RESUMO
The solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas is a relatively uncommon entity. The aim of the present study was to summarize our experiences with regard to diagnostic dilemma, surgery, postoperative follow-up, and management. This retrospective data were collected during the period from January 1, 2018 to December 31, 2020. A total of four patients (three females and one male) were identified within an age range of 13 to 25 years. All the patients were presented with nonspecific symptoms such as abdomen lumps, swelling in the abdomen, and abdominal pain. To reach a definite diagnosis, imaging studies were conducted along with endoscopic ultrasound fine-needle aspiration (EUS-FNA) and biopsy. After confirmation of SPEN on biopsy, all the patients underwent surgery without any complications. Patients are on follow-up, and to date, no metastasis has been detected. SPEN is a rare pancreatic tumor with unusual pathological features leading to a diagnostic dilemma. The pathologist should be familiar with SPEN and its salient histological characteristics that differentiate it from other look-alike pancreatic tumors and can help in timely surgery and management.
RESUMO
Nosotros reportamos un caso de neoplasia sólida pseudopapilar de páncreas en una mujer de 35 años. Ella refirió haber iniciado desde hace tres meses una enfermedad progresiva caracterizada por dolor epigástrico y baja de peso. En el examen físico solo mostró dolor moderado a la palpación profunda de mesogastrio, no se palpó alguna masa abdominal. Los exámenes auxiliares mostraron hemoglobina 13.3gr; leucocitos, plaquetas, perfil de coagulación, bioquímica, electrolitos, albúmina, globulinas, bilirrubinas, transaminasas y fosfatasa alcalina fueron normales. Examen de orina: leucocitos 14-16 por campo, urocultivo: negativo, Ca 19.9: 21.2 (0-37). Arco V (anticuerpos IgG E. granulosus):, 17.3 (nivel dudoso), Inmunoblot quiste hidatídico: negativo. La ecografía abdominal mostro entre cuerpo y cola de páncreas una imagen hipoecogénica de aspecto sólido. En la tomografía abdominal se detectó en el cuerpo del páncreas la presencia de dos nódulos hipodensos con densidad promedio de 25 U.H. y que medían 50 y 22 mm de diámetro. Las imágenes por resonancia magnetica nuclear determinaron en el cuerpo del páncreas un quiste bilobulado de 45 y 25 mm de diámetro, con isointensidad en T1, hiperintensidad en T2, sin cambios tras la saturación grasa, con realce periférico por el contraste. Intervenida quirúrgicamente, se encontró una tumoración quística en el cuerpo del páncreas; sin signos de infiltración a otros órganos. Se realizó pancreatectomía distal y esplenectomía. La tumoración era ovalada y medía 60x46x35 mm, encapsulada, de consistencia irregular, que al corte dejaba fluir material de aspecto necrótico. El estudio histológico demostró el típico patrón pseudopapilar con estroma perivascular hialinizado; en los estudios de inmunohistoquimica se observo inmunoreactividad positiva a ciclina D1 y al receptor de progesterona; también hubo positividad para vimentina, enolasa neuronoespecífica y CD-56...
We report a case of solid and papillary epithelial neoplasm of the pancreas in a 35-year-old female. She presented with epigastric pain and weight loss, these symptoms developed 3 months before. Physical examination revealed mild pain on deep palpation of mesogastrium, without palpable abdominal mass; rest of the examination was normal. The laboratory data showed hemoglobin 13.3gr/dl; WBC, platelets, blood coagulation test, blood biochemistry, electrolytes, liver function test were normals. Urine test: 14-16 leukocytes per field, urocultive negative, Ca 19.9: 21.2 (0-37). Her serology for hydatic cyst (arc V and inmunoblot) was negative. Abdominal ultrasound showed between body and tail of the pancreas a solid hypoechoic image. In abdominal CT was detected in the body of the pancreas the presence of two hypodense lesions with average density of 25 UH and mediate 50 and 22 mm in diameter. The nuclear magnetic resonance imaging identified the body of the pancreas, bilobed cyst of 45 and 25 mm in diameter, with isointensity in T1, hyperintensity in T2, unchanged after fat saturation, with peripheral contrast enhancement. Operation findings showed a cystic tumor in the body of pancreas without signs of infiltration to other organs. Therefore, distal pancreatectomy and splenectomy were carried out. The tumor was 60x46x35 mm and a half oval, encapsulated, irregular consistency, which the court left necrotic-looking material flow. The study showed the pattern typical hyalinized perivascular pseudopapillary with stroma, in immunohistochemical studies positive imunoreactivity was observed in cyclin D1 and progesterone receptor, also were positive for vimentin, enolase neuronoespecífica and CD-56. The proliferation index assessed by Ki-67 was less than 1% in tumor cells...