Case Of Solid Pseudopapillary Tumor Research Articles

Comparison between pancreatoblastoma (PB) and solid pseudopapillary neoplasm (SPN) in pediatric patients with enhanced CT

Rationale and objectivesTo investigate whether computed tomography features can differentiate pancreatoblastoma (PB) from solid pseudopapillary tumor (SPN) in children. Materials and methodsClinical and imaging data of 18 cases of PB and 61 cases of SPN confirmed by surgery or biopsy were retrospectively analyzed. All enrolled patients underwent 3 phases (non-contrast, arterial, and portal venous phases) of CT scanning. Qualitative CT analysis (location, margin, solid/cystic component proportion, calcification, hemorrhage, peritumoral vascularity, bile duct dilatation, pancreatic duct dilatation, pancreatic atrophy, vascular invasion, peripancreatic invasion, and distant metastases) and quantitative analysis (maximum tumor diameter, interface between tumor and parenchyma [delta], arterial enhancement ratio [AER], and portal enhancement ratio [PER]) were performed. The general CT morphologic features, age and tumor markers were compared also compared between the groups. Univariate analysis and the F test were conducted to identify features of PB. Then logistic Regression classifier was trained using the top five features with the highest F-value. Moreover, we used 5-fold cross-validation techniques for the validation of our model. ResultsPB exhibited a significantly higher frequency of location in the body/tail, larger tumor size, poorly defined margins, calcification, peritumoral vascularity, pancreatic atrophy, and less hemorrhage. In addition, PB had higher AER, PER and lower delta relative to SPN (p < 0.05). PB presented a younger age and higher levels of AFP. Results of the F test indicated that AFP, AER, Age, calcification and pancreatic atrophy were the top five features included in the model that could differentiate pediatric PB from SPN. The combined model of CT and clinical features performed well in differentiating PB from SPN, with an AUC of 0.981 in the training cohort and 0.953 in the validation cohort. ConclusionsAFP, AER, age, calcification and pancreatic atrophy are robust CT and clinical features for differentiating pediatric PB from SPN. A combination of qualitative and quantitative CT features may provide good diagnostic accuracy in differentiating PB from SPN in children.

A Case of Solid-Pseudopapillary Neoplasm with 30-Year Follow-Up after Multidisciplinary Treatment for Postoperative Recurrence

A Case of Solid-Pseudopapillary Neoplasm with 30-Year Follow-Up after Multidisciplinary Treatment for Postoperative Recurrence

Utility of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in a Paediatric Population: A Single-Centre Experience

Introduction: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a modern and minimally invasive technique to acquire diagnostic material from within the gastrointestinal tract, as well as from adjacent organs and structures, which can help in the diagnosis and staging of a variety of gastrointestinal malignancies, as well as for non-malignant conditions. Though well described in adults, there is limited literature on the diagnostic utility of EUS-FNA in paediatric patients. The objective of this study was to evaluate the diagnostic accuracy and clinical utility of EUS-FNA in paediatric patients performed at our centre over the last 17 years. Materials and Methods: After obtaining Institutional Review Board approval, 63 cases of paediatric EUS-FNA performed at SKMCH&RC from 2005 to 2022 were retrieved. A 22-gauge EUS-FNA needle was used for obtaining samples with the use of suction (when required). The sample was then smeared onto glass slides, with half being stained with RAPI stain while the rest with the Papanicolaou stain. Demographic details, indication for the procedure, results of rapid on-site adequacy status (ROSE), site of lesion, and cytological diagnosis were reviewed and analysed. Results: Of the 63 patients, 55 (87.3%) had an adequate sample (confirmed on ROSE). Forty-two (66.7%) were male and the mean age was 12.4 years. The most frequent indication of EUS-FNA was a sampling of enlarged lymph nodes (74.6%). The most common sites of nodal aspiration were sub-carinal (33.3%) and celiac lymph nodes (14.3%). EUS-FNA of a pancreatic lesion accounted for an additional 17.5% of cases. Involvement by Hodgkin’s lymphoma was the most common diagnosis (25.4%) followed by granulomatous inflammation (19.1%). Cases of solid pseudo-papillary tumour (4.8%) and recurrent Wilm’s tumour (3.2%) were also diagnosed. No patient suffered complications, and none required hospital admission, post-procedure. The sensitivity, specificity, PPV, and NPV of EUS-FNA were 98.1, 83.3, 96.4, and 90.9%, respectively. Conclusion: EUS-FNA is a safe, well-tolerated, minimally invasive outpatient setting procedure with high sensitivity and significant utility in the diagnosis and staging of disease.

