Pancreatic Solid Pseudopapillary Neoplasm Research Articles

NEOPLASIA SÓLIDA PSEUDOPAPILAR PANCREÁTICA MIMETIZANDO TUMOR NEUROENDÓCRINO DE BAIXO GRAU

Introduction: Solid pseudopapillary neoplasms (SPN) and pancreatic neuroendocrine tumors (NET) are rare diseases that are generally incidental findings in imaging tests. SPN is a low-grade tumor with good prognosis that more commonly affects young female patients. Pancreatic NET has a significant variability in outcomes, with low malignant potential in non-progressing tumors that are welldifferentiated. Both tumors may appear very similar in imaging tests and immunohistochemical (IHC) evaluation, which makes the differential diagnosis challenging, especially in small lesions. Case report: The authors present the case of a 34-year-old male with a medical history of a primary mediastinal germ cell tumor. The patient had no symptoms. Follow-up abdominal CT scan evidenced a single, well-delimited nodular lesion in the pancreatic neck, measuring 17mm in diameter. The patient was submitted to an endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNA) and after IHC analysis, there was a diagnostic suspicion of low-grade pancreatic NET. Central pancreatectomy (CP) was performed and complete lesion analysis evidenced a pancreatic SPN. Conclusion: The SPN can mimic low-grade nonfunctioning pancreatic NETs in imaging tests and EUSFNA IHC evaluation.

Application of MSCT characteristic nomogram model in predicting invasion of pancreatic solid pseudopapillary neoplasms

ObjectiveTo evaluate the value of multi-slice computed tomography (MSCT) characteristic nomogram model in predicting invasion of pancreatic solid pseudopapillary neoplasms (pSPN). MethodsFrom January 2016 to January 2021, the clinical characteristics, pathology and imaging data of 114 patients with pSPN were retrospectively analyzed. 42 cases were classified in invasive group while 72 cases in non-invasive group. The tumor location, shape, growth pattern, growth angle, margin calcification, floating cloud sign, annular enhancement, pancreatic and bile duct dilation, distal pancreatic atrophy, capsule, cystic degeneration and cystic to solid ratio between the two groups were analyzed. The maximum diameter and the CT value of the solid parts in the lesion were measured. ResultsThere were significant differences in tumor shape, growth pattern, margin, annular enhancement, capsule, CT value in arterial phase and venous phase (P < 0.05). There was no significant difference in tumor location, growth angle, calcification, floating cloud sign, pancreatic and bile duct dilation, distal pancreatic atrophy, cystic degeneration, cystic-solid ratio and CT value of lesion in plain scan (P > 0.05). The independent predictors of pSPN invasion included growth pattern, annular enhancement, capsule, and CT value of lesion in arterial phase. A nomogram model was successfully established to predict the invasion of pSPN. The area under the receiver operating characteristic curve was 0.888, and the calibration prediction curve was in good agreement with the standard curve. ConclusionThe nomogram model based on MSCT features has high application value in preoperative prediction of tumor invasion of pancreatic solid pseudopapillary neoplasms.

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.

Late recurrence of pancreatic solid pseudopapillary neoplasm with peritoneal carcinomatosis: a case-report

Late recurrence of pancreatic solid pseudopapillary neoplasm with peritoneal carcinomatosis: a case-report

Endoscopic Ultrasound in Solid Pseudopapillary Tumor of the Pancreas: About two Clinical Cases

Background: Solid pseudopapillary tumor of the pancreas (SPPT) or Frantz's tumor is a rare exocrine pancreatic tumor, it generally occurs among females within the second or third decade of life. The clinical symptomatology is non-specific, frequently presenting as a slowly growing abdominal mass without any biological abnormalities. The imaging usually shows a well-limited mass with little vascularity. Endoscopic ultrasound (EUS) with fine needle aspiration (FNA) helps the diagnosis. The treatment of these tumors is surgical, and the prognosis is excellent after complete resection. We report two new cases of Frantz tumor, detailing the clinicopathological features of this rare neoplasm. Case presentation: Case 1: A 19-year-old woman presented with middle upper abdominal pain. Computed tomography (CT) scan showed a solitary encapsulated mass in the pancreatic body. Endoscopic ultrasound showed a regular, well-defined, heterogenous lesion, measuring 50 × 46 cm, in the pancreatic body. endoscopic ultrasound fine-needle aspiration was then performed with cytopathological analysis compatible with SPPT. Body computed tomography confirmed the absence of metastases and she underwent a central pancreatectomy. 12 months after the diagnosis, she remains asymptomatic, continuing regular follow-up. Case 2: A 22-year-old woman presented with epigastric pain and weight loss. CT scan revealed a single 5 cm well defined mass in the pancreatic head. EUS showed a well-defined heterogenous hypoechoic encapsulated mass in the pancreatic head, measuring 64 × 44 mm; EUS-FNA was performed and cytopathological analysis was suggestive of SPPT. She underwent conventional cephalic duodenopancreatectomy. She presented septic postoperative complications, with a favorable outcome after medical and surgical therapy. she remains asymptomatic, after 6 months follow-up. Conclusion: Solid pseudo papillary pancreatic tumor is a rare exocrine low-grade neoplasm. EUS is a sensitive tool in the diagnosis of SPPT, identifying and characterizing the pathologic lesions, and allowing EUS-FNA with cytomorphological recognition, making it an invaluable tool for establishing diagnosis, helping clinical management and surgical planning.

