoplasms (SPNs) of the pancreas are defined by the new 5th edition of the World Health Organization (WHO) Classification of Digestive System Tumors as low-grade malignant tumours composed of poorly cohesive epithelial cells which form solid and pseudopapillary structures and lack a specific line of pancreatic epithelial differentiation [1]
Cubilla and Fitzgerald reported an incidence of solid pseudopapillary epithelial neoplasm (SPN) of 0.17% in 1979, Morohoshi et al reported an incidence of 2.7% in 1987, and Koshmal et al reported an incidence of 6.1% of all pancreatic tumours in 2004 [4,5,6]
Before being defined as a tumour of uncertain differentiation or solid pseudopapillary neoplasm in 1996 by the World Health Organization, it was known as a solid cystic tumour, papillary epithelial neoplasm, or papillary epithelial tumour [10]
Summary
Solid pseudopapillary neoplasms (SPNs) of the pancreas are defined by the new 5th edition of the World Health Organization (WHO) Classification of Digestive System Tumors as low-grade malignant tumours composed of poorly cohesive epithelial cells which form solid and pseudopapillary structures and lack a specific line of pancreatic epithelial differentiation [1]. Before being defined as a tumour of uncertain differentiation or solid pseudopapillary neoplasm in 1996 by the World Health Organization, it was known as a solid cystic tumour, papillary epithelial neoplasm, or papillary epithelial tumour [10]. It is a rare tumour and has an estimated incidence of 23% of all pancreatic tumours and 6–12% of all pancreatic cystic neoplasms [3]. It usually affects women below the age of 40 years (2–85 years), with a male to female ratio of 7–11 : 1. In the paediatric age group, the incidence is 8–12.5%. e
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