Laparoscopic antegrade spleen-preserving distal pancreatectomy with conservation of the splenic vessels: a prospective multi-centre case series (with video)

Introduction: Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with conservation of the splenic artery and vein (Kimura’ technique) is considered a technically challenging procedure that requires a high level of expertise in laparoscopic and pancreatic surgery. Methods: A prospective descriptive study on 18 patients with laparoscopic “antegrade” spleen-preserving distal pancreatectomy with Kimura’ technique from 2018 to 2023. The perioperative indications, clinical data, intraoperative index, pathological postoperative specimens, postoperative complications, and follow-up results were retrospectively evaluated. Results: The mean age was 39.4±13.3. Only 2 male patients accounted for 11.1%. The average operating time is 171±23 min. The average blood loss is 65.7±43 ml. The average tumor size is 4.1 cm. The average hospitalization is 9.4 days. The rate of pancreatic fistula is 66.7%. There is no case of transferring open surgery or blood transfusion during surgery. The results of pathological after surgery there were eight cases of solid pseudopapillary tumors, four cases of mucinous cystadenoma, six cases of neuroendocrine tumors. Conclusion: Kimura’s technique for laparoscopic spleen-preserving distal pancreatectomy is safe and feasible, which can be applied to benign tumors in the body and tail of the pancreas. However, this is a difficult technique in laparoscopic surgery that requires surgeons to have a lot of experience and equipment need to be adequate.

Solid pseudopapillary neoplasm of the pancreas during pregnancy presenting as gastrointestinal stromal tumor: A case report and review of literature

Solid pseudopapillary neoplasm (SPN) is a rare tumor that can complicate pregnancy. More than its rarity, SPNs are unique neoplasms because of their obscure histogenesis, cytology, immunohistochemical profile, and imaging characteristics. This report describes the case of a 32-year-old gravida 2 para 1 (1001) seen at 24 weeks with an intra-abdominal mass. The patient presented with a long-standing history of abdominal mass with the working impression of gastrointestinal stromal tumor. We employed a multidisciplinary approach to closely monitor tumor growth, ensure maternal and fetal well-being, avert complications, and avoid unnecessary clinical interventions. Histopathological evaluation and immunohistochemistry studies of representative specimens taken at the time of delivery revealed the diagnosis of SPN of the pancreas. Based on a review of local search engine databases, this is the first documented case of SPN complicating pregnancy in the Philippines.

Sixteen cases of laparoscopic central pancreatectomy for benign or low-grade malignant tumours in the pancreatic neck and proximal body.

The purpose of this study is to examine and analyse the outcomes and patient experiences associated with laparoscopic central pancreatectomy. The perioperative data of 16 patients who underwent laparoscopic central pancreatectomy were retrospectively analysed at Ningbo Medical Center Lihuili Hospital (Xingning Branch and Eastern Branch) from September 2017 to July 2023. All surgical procedures were completed without the need for intraoperative conversion to open surgery. In two cases, intraoperative cholangiography was performed, while in four cases, intraoperative fluoroscopic laparoscopic assistance was utilized. The duration of the operations varied from 160 to 360 min, with an average of 281.75 min. The estimated volume of intraoperative bleeding ranged from 50 to 300 mL, with an average of 113.75 mL. The postoperative pathology results revealed that there were two cases of intraductal papillary mucinous neoplasm, six cases of serous cystic neoplasms, one case of mucinous cystic neoplasm, five cases of solid pseudopapillary neoplasms, and two cases of neuroendocrine tumours. The maximum diameter of the tumours ranged from 3.0 to 5.0 cm, with an average of 3.67 cm. There were no instances of postoperative common bile duct stenosis or biliary leakage. Among the cases, five did not exhibit pancreatic fistula, six experienced biochemical leakage, three had grade B pancreatic fistula, and two had grade C pancreatic fistula. Laparoscopic central pancreatectomy, as a method to preserve pancreatic function, entails specific surgical risks and a notable likelihood of postoperative pancreatic fistula, necessitating the expertise of seasoned surgeons for its execution.