Laparoscopic Subtotal Pancreatectomy and Splenectomy for Pancreatic Body Solid Pseudopapillary Tumor: A Case Presentation with Video

Background: Most Pancreatic solid pseudopapillary tumors are asymptomatic and incidentally found by imaging. In some cases, patients may present with nonspecific symptoms, including abdominal discomfort, nausea, vomiting, or pain. Many of these lesions, located frequently in the body or tail of the pancreas, require resection. Aim: My aim is to present a case of young female patient underwent laparoscopic subtotal pancreatectomy and splenectomy for pancreatic solid pseudopapillary tumor located in the pancreatic body, describing the technique along with the post-operative course. Methods and Results: A case of young female patient underwent a laparoscopic subtotal pancreatectomy and splenectomy using a five ports technique and surgical staplers for pancreatic transaction and vascular control. Specimen was retrieved through small Fanestiel incision. The patient had a smooth postoperative course. Specimen came as pancreatic solid pseudotumor tumor. Conclusion: Laparoscopic approach is feasible and safe for subtotal pancreatectomy and splenectomy for pancreatic body tumor resection.

Case Report: Surgical Resection of an Aggressive Pancreatic Solid Pseudopapillary Tumor with Local Advance and Hepatic Metastasis

We are presenting a case of surgical resection of a solid pseudopapillary neoplasm (SPN) of the pancreas with multiple hepatic metastatic neoplasms. SPN is a rare neoplasm with low-grade malignancy usually characterized by a tick-encapsulated mass primarily found in the body and tail of the pancreas. However, in our case, the tumor was located in the head of the pancreas with an invasion of the superior mesenteric vein/portal vein (SMV/PV), along with the presence of multiple hepatic metastases with enlarged retroperitoneal lymph nodes were also observed through radiological examination.

Clinicopathological factors associated with recurrence in patients undergoing resection of pancreatic solid pseudopapillary neoplasm

PurposeSolid pseudopapillary neoplasm (SPN) is an uncommon pathology with a low-grade malignancy. Surgery is the milestone treatment. Nevertheless, despite appropriate management, some patients present recurrence. Risk factors associated with recurrence are unclear. The objective was to identify the clinicopathological factors associated with recurrence in patients with SPN treated with pancreatic resection.MethodsMedical records of patients treated with pancreatic resection during 2006–2020 were evaluated. Patients with histological diagnosis of SPN were included. Survival analysis was performed to identify the clinicopathological factors related to recurrence.ResultsSeventy-four patients were diagnosed with SPN; 70 (94.6%) patients were female, and the median age was 20 years old. The median tumor diameter was 7.9 cm. Multivisceral resection was performed in 9 (12.2%) patients. Four (5.4%) patients presented lymph node metastasis.R0 resection was achieved in all cases. Six (8%) patients presented recurrence and the liver was the most frequent recurrence site (n = 5).After a median follow-up of 40.2 months, 9 (12%) patients died. Five (6.8%) patients died of disease progression. The 1–3- and 5-year overall survival (OS) was 97.1%, 90.2% and 79.9%, respectively. The 1–3-and-5-year recurrence-free survival (RFS) was 98.4%, 89.9% and 87%, respectively. In the univariate Cox-regression analysis, age ≥ 28 years(HR = 8.61, 95% CI 1.1–73.8),tumor diameter ≥ 10 cm(HR = 9.3, 95% CI 1.12–79.6),invasion of adjacent organs (HR = 7.45, 95% CI 1.5–36.9), lymph node metastasis (pN +) (HR = 16.8, 95% CI 2.96–94.9) and, AJCC Stage III (HR = 10.1, 95% CI 1.2–90.9) were identified as predictors for recurrence.ConclusionsSPN is more frequently diagnosed in young women with a good overall prognosis after an R0 surgical resection even with disease recurrence. Age ≥ 28 years, larger tumors ≥ 10 cm, invasion of adjacent organs, lymph node metastasis(pN +) and, AJCC Stage III were predictors factors of recurrence in resected SPN.

