Maimonides Medical Center Brooklyn, NY, United States
Sarthak Kulshreshtha, , Shmuel Golfeyz, MD, Stanley Yakubov, MD, Sasis Sirikanjanpong, MD, Meredith E. Pittman, MD, Jeffrey F. Lipton, MD, Danny A. Sherwinter, MD, Dmitriy O. Khodorskiy, MD Maimonides Medical Center, Brooklyn, NY
Introduction: Solid pseudopapillary neoplasm (SPN) of the pancreas is an encapsulated exocrine tumor with low malignant potential. It is typically diagnosed as an incidental finding on abdominal imaging. We present a case of a large solid pseudopapillary tumor of the pancreas which was felt to be adenocarcinoma versus focal lymphoma versus pseudocyst.
Case Description/Methods: Patient is a 40 year old African American woman with no significant past medical history who underwent an abdominal CT scan for further evaluation of abdominal pain. Of note, patient denies prior episode(s) of pancreatitis. She was found to have a 16.5 x 14.0 x 10.4 cm soft tissue non-calcified heterogeneous predominantly solid mass density with lobulated borders in the left upper abdomen possibly originating from tail/distal body region with displacement of mid-portion of pancreas body region, stomach and small/large bowel loops. The patient was referred for endoscopic ultrasonography (EUS) which revealed a 10.4 x 8.63 cm heterogeneous and hypoechoic peripancreatic lesion with well-defined borders and a 2.92 x 5.06 cm anechoic compartment, consistent with a cystic component. EUS-guided fine needle biopsy of the solid component was performed. Beta-catenin immunostaining revealed nuclear and cytoplasmic expression. The morphologic and immunophenotypic features were consistent with diagnosis of SPN. The patient underwent an open exploratory laparotomy with distal pancreatectomy. Final pathology confirmed SPN confined to the pancreas with negative resection margins and without lymphovascular or perineural invasion.
Discussion: SPN of the pancreas is a rare exocrine pancreatic tumor with high incidence in young females, typically of Asian and African American descent. The histogenesis of this tumor is unclear but may be of ductal, endocrine, and/or acinar origin. Typical radiographic appearance is a hyper-vascular well-encapsulated lesion. Although typically an incidental finding SPNs can rarely present with signs of biliary obstruction. While usually benign, 15% of SPNs have malignant potential with invasion of nearby structures, with majority of these tumors having high proliferative rate (Ki-67 > 4%). Various studies have indicated that liver and omentum are the usual sites of metastasis. Overall, SPNs have a good prognosis, even if metastatic, and can be treated via curative surgically resected. As these tumors are infrequent, it is imperative to keep a high index of suspicion when an incidental pancreatic lesion is identified.
Figure: A. EUS depicting large pancreatic lesion with cystic component B. Microscopic Appearance of SPN: Bland epithelial cells arranged around-cores. Tumor cells do not show cellular atypia or mitotic activity C. Microscopic Appearance of SPN: Tumor (Green Arrow) with adjacent normal pancreas (Red Arrow)
Disclosures: Sarthak Kulshreshtha indicated no relevant financial relationships. Shmuel Golfeyz indicated no relevant financial relationships. Stanley Yakubov indicated no relevant financial relationships. Sasis Sirikanjanpong indicated no relevant financial relationships. Meredith Pittman indicated no relevant financial relationships. Jeffrey Lipton indicated no relevant financial relationships. Danny Sherwinter indicated no relevant financial relationships. Dmitriy Khodorskiy indicated no relevant financial relationships.
Sarthak Kulshreshtha, , Shmuel Golfeyz, MD, Stanley Yakubov, MD, Sasis Sirikanjanpong, MD, Meredith E. Pittman, MD, Jeffrey F. Lipton, MD, Danny A. Sherwinter, MD, Dmitriy O. Khodorskiy, MD. P2165 - A Rare Case of Solid Pseudopapillary Neoplasm of the Pancreas, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.