Abstract
Introduction: Typically found in young women, solid pseudopapillary tumors of the pancreas (SPTP) are part of the differential diagnosis for solid and cystic neoplasms of the pancreas. SPTP may cause diagnostic confusion when presenting with massive cystic degeneration. Case Report: A 59 year-old woman undergoing surveillance PET-CT was found to have a 9 cm, calcified, complex cyst arising in the pancreatic tail. Endoscopic ultrasound, as well as cytology and fluid analysis from fine needle aspiration findings were thought to be consistent with pancreatic pseudocyst; however, after referral to a specialty surgical clinic, resection was offered because the unusual appearance and presentation of the pseudocyst triggered concern for an underlying neoplasm. After distal pancreatectomy with splenectomy, histologic examination of the cyst revealed SPTP with necrosis and no evidence of pancreatic pseudocyst. Discussion: SPTP may be confused for pancreatic pseudocyst when significant tumor necrosis and cystic degeneration has occurred. Clinicians evaluating pancreas cysts must keep a high index of suspicion for cystic neoplasm particularly when the history lacks the common causes of pancreatic pseudocyst.
Highlights
Found in young women, solid pseudopapillary tumors of the pancreas (SPTP) are part of the differential diagnosis for solid and cystic neoplasms of the pancreas
Solid pseudopapillary tumor of the pancreas (SPTP) may be confused for pancreatic pseudocyst when significant tumor necrosis and cystic degeneration has occurred
Clinicians evaluating pancreas cysts must keep a high index of suspicion for cystic neoplasm when the history lacks the common causes of pancreatic pseudocyst
Summary
Solid pseudopapillary tumor of the pancreas (SPTP) occurs most frequently in young adults and affects women far more often than men [6]. As with other solid pancreatic neoplasms, cystic degeneration in SPTP may be massive [2,3]. As in the case presented here, SPTP with massive cystic degeneration may be initially identified as a pancreatic pseudocyst [2,3]. Pseudocysts are nonepithelial lined cavities filled with debris and fluid, SPTP with massive cystic degeneration may be difficult to distinguish from pancreatic pseudocyst preoperatively. We present a case of SPTP with massive cystic degeneration initially identified as a pancreatic pseudocyst. This case highlights the capacity of SPTP with cystic degeneration to appear as other cystic lesions of the pancreas by axial imaging and FNA with cytology. We recommend referral to a specialty center with experience in evaluation and treatment of pancreas neoplasms when the diagnosis does not match the clinical parameters
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