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.

How does the pancreatic solid pseudopapillary neoplasm confuse us: Analyzing from the point view of MRI-based radiomics?

ObjectivesTo construct MRI-based radiomics logistic model in differentiating solid pseudopapillary neoplasm (SPN) from three differential diseases containing adenocarcinoma, neuroendocrine tumor (NET), and cystadenoma of pancreas. Materials and methodsA total of 21 SPNs and 140 differential diseases were enrolled. The MRI images of T1WI, T2WI, DWI, and contrast-enhanced (CE) sequences were taken to delineate the volume of interest, and the corresponding radiomics features were calculated. After the preprocess of data balance and image standardize, the data was divided into training set (6 SPNs and 42 differential diseases) and validation set (15 SPNs and 98 differential diseases) with a proportion of 7:3, randomly. Then after feature selection, four MRI-based logistic models included T1WI, T2WI, DWI, CE, and sum logistic models (Log-T1WI, Log-T2WI, Log-DWI, Log-CE, and Log-sum) were established. The receiver operation curve (ROC) was depicted to evaluate the efficacy of each model. ResultsTo the single MRI sequence, the AUCs of Log-T1WI, Log-T2WI, Log-DWI, and Log-CE were similar. Seemingly the AUCs of Log-T2WI were slightly higher with 0. 876 (95%CI, 0.797–0.956) in the training set and 0.853 (95%CI, 0.708–0.998) in the validation set. The Log-sum of four MRI sequences displayed better differentiating efficiency, with AUCs of 0.929 (95%CI, 0.877–0.980) in the training set and 0.925 (95%CI, 0.845–1.000) in the validation set. The Log-Ra/Clin model combined clinical information and radiomics showed the highest AUC of 0.962 (95%CI, 0.919–0.985). ConclusionsMRI-based radiomics analysis helped to discern SPNs from radiologically misdiagnosed adenocarcinoma, neuroendocrine tumor, and cystadenoma of pancreas. The efficacy of single sequence logistic model was similar. The Log-sum combined four sequences and Log-Ra/Clin combined clinical information and radiomics demonstrated the better performance in distinction.

Resection of a recurrent solid pseudopapillary neoplasm of the pancreas after duodenal sparing pancreaticoduodenectomy: A case report.

IntroductionSolid Pseudopapillary Neoplasm (SPN) is a rare pancreatic neoplasm with low malignant potential and a relative indolent course. Complete resection of the SPN is curative for most cases and has a high survival rate. Recurrences, though rare, can still occur despite adequate resection. Pancreaticoduodenectomy is commonly performed to treat pancreatic head SPNs. In recent years, duodenum-preserving pancreatic head resection (DPPHR) has been reported as a less radical and acceptable alternative.Case presentationWe are reporting a case of 26-year old female who presented with a 7 month history of epigastric pain and increasing abdominal girth. She was diagnosed by MRI to have a huge but resectable pancreatic head mass and subsequently underwent duodenum-preserving pancreatic head resection (DPPHR) with pancreaticojejunostomy. Histopathologic examination revealed a solid pseudopapillary tumor (SPN) with lymphovascular invasion and negative margins of resection. The patient underwent hepaticojejunostomy 5 months after resection for biliary stricture. Surveillance imaging revealed tumor recurrence warranting re-exploration for recurrence 3 years after the initial surgery. Intraoperative findings revealed the mass at the distal pancreatic remnant, requiring distal pancreatectomy and splenectomy.DiscussionSolid pseudopapillary neoplasms are rare pancreatic neoplasms. Surgical resection of SPNs affords long term cure with good 5-year survival rates for localized tumors Despite the low malignant potential of SPNs, relapse after resection can still occur.ConclusionComplete local resection of the tumor is the treatment of choice in SPNs. DPPHR should be considered as an alternative in young patients with a localized SPN in the pancreatic head.