Surgery for Solid Pseudopapillary Neoplasm: Observational Study at a Nepalese Tertiary Center

Introduction: Solid pseudopapillary neoplasms (SPN) are rare, relatively indolent tumors with potential malignant behavior. This study aimed to analyze the clinicopathological details, surgical management, and short- and long-term outcomes of operated cases of SPN. Methods: This was an observational descriptive study of diagnosed SPNs confirmed histopathologically after surgical resections at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal from 2006 November to 2019 January. Patient’s clinical details, surgical procedures, perioperative outcomes, and follow-up were recorded. Long-term follow-up was evaluated for a minimum of three years post-surgery. Results: Over 13 years, a total of 15 cases with a median age of 22 years (11-52) were encountered and had female predominance (14, 93.3%). Five cases were diagnosed incidentally, while pain abdomen (5, 33.3%) was the most common presentation followed by lump (4, 26.7%). There were four tumors in the head of the pancreas, two in the uncinate process, two in the neck, four in the body, and three in the tail of the pancreas. Four cases underwent pancreaticoduodenctomy, three cases underwent enucleation, and four cases underwent central pancreatectomy. Similarly, one patient underwent spleen preserving distal pancreatectomy and three patients underwent distal pancretosplenectomy. Postoperatively, 20% developed major complications with Clavien-Dindo (grade III &amp; above) out of which one patient had mortality. Over the median follow-up of 72 months, no recurrences were noted. Conclusion: Solid pseudopapillary neoplasms were relatively rare. Complete surgical resection was the most commonly used surgical management, post-operative complications were minimal and survival rate was excellent.

Analysis of the clinical efficacy of laparoscopic middle pancreatectomy in the treatment of benign or low-grade malignant tumors of the pancreas.

The aim of this study was to investigate the clinical efficacy of laparoscopic middle pancreatectomy in the treatment of benign and junctional tumors of the pancreas. Retrospective analysis of basic data, tumor diameter, statistical analysis, and evaluation of efficacy-related indicators such as operative time, intraoperative bleeding, pathological findings, postoperative hospital stay, postoperative pancreatic fistula incidence, and pancreatic endocrine function was carried out on 17 patients diagnosed with benign or low-grade malignant tumors of the pancreas and laparoscopic middle pancreatic resection from January 2018 to January 2023 at the First Affiliated Hospital of Hunan Normal University. A total of 17 patients were screened. There were eight males and nine females; mean age was 42.8 ± 17.4 years (range: 15-69 years); BMI was 22.6 ± 2.5 kg/m2 (range: 18.4-27.5 kg/m2), and the tumor size was 3.4 ± 1.2cm (range: 1.5-5.5 cm). Preoperative glycan antigen CA19-9 was negative and CA125 was negative. Surgical time was 393.2 ± 57.9min; intraoperative bleeding was 211.7 ± 113.9ml; tumor diameter size was 3.4 ± 1.2cm; postoperative admission time was 19.4 ± 7.6 days; postoperative pancreatic fistula (POPF) grading was 17 cases, including nine cases of A-grade fistula, three cases of B-grade fistula, and none of C-grade fistula; postoperative pathology results were five cases of plasmacytoma, three cases of mucinous cystadenoma, four cases of SPN (solid pseudopapillary neoplasm), one case of Intraductal Papillary Mucinous Neoplasm (IPMN), three cases of pancreatic Neuroendocrine Neoplasm (pNEN), one case of inflammatory myofibroblastic osteoblastoma. All cases did not develop pancreatic origin diabetes or exacerbation of previous diabetes, and no cases presented symptoms of exocrine insufficiency such as dyspepsia and diarrhea. Laparoscopic middle pancreatectomy is safe and feasible in the treatment of benign or low-grade malignant tumors in the body of the pancreatic neck and is not accompanied by increased risk of intraoperative and postoperative complications and endocrine dysfunction of the pancreas.

Study on the application value of fluorescent laparoscopy in pancreatic tumor surgery.

