Solid and Papillary Epithelial Neoplasms of the Pancreas / 한국간담췌외과학회지

BACKGROUND: Solid and papillary epithelial neoplasm(SPEN) of the pancreas is a rare tumor with low grade malignant potential and usually found in young female patients. The prognosis of this lesion is reported to be much more favorable than other pancreatic neoplasms. METHODS: We report four cases of SPENs of the pancreas treated at the department of surgery, Keimyung University Dongsan Medical Center. Three were women and one was a man and their mean age at the time of surgery was 19 years with the ranges between 11 and 29 years of age. Two patients were admitted with a palpable abdominal mass and another two patients with abdominal pain. Results of laboratory studies including serum amylases and tumor markers were all within normal limits. Diagnosis was made preoperatively in three patients by MRI and needle biopsies. Tumors were located in the head portion in three patients and in the body of the pancreas in one patient. RESULTS: All patients underwent complete resection which involved three enucleations and one pancreaticoduodenectomy. All patients are alive at the time of this report with mean follow up period of 69.5 month (the ranges between 8 and 105 months) without evidence of recurrence. CONCLUSION: In our experience, complete resection of this neoplasm is the treatment of choice and the prognosis is excellent.

A Case of a Solid and Papillary Epithelial Neoplasm of the Pancreas with Local Invasion into the Duodenum / 대한소화기내시경학회지

A solid and papillary epithelial neoplasm of the pancreas is a very rare and low-grade type of malignancy, although an increasing number of cases have been reported in recent years. Patients with a solid and papillary epithelial neoplasm of the pancreas have a good prognosis and may be cured if the disease is diagnosed before metastasis and diffuse local invasion. A 23-year-old female who had a 4-year history of recurrent abdominal pain, was admitted due to lower abdominal pain. Incidentally a calcified, 6 4 cm sized ovoid mass was found in the right upper quadrant, from a simple abdominal X-ray. An ERCP, abdominal sonography, and CT were performed, as well as a pylorus preserving pancreatoduodenectomy. Gross pathologic examination revealed a well encapsulated mass with cystic degeneration and hemorrhagic necrosis. Microscopically, the tumor had papillary fronds with a fibrovascular connective tissue core. There was focal infiltration of tumor cells into the duodenal wall and heterotropic pancreatic tissue in the submucosa. Immunohistochemistry revealed positivity for neuron-specific enolase. The patient maintained a healthy status for one year since the operation.

Solid and Papillary Epithelial Neoplasm of the Pancreas in Children

Six children with solid and papillary epithelial neoplasm of the pancreas were studied retrospective manner. There were 2 boys and 4 girls in this series. The mean age at operation was 11 years (range, 8 to 13 years). There were three incidental abdominal masses, two nontender abdominal masses and one tender abdominal mass. The size ranged from 6.5x6.0cm to 10.5x8.0cm. Five tumors were located in the head of pancreas, whereas one tumor was in the tail of pancreas. On exploration, all patients had no local invasion or metastasis. All patients underwent complete resection, which included three pylorus-preserving pancreaticoduodenectomy, two Whipple's operation and one distal pancreatectomy. All patients had the characteristic histologic pattern of a solid and papillary epithelial neoplasm of the pancreas. All patients are alive with a mean follow up of 5.0 years (range, 0.5 to 12.0 years) without recurrence. Compare to the adult, solid and papillary epithelial neoplasm of the pancreas in children had a slight higher incidence in male. We speculate that this tumor have the characteristic of low-grade malignancy. So complete resection is the treatment of choice for the neoplasm arising anywhere in the pancreas.