Pseudopapillary Tumor: Still a Possibility in Old Age 1368

• Published in: The American journal of gastroenterology Vol. 113; no. Supplement; p. S785
• Main Authors: Amjad, Waseem, Khalil, Anish, Lodhi, Hanan T., Hussain, Qulsoom, Inayat, Faisal, Ilyas, Ghulam, Munir, Ahmed, Ullah, Waqas, Zafar, Fahad
• Format: Journal Article
• Language: English
• Published: New York Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01-10-2018
• Subjects: Abdomen; Females; Gastroenterology; Metastasis; Pancreas; Tumors
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/00000434-201810001-01368

Solid pseudopapillary tumor (SPT) of the pancreas is a rare neoplasm that was first described by Franz in 1959. They tumor is characterized by a large, solitary, well-encapsulated mass on abdominal imaging. The mainstay of treatment is complete surgical resection which is curative in most cases. The following is an unusual presentation of SPT of the pancreas in an elderly female patient. A 71 year-old female with diabetes mellitus presented with epigastric pain for 1 month, loss of appetite, and 40 pound weight loss. An initial CT of the abdomen showed a 1.0 cm x 0.8 cm hypoenhancing mass in the pancreatic body with pancreatic duct dilatation (Image 1). She eventually underwent EUS which revealed a 2.6 x 2.3 cm hypoechoic lesion in the pancreatic body along with a dilated pancreatic duct in the neck, body, and tail up to 6.8 mm (Image 2). Fine needle aspiration (FNA) showed sheets of tumor cells with papillary architecture (Image 3). Immunohistochemical analysis was consistent with SPT. The tumor was removed surgically. Patient was followed for 6 months without complications. SPT of the pancreas is a rare exocrine tumor accounting for 1-2% of all pancreatic tumors. Law JK and colleagues study showed that the tumor is more common in females, mean age is 28.5 years and mean size is 8.6 cm. The most common symptom was non-specific abdominal pain in 63.6% and incidentally detected in 38.1%. SPTs are regarded as low-grade malignant potential tumors, though up to 9-15% of patients can present with local invasion or metastasis with the liver and omentum being the most common metastatic sites. CT is the primary imaging modality used to evaluate SPT with the typical appearance being a mixed-density lesion with a solid component peripherally and cystic component centrally. These tumors typically displace adjacent structures rather than invade them and peripheral calcification can be seen in 30% of cases. Characteristic appearance of a heterogeneous, mixed solid, or cystic hypoechoic lesion can be seen on endoscopic ultrasound (EUS). The addition of FNA significantly increases the diagnostic yield of SPT to 82.4% when compared with either CT or CT and EUS. Surgical resection is the treatment of choice, even in the case of distant hepatic metastasis or local recurrence and has an overall 5-year survival rate of 95%. Solid pseudopapillary tumor is rarely seen in old age. The tumor has low malignant potential. Surgical resection is considered treatment of choice.