Fluorescent laparoscopy is rarely used in pancreatic surgery. The aim of this study was to investigate the value of fluorescent laparoscopy in pancreatic tumor surgery. A total of 19 patients with pancreatic tumors who were treated in the Department of Hepatobiliary Surgery at the First Affiliated Hospital of Wannan Medical College from January 2021 to August 2022 were selected. Fluorescent laparoscopy was used intraoperatively, and the imaging characteristics of different tumors were recorded and analyzed. Among the 19 participants, postoperative pathology confirmed 12 cases of pancreatic cancer (8 cases of moderately differentiated adenocarcinoma, 3 cases of moderately-poorly differentiated adenocarcinoma, and 1 case of acinar cell carcinoma), 4 cases of pancreatic cystic tumors (1 case of microcystic serous cystadenoma, 1 case of serous cystadenoma, 1 case of solid pseudopapillary tumor, and 1 case of solid-cystic pseudopapillary tumor), 1 case of pancreatic neuroendocrine tumor (G1 stage), and 2 cases of inflammatory lesions. There were 8 cases of pancreaticoduodenectomy, 6 cases of distal pancreatectomy, 3 cases of middle pancreatectomy, 1 case of local pancreatectomy, and 1 case of duodenum-preserving pancreatic head resection. One minute after intravenous injection of indocyanine green (ICG), 10 of the 12 patients with pancreatic cancer showed tumor peritumor imaging; 2 cases of pancreatic serous cystic tumors did not show imaging; 2 cases of solid pseudopapillary tumors had tumor body imaging; 1 case of neuroendocrine tumor had tumor body imaging, with complete fluorescence imaging after specimen dissection; there were 2 cases pathologically confirmed as inflammatory lesions, 1 case with tumor body imaging, and 1 case with capsule imaging. By reasonably controlling the administration time and dose of ICG during surgery, some pancreatic tumors can be fluorescently imaged, which is beneficial for intraoperative tumor localization and margin determination.

Clinical outcomes of minimally invasive duodenum-preserving pancreatic head resection

BackgroundThe procedure of total duodenum-preserving pancreatic head resection (DPPHRt) has been reported frequently, but rare in minimally invasive procedure, especially robotic-assisted operation. Here we share our experience and analyze the clinical outcomes of minimally invasive DPPHRt in the treatment of benign lesions or low-grade malignant tumors of the pancreatic head in this study.Materials and methodsFrom October 2016 to January 2022, three patients received robot-assisted DPPHRt(RA-DPPHRt), and seventeen patients received laparoscopic DPPHRt(LDPPHRt). Data were retrospectively collected in terms of demographic characteristics (age, gender, body mass index, and pathological diagnosis), intraoperative variables (operative time, estimated blood loss), and post-operative variables (post-operative hospital stay, and complications).ResultsAll 20 patients received minimally invasive total duodenum-preserving pancreatic head resection successfully without conversion, including 8 males and 12 females. Pathological diagnosis suggested 1 case of serous cystadenoma (SCA), 4 cases of intraductal papillary mucinous neoplasm (IPMN) ,5 cases of mucinous cystic neoplasm (MCN), 4 cases of pancreatic neuroendocrine neoplasm (PNET), 2 cases of chronic pancreatitis (CP),4 case of solid pseudopapillary tumor (SPT). The average operation time was (285.35 ± 95.13 min), ranging from 95 to 420 min. The average estimate blood loss was (196.50 ± 174.45ml) ,ranging from 10 to 600ml.The average post-operative hospital stay was(20.90 ± 14.44days),ranging from 8 to 54 days. Postoperative complications occurred in 10 patients (50%). A total of 5 patients (20%) suffered grade B or C pancreatic fistula. Two patients (10%) suffered from biliary fistula. Two patients (10%) suffered from delayed gastric emptying. One patient (5%) suffered from abdominal bleeding. The 90-day mortality was 0. No patient was observed tumor recurrence and new-onset diabetes but one developed diarrhea.ConclusionRA-DPPHRt or LDPPHRt provided a minimally invasive approach with good organ-preservation for patients with benign and low-grade malignant pancreatic head tumor. It is only recommended to be performed in high-volume pancreatic centers by experienced pancreatic surgeons.

