Solid pseudopapillary tumour of pancreas

Abstract

Solid Pseudopapillary tumor (SPT) is a tumor with low malignant potential and comprises around 1-2% of all tumors occurring in Pancreas. Pseudocyst of Pancreas, Microcystic adenoma, neuroendocrine tumor and mucinous cystic neoplasm are considered as challenging differentials of SPT. High suspicion followed by accurate diagnosis is key to management because SPT is known for its good prognosis and successive cure rate on surgical resection. 21-year-old female patient presented with complaints of abdominal pain and dyspnoea. Imaging studies revealed a retroperitoneal tumor. Surgical resection carried out. Gross examination of the specimen showed circumscribed lobular brown mass weighing around 468 gm with a measurement of 15x12x10 cm. On sectioning, the tumor had a variegated appearance containing multiple cysts varying from 1 - 3 cm in size. Microscopic examination revealed an encapsulated cellular neoplasm with individual tumor cells arranged in solid, pseudopapillae and cystic patterns. Tumor cells were round to oval with no distinct nucleoli. Mitotic figures were very few in number. Hyaline globules were noted. Mucinous changes were seen focally. Occasional areas exhibited clear cell change of tumor cells. Cystic areas were filled with heamorrhage. Vascular areas were unremarkable. Normal Pancreatic parenchyma was noted at the tumor edge. Morphology of SPTs are varied ranging from solid to cystic appearance. No definitive morphology is identified to differentiate benign from malignant SPT. SPT are known to mimic a wide range of pancreatic and retroperitoneal lesions that may pose a challenge to diagnostic pathologists as seen in this case.