Solid-cystic pseudo papillary tumor of the pancreas discovered during presentation of acute appendicitis

to present a rare case of pancreatic pseudo-papillary and solid tumor in children and to make a review of the literature. Solid-pseudo-papillary tumor of the pancreas (TPPS) is infrequently case of neoplasm in children. It is low-grade malignant potential. A 15-year-old boy with a pancreatic solid pseudo papillary tumor (TPPS) is reported, discovered after acute appendicitis. ultrasound and Contrast enhanced computerized tomography (CECT) abdomen revealed acute appendicitis and pancreatic mass centered on the distal pancreas. In the first step, appendectomy was done and the exploration was completed. After few months, distal pancreatectomy with spleen preservation was done. The histopathologic report was a pancreatic solid pseudo papillary tumor without malignant cells. Clinical evolution has been satisfactory without recurrence of the tumor till 10 months of follow-up. the most common clinical presentation is abdominal mass. The treatment is surgical and Distal pancreatectomy offers an excellent prognosis.

Aggressive pancreatic resections for Frantz tumours in a low-volume Caribbean hospital

Background: Frantz tumours are uncommon lesions worldwide and many surgeons would not encounter this lesion commonly throughout their practices. Aims: This study sought to document the therapeutic outcomes after pancreatic resections for Frantz neoplasms in a low-volume, resource-poor setting in the Caribbean. Materials and Methods: Data were retrospectively collected from patients who had pancreatic resections for Frantz tumours in Trinidad and Tobago between 1 June 2012 and 1 July 2017. Results: There were 12 patients with confirmed Frantz tumours, treated by one of four surgeons at a low volume of 0.6 cases per surgeon per year. The patients were all females at a mean age of 24.83 years (standard deviation [SD] ±7.6; Range 8–35; Median 25.5). A Whipple's resection was performed in 1 patient with a pancreatic head lesion, 2 had central pancreatectomies for lesions in the body and 6 had distal pancreatectomies, 2 with splenic preservation. Histologically, clear margins were achieved in all cases and none of the nodes examined contained metastatic disease. Nine (75%) patients had poor prognostic features present on pre-operative computed tomography scans and/or histopathologic examination. The sole complication was a Grade 1 post-operative pancreatic fistula. No deaths were recorded. All patients were alive without disease recurrence after a median of 34 months (Mean 36.75; SD ± 12.8; Range 12–52). Conclusion: Surgeons practicing in the Caribbean treat patients with pancreatic Frantz tumours at minimal volumes, performing aggressive resections with good outcomes. We advocate aggressive surgical resections for pancreatic solid pseudopapillary neoplasms, considering that outcomes are good and 75% of patients have unfavourable radiologic and/or histopathologic features present at the time of diagnosis.

Pancreatic solid pseudopapillary neoplasm: a single-institution study.

Solid pseudopapillary neoplasms (SPNs) are a distinct but rare form of low-grade pancreatic neoplasia, accounting for 0.3%-2.7% of all pancreatic tumours. They are most common in young females. Local recurrence and distant metastasis are reported but extremely rare, and are usually resectable with curative intent. We report the clinicopathological features and long-term outcomes of SPNs following surgical resection from a single institution. A total of 1296 patients undergoing pancreatic resection during the 30 years period from 1991 to 2020 were retrospectively reviewed, and those with a confirmed pathological diagnosis of pancreatic SPN on review were included. Twenty-two patients (1.7% of all patients undergoing resection), were identified. Twenty patients (91%) were female. Unlike previous studies, most patients (91%) were symptomatic at diagnosis. On diagnostic CT, cystic components were visible in 16 patients (73%), calcifications were found in two patients (9%), haemorrhage in one patient (5%) and a defined capsule was seen in four patients (18%). Surgical resection was undertaken on all cases, with distal pancreatectomy the most commonly performed (n= 11, 50%). One patient (4.7%) had nodal involvement, nine patients had an incomplete tumour capsule (41%) and seven patients (32%) had tumour extension into the pancreatic parenchyma. Despite this, no patients had disease recurrence at 10 years. One patient died within 5 years of heart failure unrelated to the SPN process; no patients died within 10 years of the disease. We confirm a high proportion of female patients. Interestingly, a high proportion of our cohort was investigated for symptomatic disease. Despite a high proportion of tumours with an incomplete capsule, and extension into the pancreatic parenchyma, our findings indicated that SPN patients have excellent survival after margin-negative surgical resection.