A case of middle-aged male with multicentric solid pseudopapillary neoplasm of the pancreas.

Solid pseudopapillary neoplasm (SPN) of the pancreas is a low-grade, malignant pancreatic tumor that occurs predominantly in young females. In this report, an extremely rare case of multicentric SPNs in a middle-aged male is discussed. A 55-year-old man was incidentally found to have a mass in the pancreatic body on abdominal ultrasonography during a medical checkup. Contrast-enhanced computed tomography (CT) revealed masses with 50-mm and 25-mm diameters with internal calcification in the pancreatic body and tail, respectively. These masses had a gradually increasing enhancement pattern though the center of the pancreatic body mass and the periphery of the pancreatic tail lesion were non-enhancing. Magnetic resonance imaging revealed a hyperintense signal in the mass of the pancreatic tail suggestive of hemorrhage on T1-weighted imaging. Positron emission tomography-CT revealed abnormal uptake of fluorodeoxyglucose in both lesions. Endoscopic ultrasound-guided fine needle aspiration was performed on both lesions, and tumor tissue with a solid proliferation of poorly pleomorphic small cells was observed. The tumor cells were positive for CD10 in the cytoplasm and β-catenin in the nucleus. The patient was diagnosed with SPNs and underwent a successful distal pancreatectomy.

Solid pseudopapillary neoplasm of the pancreas after living-donor liver transplantation

Solid pseudopapillary neoplasm of the pancreas has been classified by the World Health Organization as a low-grade malignant tumor with potential to metastasize. The standard treatment for this neoplasm is complete surgical resection. However, it is not always feasible to perform a complex procedure such as pancreaticoduodenectomy or distal pancreatectomy, especially for patients with a history of hepato-biliary-pancreatic surgery. In such cases, the treatment strategy must consider the patient's postoperative quality of life. We herein report a case of solid pseudopapillary neoplasm of the pancreas following living-donor liver transplantation. The patient was a 13-year-old girl who had undergone the Kasai procedure for biliary atresia at 140 days of age. She thereafter underwent living-donor liver transplantation because of recurrent cholangitis and progressive jaundice. Her repeated history of cholangitis had caused narrowing of the portal vein. Therefore, the portal vein was reconstructed using the donor's ovarian vein as an interposition graft. At 13 years of age, a mass was identified at the head of the pancreas. Biopsy was performed and the patient was diagnosed with solid pseudopapillary neoplasm of the pancreas. Surgical resection was planned, and three options were considered: pancreaticoduodenectomy, duodenum-preserving pancreatic head resection, and enucleation. Considering the complications associated with radical surgery, tumor enucleation was performed. The patient developed a postoperative pancreatic fistula that required prolonged fasting and drainage. She began a low-fat diet on postoperative day 15. Because the pancreatic fistula was well controlled with a low-fat diet, the patient was discharged on postoperative day 51 after she and her parents had received dietary guidance. At the time of this writing, 1 year had passed since the enucleation with no evidence of recurrence. We have herein reported a case of solid pseudopapillary neoplasm of the pancreas after living-donor liver transplantation. Although a radical operation such as pancreaticoduodenectomy or distal pancreatectomy is preferable from an oncological perspective, enucleation should be considered for patients with high surgical risk.

Cytological Diagnosis of Pancreatic Solid-Pseudopapillary Neoplasm: A Single-Institution Community Practice Experience.

