Solid pseudopapillary neoplasms (SPN) of the pancreas are extremely rare epithelial tumor with low malignant potential, account for 1-2% of exocrine pancreatic tumors. When symptomatic, these tumors come to light due to mass affect on neighboring structures. Peculiarly, we encountered a healthy 34-year-old female who was found to have an elevated dehydroepiandrosterone (DHEA) and testosterone level during evaluation of irregular menstrual cycles. She subsequently underwent a CT scan with no abnormalities of the adrenal glands; however, an indeterminate pancreatic tail mass was seen. MRI of abdomen further characterized the lesion as an enhancing pancreatic tail mass measuring up to 2.7 cm, that was concerning for pancreatic neoplasm. The patient underwent upper endoscopic ultrasound which confirmed a hypoechoic mass in the pancreatic tail, measuring 2.3 by 1.7 cm. An intact interface was seen between the mass and adjacent structures, suggesting a lack of invasion. Fine needle biopsy was performed and cytology revealed solid pseudopapillary tumor (Figures 1&2). The patient was advised to undergo distal pancreatectomy. Although there does to be a female predilection of SPNs, the underlying role of sex hormones (ie: estrogen and progesterone) in neoplasm growth or histogenesis remains unclear. One retrospective study, spanning 15 years, noted the clinical presentation was generally nonspecific. Abdominal or vague pain was seen in ˜70% of their patients and was followed by symptoms of tumor mass effects. SPNs are generally inactive on screening modalities such as tumor markers (ie: AFP, CEA, CA 19-9 and CA 125). Histochemically there is no evidence of pancreatic insufficiency, pancreatic parenchymal injury, abnormal liver function, or cholestasis. To our knowledge this is the first documented presentation with elevated DHEA and Testosterone level in an asymptomatic woman. Extensive workup reveled no secondary (including adrenal) etiology for her hormonal dysregulation. We recommend further review and investigation into this potential correlative relationship in an effort to guide future management of this unusual neoplasm.1319_A.tif Figure 1: No Caption available.1319_B.tif Figure 2: No Caption available.
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