Prediction of Recurrence of Completely Resected Pancreatic Solid Pseudopapillary Neoplasms in Pediatric Patients: A Single Center Analysis.

Background: Many previous studies have investigated the risk factors for the recurrence of pancreatic solid pseudopapillary neoplasms (SPNs), although a consensus has not yet been reached, despite this effort. We aimed to identify the predictive factors for recurrence in patients with SPNs who underwent complete surgical resection of the tumor. Methods: We retrospectively analyzed the records of pediatric patients with SPNs who underwent surgical resection at a single center between 2001 and 2018. Results: During the study period, 47 patients with SPNs underwent radical resection of the tumor. The median age of the patients was 14 (8–18) years. R0 resection was confirmed in every case and none of the patients presented with systemic metastasis at the time of diagnosis. The median follow-up period was 53.1 (30.8–150.8) months. Of the 47 patients, only two (4.2%) experienced recurrence. Using comparative analysis, we found that some factors such as a large tumor size, peripancreatic tissue invasion, and capsule invasion did not increase the risk of recurrence of SPNs. Lymph node metastasis was the only significant factor for recurrence in our study (p = 0.043). Conclusion: During our single center analysis, we found that only lymph node metastasis was a predictive factor for recurrence of SPNs among patients who underwent complete tumor resection. Long-term follow-up is required to determine whether SPNs will recur if lymph node metastasis is observed after surgery. Furthermore, therapeutic benefits of routine lymphadenectomy or sentinel lymph node biopsy should be investigated in future studies to reduce the risk of recurrence in patients with SPNs.

Development of CT-Based Imaging Signature for Preoperative Prediction of Invasive Behavior in Pancreatic Solid Pseudopapillary Neoplasm.

PurposeIt is challenging for traditional CT signs to predict invasiveness of pancreatic solid pseudopapillary neoplasm (pSPN). We aim to develop and evaluate CT-based radiomics signature to preoperatively predict invasive behavior in pSPN.MethodsEighty-five patients who had pathologically confirmed pSPN and preoperative contrasted-enhanced CT imaging in our hospital were retrospectively analyzed (invasive: 24; non-invasive: 61). 1316 radiomics features were separately extracted from delineated 2D or 3D ROIs in arterial and venous phases. 200% (SMOTE) was used to generate balanced dataset (invasive: 72, non-invasive: 96) for each phase, which was for feature selection and modeling. The model was internally validated in the original dataset. Inter-observer consistency analysis, spearman correlation, univariate analysis, LASSO regression and backward stepwise logical regression were mainly applied to screen the features, and 6 logistic regression models were established based on multi-phase features from 2D or 3D segmentations. The ROC analysis and Delong’s test were mainly used for model assessment and AUC comparison.ResultsIt retained 11, 8, 7 and 7 features to construct 3D-arterial, 3D-venous, 2D-arterial and 2D-venous model. Based on 3D ROIs, the arterial model (AUC: 0.914) performed better than venous (AUC: 0.815) and the arterial-venous combined model was slightly improved (AUC: 0.918). Based on 2D ROIs, the arterial model (AUC: 0.814) performed better than venous (AUC:0.768), while the arterial-venous combined model (AUC:0.893) performed better than any single-phase model. In addition, the 3D arterial model performed better than the best combined 2D model. The Delong’s test showed that the significant difference of model AUC existed in arterial models in original dataset (p = 0.019) while not in arterial-venous combined model (p=0.49) as comparing 2D and 3D ROIs.ConclusionThe arterial radiomics model constructed by 3D-ROI feature is potential to predict the invasiveness of pSPN preoperatively.

Solid Pseudopapillary Neoplasms of the Pancreas: a Single-Center Experience and Review of the Literature.

Pancreatic solid pseudopapillary neoplasms (SPNs) are rare borderline tumours mainly affecting young female patients. The number of patients diagnosed with SPNs has increased significantly in the last decades owing to the increased use of cross-sectional imaging investigating different abdominal symptoms, whilst a significant proportion are incidentally discovered during the process of evaluating other pathologies. We herein present our institutional experience of patients with SPN who underwent curative resection focusing on clinical, pathological features, and the long-term outcomes. All patients undergoing pancreatectomy in our institution for SPN from January 2010 until December 2018 were included. Clinical, perioperative, histological, and long-term outcomes were collected and analysed. During the inclusion period, a total of 19 patients had a pathological diagnosis of SPNs after surgical resection. Sixteen of them were female (84%), while the median patient age was 30 (range 16-66) years. Nine patients (47%) underwent distal pancreatectomy and splenectomy, 2 (11%) underwent spleen preserving distal pancreatectomy, 6 (32%) underwent pancreatoduodenectomy, one (5%) underwent total pancreatectomy, and one (5%) central pancreatectomy. Seventeen patients underwent R0 resection. During a median follow-up of 23months, no tumour recurrence or death was recorded. In our experience, SPNs are rare tumours with low malignant potentials. Surgical resection remains the gold standard treatment and is associated with good prognosis.