Introduction. Pancreatic solid-pseudopapillary neoplasm (SPN) is a rare tumor that typically occurs in young females. Although a cytological diagnosis may be easily made in this age group when there are typical features, atypical clinical presentations and unusual cytological features may make this a challenging diagnosis. We present our single-institution experience in a cohort of these tumors, outlining both typical and atypical features. Awareness of unusual clinical and cytological features can help to avoid pitfalls during diagnosis. Methods. We performed a review of all cases of pancreatic SPNs diagnosed over a 15-year period (January 2007 to December 2021). Detailed cytological, clinical, and follow-up histological features were presented and analyzed. Results. Twenty-two cases of SPN were diagnosed at our institution during this 15-year period. Patients ranged from 12 to 73 years of age (mean 33 y, median 26 y) and included 19 females and 3 males. Seventeen patients had cytological material, and fourteen were diagnosed by EUS-FNA. Typical cytological features included papillary clusters with central capillaries, myxoid stroma, monomorphism, cercariform cells, and hyaline globules. Atypical or unusual cytological features that were seen in a few cases were multinucleated giant cells, clear cells, and/or foamy macrophages. A few cases showed features that were similar to pancreatic neuroendocrine tumors (PanNETs). Tumor cells were always positive for β-catenin, CD10, CD56, cyclin-D1, progesterone receptor (PR), and vimentin by immunohistochemistry. They were always negative for chromogranin. Pancytokeratin and synaptophysin stains were positive in 9% and 46% of cases evaluated, respectively. All cases had histological confirmation on resection. The median follow-up duration was 69 months (a range of 2–177 months), with only three cases lost to follow-up. No recurrence or metastasis was identified. Conclusions. We present our experience with cytological diagnoses of SPN in a well-characterized cohort of 22 patients with histological correlation and follow-up data. These tumors occur over a wide range and show varied cytological features. SPNs can be confidently diagnosed on limited cytological material, with limited panel immunohistochemistry aiding diagnosis in atypical cases. Recognizing the associated degenerative changes is crucial in avoiding a misdiagnosis.

Utility of SOX11 for the diagnosis of solid pseudopapillary neoplasm of the pancreas on cytological preparations.

The diagnosis of solid pseudopapillary neoplasm (SPN) on fine needle aspiration specimens can be challenging because of morphological overlap with other pancreatic neoplasms, including pancreatic neuroendocrine tumour (PanNET). SRY-related high-mobility group box 11 (SOX11) is a recently described sensitive and specific marker for SPN diagnosis. However, SOX11 immunocytochemistry on cytological smears has not been reported. We evaluated the utility of SOX11 for diagnosis of SPN on cytological preparations. SOX11 immunocytochemistry was performed on Papanicolaou-stained smears and/or corresponding cell blocks from aspirates of 7 SPN and 10 PanNET cases identified between 2005 and 2020. Findings were compared with those for beta-catenin, a frequently used diagnostic marker for SPN. Six smears and 6 cell blocks from SPN cases and 8smears and 10 cell blocks from PanNET cases were available for immunostaining. For SPN, nuclear staining for SOX11 was seen in 6 of 6 (100%) smears and 5 of 6 (83%) cell blocks, with equivocal staining in 1 cell block. In contrast, 7 of 8 (88%) smears and 9 of 10 (90%) cell blocks were negative for SOX11 for PanNet, with equivocal staining seen in 1 case. Beta-catenin immunocytochemistry showed nuclear staining in 6 of 7 (86%) SPN cases and no staining in all 10 (100%) PanNET cases. SOX11 detected by immunocytochemistry can serve as a useful diagnostic marker for SPN, in addition to beta catenin, and can be performed on cytological smears in cases without a cell block preparation.

Prognostic Enigma of Pancreatic Solid Pseudopapillary Neoplasm: A Single-Center Experience of 63 Patients.

Background: Studies investigating prognostic factors of solid pseudopapillary neoplasm (SPN) have been published with conflicting findings.Methods: Retrospective analysis of 63 consecutive cases of SPN in our institution from January 2010 to December 2019 was carried out. The clinicopathological features, treatment practices along with survival associations were collected and analyzed.Results: Fifteen patients (23.8%) were male, and 48 (76.2%) were female, with a median age of 34.0 ± 14.5 years. The larger tumor size was correlated with the more mixed components (p = 0.000) and the higher Ki-67 index (p = 0.042). No recurrence was found in the nine patients whose tumors fulfilled the WHO criteria for malignancy due to the presence of at least perineural invasion (6.4%), angiovascular invasion (2.3%), and/or adjacent organ invasion (6.4%). Microscopic infiltrative growth was detected in 9 (14.3%) tumors, which was correlated significantly with the WHO criteria (p = 0.002), capsule invasion (p = 0.005), and pancreatic parenchyma invasion (p = 0.001), but not with disease-free survival (p = 0.13). CD99 was found to be positively expressed in 88.9% (40/45) of tumors and more likely to have depressed Ki-67 index (p = 0.016). After a median follow-up of 58 months, only two patients (3.2%) had a recurrence after their first operation outside of our hospital. No patient died due to tumor progression.Conclusions: Although survival is favorable with aggressive surgery, it is actually difficult to assess the prognostic factors of resected SPNs. Future investigations into the role of clinicopathological evaluation will unveil the prognostic enigma of pancreatic SPN after resection.

