Unusual Presentation of Solid Pseudopapillary Tumor of the Pancreas With Pyelonephritis and Weight Loss

Abstract

Solid pseudopapillary tumor (SPT) is a rare exocrine pancreatic neoplasm that accounts for 2-3% of pancreatic neoplasms. We present a unique case of a 20-year-old female that presented with pyelonephritis plus weight loss and was found to have SPT of the pancreas. A 20-year-old Jordanian female with history of type I diabetes mellitus presented to the ED with nausea, vomiting, dysuria, left sided flank pain, and a subjective 20-pound weight loss over the past 3 months. On physical exam, left sided CVA tenderness was elicited, but no palpable abdominal masses were found. Urinalysis and laboratory findings were consistent with pyelonephritis. Patient underwent CT abdomen/pelvis to evaluate for possible nephrolithiasis. Imaging was negative for nephrolithiasis but revealed a 7.5 x 7 cm mass in the pancreatic head with mass effect; suggestive of SPT of the pancreas or GIST tumor. GI recommended outpatient follow-up after resolution of the infection. Upon follow-up, EUS-FNA was performed and revealed an epithelial neoplasm, consistent with SPT of the pancreas. The tumor was compressing the gastric antrum and duodenal bulb causing partial gastric outlet obstruction. Surgery then performed a pylorus preserving Whipple resection. Patient recovered well post-op and was discharged home. SPT of the pancreas is a rare tumor that accounts for less than 3% of all pancreatic tumors. There has been a 7-fold increase in the incidence of SPTs since the year 2000, likely attributed to improved imaging and access to EUS. SPT predominantly affects younger females and is typically found in the pancreatic head or tail. The most common presenting signs are upper abdominal pain, palpable abdominal mass, or no symptoms altogether. In our case, the only presenting sign associated with SPT was weight loss, which is extremely rare. Diagnosis of SPT is made through a combination of imaging and pathologic findings. CT scan is the most common initial imaging modality followed by confirmation with EUS guided FNA. Overall, patients have a favorable outcome with a 5-year survival of 94-97% following surgical resection and have a recurrence rate less than 5%.1417_A.tif Figure 1: Non-contrast abdominal CT scan identifying SPT and duodenal compression1417_B.tif Figure 2: EUS identifying portal vein confluence1417_C.tif Figure 3: EUS identifying SPT and pancreatic bodyThis case is a unique presentation of SPT involving a patient with pyelonephritis and weight loss secondary to gastric outlet obstruction. Physicians should consider this neoplasm as a differential among patients, specifically females 20-30 years old, that present with unexplained weight loss and abdominal pain.