Risk factors associated with recurrence of pancreatic solid pseudopapillary neoplasms: a single institution experience

Background: Pancreatic solid pseudopapillary neoplasms are rare and low-grade tumors. The milestone of treatment is surgical resection, however, some patients relapse after surgery. The aim of this study is to analyze the clinical and pathological features associated with increased risk of recurrence in SPN. Methods: Between 2000 and 2019 seventy-four patients with SPN underwent surgical resection and then were followed up periodically. Clinicopathological data were statistically analyzed. Results: Of the 74 total patients, 70 (94.6%) were women and 4 (5.4%) were men. The median age was 25.1 (range, 7-68 years). The median tumor size was 8.7 (range, 2-20 centimeters) and the tumor localization was: head (n= 35), body (n=16) and tail (n= 23). The surgical treatment was: duodenopancreatectomy (n=32), central pancreatectomy (n=9) and distal pancreatectomy (n= 33). For patients with R0 resection, the Kaplan Meier five years survival was 87%. The five-year rate of locoregional tumor recurrence was 6.7%. The presence of larger tumors size (diameter>5cm), perineural invasion, lymph node metastasis, positive margins, and multi-visceral resection were significant factors for locoregional recurrence and cancer-related survival. Conclusions: Factors including a larger tumor size (diameter > 5cm), perineural invasion, lymph node metastasis, positive margins, and multi-visceral resection may increase the risk of recurrence of resected SPNs.

Solid pseudopapillary neoplasm in the pancreatic head with fat replacement of the pancreas

Fat replacement of the pancreas is rare. Obstruction of the main pancreatic duct by a tumor in the head of the pancreas may cause fatty degeneration of the pancreatic parenchyma. We describe the case of a pancreatic solid pseudopapillary neoplasm, associated with fat replacement of the remaining pancreas. A 44-year-old woman presented with epigastric discomfort since one week and was admitted to our hospital. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 4cm sized tumor in the head of the pancreas with calcification and fatty replacement of the parenchyma in the body and tail.

Solid-pseulopapillary tumors: possibilities of preoperative verification

Objective: To determine the possibilities of preoperative verification of pancreatic solid-pseudopapillary tumor (SPPT) on the basis of own experience. Materials and methods: In A.V. Vishnevsky NMRC of Surgery 50 patients with morphologically verified pancreatic SPPT were treated (2005-2019), wemen prevailed (96.0%), average age - 33.6±1.3 years. Preoperatively study: ultrasound, MSCT, MRI. All patients were operated on. Results: There are three types of SPPT MRI-images (Yu C.-C. et al., 2007): 1st - completely solid neoplasms; 2nd - combination of solid sites with hemorrhages; 3rd - extensive hemorrhages and cystic formations. It´s appropriate to apply this classification in the diagnosis of SPPT as a whole. The greatest difficulties caused by the 1st type lesions diagnostics. Ultrasound: it´s almost impossible to differentiate individual microcavities in solid lesion. SPPT is well-vascularized, however, for the lesion up to 3.0 cm, data of bloodflow at DS cann't obtained. MSCT: high indicators of HU in the liquid component of the 1st type are possible, because of the cystic cavities are very small and a “trimmed” solid component can get to the measurement point on CT-scans. MRI makes it possible to identify small liquid lesion gaps and to differentiate their hemorrhagic contents (which is explained by the significant paramagnetic effect of methemoglobin). Preoperative verification: 56.0%. Misdiagnosis (32.0%): neuroendocrine (5), cystic (5), retroperitoneal (3) tumors, adenocarcinoma (2); pseudocyst with hemorrhage (1). Differential diagnosis was made in 12.0%. Conclusion: It's advisable to consider MRI as the method of choice for SPPT diagnosis. Immunohistochemistry is of decisive importance in SPPT diagnosis.