Solid Pseudopapillary Neoplasm (SPN) of the Pancreas: A 7-year Study in A Tertiary Level Teaching Hospital in Bangladesh

Solid pseudopapillary neoplasm (SPN) of the pancreas, also referred to as Frantz's tumour, is a rare tumour and represents 1-3% of all pancreatic tumours, which typically affects young women without significant clinical symptoms. This cross-sectional study was done in the Department of Pathology, Bangabandhu Sheikh Mujib Medical Un iversity (BSMMU) between January 2009 and December 2015. A total of nineteen cases of solid pseudopapillary neoplasm (SPN) of pancreas were detected in patients and included in this study. In all the patients the diagnosis was confirmed by histopathology after the surgery. Tumours were nodular, cystic or solid-cystic, often encapsulated. Some of them were received as irregular fragmented pieces, as intact removal was not possible. Cut surfaces were partly grey-white and partly tan-brown with cystic degeneration. Areas of necrosis and hemorrhage were present in all the specimens.The age range was of 14-45 years (mean age 26.9±3.7 years) (Table-I). Among the tumours, 18 were found in female patients, while only 1 was from male patient. In all the cases, preoperative imaging contributed to diagnosis of an abdominal mass in the patients. 11 of these were reported as pancreatic mass, while 3 as pancreatic cystic mass, 2 as retroperitoneal mass, 2 as mesenteric mass and only 1 as adrenal mass. Tumour-size ranged from 6 to 19 cm (mean size 9.3±1.5 cm). 7 tumours were solid and cystic in nature, while 8 were solid and 4 were only cystic. Complete capsule was found in 17 specimens. Calcifications were found in only 5 specimens. Surgical resection was found generally curative. In our study, absence of metastasis suggests that these tumours hardly show aggressive clinical behaviour. However, follow-up is important to observe potential local recurrence and metastasis.&#x0D; CBMJ 2020 July: Vol. 09 No. 02 P: 34-38

Solid pseudopapillary neoplasm of pancreas in a 14-year-old girl

Solid pseudopapillary neoplasm (SPN) of the pancreas is an infrequent neoplasm that is known to have a low malignant potential and represents less than 3% of all exocrine tumors. Herein, we report a case of SPN of the pancreas in a 14-year-old girl who presented with a long history of dyspepsia and epigastric pain. CT revealed a sizeable well-defined cystic mass at the porta hepatis/pancreatic head mesenteric region. On exploration, showed a tumor in the head of the pancreas, which was completely resected. The final diagnosis was Solid pseudopapillary neoplasm of the pancreas. We highlight its pathological and surgical background as well.

A limited panel of INSM1 and LEF1 immunostains accurately distinguishes between pancreatic neuroendocrine tumor and solid pseudopapillary neoplasm

Solid pseudopapillary neoplasm (SPN) and well differentiated pancreatic neuroendocrine tumor (PNET) can show significant cytomorphological overlap. In this study, we evaluated the role of INSM1 and LEF1 immunohistochemical stains in distinguishing between these two tumors. 22 SPN and 25 PNET surgically resected cases were stained for both INSM1 and LEF1. All the 22 cases of SPN showed strong and diffuse nuclear staining for LEF1 (in >95 % of tumor cells), while all 25 PNET were negative for LEF1. All 25 PNET cases were positive for INSM1 (moderate to strong intensity nuclear staining in >50 % of the tumor cells), while all 22 cases of SPN were negative for INSM1. The results of our study show that a limited panel comprising of INSM1 and LEF1 immunostains accurately distinguishes between SPN and PNET.

