Solid Pseudopapillary Neoplasm of the Pancreas - A rare entity with emphasis on the differential diagnosis.

Dr Sabina Khan,Dr Monal Trisal,Dr Musharraf Husain,Dr Mohd Jaseem Hassan,Dr Sujata Jetley,Dr Shaan Khetrapal

doi:10.17511/jopm.2021.i01.10

Abstract

Solid Pseudopapillary Neoplasm of Pancreas (SPNP) is a rare, low-grade malignant solid-cysticneoplasm with papillary architecture. It accounts for 2% to 3% of pancreatic neoplasms and 0.9% to2.7% of exocrine pancreatic neoplasms. It occurs almost exclusively in young women and has anexcellent postsurgical curative rate. Metastasis is rare although it may be locally aggressive. Thesolid pseudopapillary neoplasm of the pancreas pose a diagnostic challenge both clinically andradiologically as it has a nonspecific clinical presentation with vague radiologic features.Histopathological evaluation and immunohistochemistry remains the gold standard in reaching adefinitive diagnosis. Due to its low incidence, the clinical and pathologic features of SPNP have notbeen extensively studied. We report a case of a 32-year-old lady with solid pseudopapillaryneoplasm of the pancreas that was suspected on abdominal CECT as a well-defined mass in theampullary-periampullary region abutting head of the pancreas and confirmed on histopathologicalevaluation with immunohistochemistry.

Highlights

The majority of the tumours of the exocrine pancreas include adenocarcinoma, intraductal papillary mucinous neoplasm, mucinous cystadenocarcinoma and acinar cell carcinoma.[1]
We report a case of a 32-year-old lady with solid pseudopapillary neoplasm of the pancreas that was suspected on abdominal CECT as a well-defined mass in the ampullary-periampullary region abutting head of the pancreas and confirmed on histopathological evaluation with immunohistochemistry
[4] We present a case of a 32-year-old lady diagnosed with solid pseudopapillary neoplasm with emphasis on its clinicopathological features and histo- radiological findings

Summary

Introduction

The majority of the tumours of the exocrine pancreas include adenocarcinoma, intraductal papillary mucinous neoplasm, mucinous cystadenocarcinoma and acinar cell carcinoma.[1]. Whipple’s procedure was done and intraoperative findings showed a large approximately 3x3cm mass in the periampullary region in the head of the pancreas with grossly dilated CBD with multiple periportal and peripancreatic lymph nodes. (Figure 2B) On histopathological examination, a well-demarcated, encapsulated tumor composed of uniform monotonous round to oval cells in solid sheets, cords and organoid pattern with the presence of pseudopapillae were seen. (Figure 3B) Some of the tumor cells showed PAS-positive hyaline globules in their cytoplasm. Immunohistochemical stains showed nuclear positivity for β-catenin (Figure 3C), and chromogranin (Figure 3D) and were negative for CD-10

Findings

Discussion

Conclusion