Neoplasia sólida pseudopapilar del páncreas / Solid pseudopapillary tumor of the pancreas

Antecedentes: la neoplasia sólida pseudopapilar (NSSP) del páncreas es un raro tumor pancreático que se da comúnmente en mujeres jóvenes. Por lo general, son poco sintomáticos y el pronóstico es bueno ante cirugía resectiva. Objetivo: describir 6 casos tratados en 3 centros diferentes y hacer una revisión actualizada del tema. Material y métodos: análisis de historias clínicas, biopsias y protocolos quirúrgicos. Período enero de 2014 hasta abril de 2017. Resultados: encontramos 6 casos (5 mujeres y 1 hombre); el promedio de edad fue 39,7 años (rango 28 a 54 años). En 3 casos se trató de hallazgos incidentales. En todos los casos se utlizaron Ecografia y tomografia computarizada (TC) para el diagnóstico y en 2 casos se realizó resonancia magnética (RM). Todos los tumores se encontraron en el cuerpo o la cola del páncreas o en ambos. En 2 cirugías se realizó un abordaje videolaparoscópico; el tempo quirúrgico promedio fue de 91,17 minutos y el promedio de días de hospitalización fue de 5,5, con 3 pacientes que reingresaron por complicaciones durante el posoperatorio (un absceso y 2 fistulas pancreáticas). Conclusiones: se trata de tumores poco frecuentes; sin embargo, creemos que el avance en métodos por imágenes permitrá aumentar el diagnóstico y tratamiento de esta patología por lo que su incidencia aumentará. Queremos destacar la importancia del abordaje videolaparoscópico para este tpo de patología, ya que en la mayoría de los casos resulta factible con buenos resultados. Estas cirugías deben realizarse en centros donde puedan manejarse sus complicaciones para evitar reintervenciones.

Background: Solid Pseudopapillary Neoplasia (NSSP) pancreas is a rare pancreatic tumor commonly found in young women. They are usually not very symptomatic and the prognosis is good in resective surgery. Objective: to describe 6 cases from 3 diferent centers and to make an updated review of the topic. Materials and methods: analysis of clinical histories, biopsies and surgical protocols. Period from January 2014 to April 2017. Results: we found 6 cases, with 5 women and 1 male; the mean age was 39.7 years (range 28 to 54 years). In 3 cases we dealt with incidental findings. In all cases, echography and CAT were used for the diagnosis and in 2 cases, MRI was performed. All tumors were found in the body and / or tail of the pancreas. In 2 surgeries a videolaparoscopic approach was performed, the mean surgical tme was 91.17 minutes and the mean number of days of hospitalizaton was 5.5, with 3 patents reentered for postoperative complicatons (one abscess and two pancreatic fistulas). Conclusions: these tumors are rare; however we believe that the advances in imaging methods will increase the diagnosis and treatment of this pathology so that its incidence will increase. We want to emphasize the importance of the videolaparoscopic approach for this type of pathology since in most cases it is feasible with good results. These surgeries should be performed in a center where their complicatons can be managed to avoid reinterventons.

Pathologic Features of Pancreatic Cystic Neoplasms / 대한내과학회지

Pancreatic cystic lesions are being recognized with increasing frequency due to the development of imaging technologies. Pancreatic cystic lesions can be divided into neoplasms and non-neoplasms, and neoplasms can be further categorized as epithelial and non-epithelial tumors depending on the cells of origin. A significant percentage of pancreatic cystic neoplasms have malignant potential and surgical resection is mandatory. To make the proper decision regarding the management of pancreatic cystic neoplasms, it is important to understand the clinicopathologic features of these tumors.

Overview of cystic lesion of the pancreas / 대한내과학회지

Cystic lesions of the pancreas have been detected more frequently than before because of the development of imaging technologies. Pancreas cysts can be divided into neoplastic or non-neoplastic and neoplastic cyst can be categorized as potentially malignant or non-malignant. Cystic lesion that contains mucinous material has malignant potential. Some factors that can predict the presence of malignant tissue has been identified. Serous neoplasm, congenital cysts and pseudocyst do not have malignant potential. Solid pseudopapillary tumor or endocrine tumor can undergo cystic degeneration and also have malignant potential of low level.

Clear-cell variant of solid-pseudopapillary neoplasm of the pancreas: a case report and review of the literature

Solid-pseudopapillary neoplasm (SPN) of the pancreas is a rare neoplasm reported to have a favourable prognosis because of its slow-growing behaviour. Ignored and misdiagnosed in the past, SPN has recently been increasingly studied. Its clear cell variant creates challenges in distinction from other clear cell tumours in the pancreas. We report a 31-year-old Cambodian woman who presented with abdominal pain and a palpable epigastric mass. Exploratory laparotomy revealed a 5.2 cm well-demarcated tumour in the head of the pancreas, which was treated with Whipple procedure. Microscopically, the tumour showed an extensive solid growth pattern consisting of cells with abundant clear cytoplasm, and papillary areas containing cells with eosinophilic cytoplasm, indicating a clear-cell solid-papillary neoplasm. Perineural and duodenal wall invasion was present. The tumour cells were immunonegative for chromogranin-A and synaptophysin but positive for CD56, cyclin D1, CD10, vimentin, and progesterone receptor. They showed strong nuclear and cytoplasmic expression and reduced membranous expression of beta-catenin protein. In the pseudopapillary area, they showed nuclear E-cadherin localization and absence of membranous staining. The patient was well without local recurrence or metastasis at one year follow-up. Diffi culties are recognized in differentiating clear-cell SPN from “sugar” tumours, metastatic renal cell carcinoma, clear-cell variant of pancreatic endocrine neoplasm and ductal adenocarcinoma. When facing such diffi culties, nuclear and cytoplamic beta-catenin, nuclear E-cadherin expressions and absence of membranous E-cadherin staining are useful in differentiating clear-cell SPN from other clear cell tumours in the pancreas. Although a rare neoplasm, it is important to recognize this entity for appropriate management.

Postpartum incidental solid pseudopapillary tumor of the pancreas: case report

Solid pseudopapillary tumors of the pancreas are usually described as rare lesionswith low malignant potential and unpredictable behavior. The prognosis may be favorableeven with local or distant dissemination. Despite the steady increase of cases diagnosed,the pathogenesis of this neoplasm remains unclear. We present a case of an incidentaltumor discovered because of an acute abdomen in a postpartum woman without previousevidence of a tumor during the pregnancy.