Solid Pseudopapillary Neoplasm of the Pancreas

Excerpt

A-52-year-old female patient was referred to gastroenterology clinic for cystic pancreas lesion which was detected in an outside hospital by abdominal ultrasonography. She had complaints of nausea and vomiting 2 months ago. At admission, the patient was asymptomatic. The patient has medical history of diabetes mellitus, hypertension, and hypertriglyceridemia. Physical examination was unremarkable. Complete blood count and biochemical tests were within normal levels except elevated triglyceride (578 U/mL), glucose (144 mg/dL), and HbA1c (7.5) levels. Abdominal computed tomography scan showed 5 × 4 cm cystic mass lesion with peripheral coarse calcification (Fig. 1a). Pancreatic atrophy and dilatation of the main pancreatic duct was not observed (Fig. 2a). Endoscopic ultrasonography (EUS) revealed solid cystic lesion with calcification around the lesion. Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) cytology was performed by using fanning technique with a 22-gauge needle. Cytology showed single and clusters of uniform neoplastic cells with fine chromatin, some with papillary appearance (Fig. 2b). Modified Whipple resection was performed with the preoperative diagnosis of solid pseudopapillary neoplasm (SPN). Gross examination of the surgical specimen revealed 5 × 5 × 4.5 cm stony hard, well-circumscribed tumor with densely calcified cut section (Fig. 1b) in the pancreatic head. Microscopic examination showed extensive bone formation and calcification throughout the tumor (Fig. 3a, b). Small area of neoplastic tissue displayed uniform cells with secondary hemorrhagic changes (Fig. 3c). Immunohistochemical markers found to be positive for β-catenin, CD10, and vimentin, and negative for chromogranin and synaptophysin.

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