S1440 A Case Series of Five Solid Pseudopapillary Neoplasm of Pancreas: Comparison of Four Putative Immunohistochemical Stains With Four Conventional Immunohistochemical Stains

INTRODUCTION: Solid pseudopapillary neoplasm (SPN), a rare exocrine tumor, accounts for 0.2-2.7% of primary pancreatic tumors occurs mostly in young females. The histologic origin is debatable and thus, it is important to identify the most sensitive and specific biomarkers. Through this case series, we are addressing the comparative analysis of four commonly used immunostains with 4 new putative immunohistochemical markers. CASE DESCRIPTION/METHODS: We performed an electronic search of pathology records for a 25 years-period (1994-2019) for SPN. Formalin-fixed, paraffin-embedded tissue blocks were retrieved and used for staining for four commonly used (CD-10, Beta- Catenin, Progesterone receptor, Alpha-1 antitrypsin) and four new (LEF-1, TFE-3, SOX-11 and AMACR) immunohistochemical markers.: In our case-series, female-to-male ratio is 4:1, with a mean age of 37.6 years. The tumor size ranged from 2.3 to 14 cm. Only one case showed aggressive features of necrosis, perineural invasion and lymphovascular invasion. None of the cases showed lymph node or distant metastasis. The results from the immunohistochemical staining are noted in Table 1. DISCUSSION: In our case series, lymphoid enhancer factor-1 (LEF-1) emerged out as the most sensitive new putative marker with 100% diffuse nuclear positivity among the other new markers. To the best of our knowledge, these novel results are noted for the first time in our case series. This significant finding is in congruence with the emerging molecular diagnostic finding that the long isoform of LEF-1 expresses b-catenin binding domain and functions as a transcriptional enhancer factor. It also emphasizes the involvement of Wnt/β-catenin signaling pathway in the histologic origin of this tumor. Further studies are needed to evaluate its specificity especially against SPN mimickers such as Acinar-cell carcinoma and pancreatic neuroendocrine tumors.Figure 1.: Figure 1: A. Solid pseudopapillary neoplasm H&E section at 200x. B. SPN TFE-3 stain at 200x C. SPN Alpha 1 antitrypsin 200x D. SPN AMACR stain at 400x E. SPN Beta Catenin at 400x F. SPN CD10 at 400x G. SPN LEF-1 stain at 400x H. SPN SOX-11 stain at 400x.Table 1.: Staining pattern and comparison of four conventional stains with 4 putative stains in 5 cases of Solid Pseudopapillary neoplasm of pancreas.

Differential diagnosis of pancreatoblastoma (PB) and solid pseudopapillary neoplasms (SPNs) in children by CT and MR imaging.

To determine whether features on computed tomographic and/or magnetic resonance imaging can differentiate pancreatoblastoma (PB) from solid pseudopapillary neoplasms (SPNs) of the pancreas in children. Clinical and imaging data for 20 cases of SPNs and 14 cases of PB confirmed by surgery or biopsy were retrospectively analysed. The size, border, calcification, haemorrhage, solid/cystic component proportion, intratumoural vessels, tumour capsulation, pancreatic duct dilatation, peripancreatic vessel invasion, distant metastasis status and apparent diffusion coefficient (ADC) values of the two groups were examined, and key diagnostic features were identified. Statistical analysis was performed using the chi-square test and Student's t test. Sensitivity and specificity values were calculated when a single criterion was used. Age ≤ 5 years, elevated serum α-fetoprotein (AFP), larger size, ill-defined border, calcification, absence of haemorrhage, intratumoural vessel, peripancreatic vessel invasion and distant metastasis differentiated PB from SPN (p < 0.05). ADC values of SPN were higher than those of PB (p = 0.001). There were no significant differences regarding tumour capsule (p = 0.435), pancreatic duct dilatation (p = 1.000) or cystic degeneration area over 50% of the tumour volume (p = 1.000) between the two groups. The following features are helpful for differentiating PB from SPN: age ≤ 5 years, elevated serum AFP, larger size, ill-defined border, calcification, haemorrhage absence, intratumoural vessel, peripancreatic vessel invasion, distant metastasis and lower ADC value. • CT and MRI are helpful to differentiate pancreatoblastoma (PB) from solid pseudopapillary neoplasms (SPNs) of the pancreas in children. • The following features are helpful to differentiate PB from SPN: age ≤ 5 years, elevated serum AFP, larger size, ill-defined border, calcification, absence of haemorrhage, intratumoural vessel, peripancreatic vessel invasion, distant metastasis and lower ADC value.