Diagnosis and treatment of solid-pseudopapillary tumors of the pancreas: A single institution experience with 97 cases

doi:10.1016/j.pan.2017.12.012

Pancreatology

Volume 18, Issue 4, June 2018, Pages 415-419

https://doi.org/10.1016/j.pan.2017.12.012 Get rights and content

Abstract

Background/objectives

We evaluated the diagnoses and surgical management of solid pseudopapillary tumors of the pancreas (SPTP) in a single center setting.

Methods

Demographic details, clinical presentations, imaging features, surgical strategies, and pathological findings of 97 consecutive patients who underwent surgery for pathologically confirmed SPTP between 2008 and 2016 were analyzed retrospectively.

Results

A total of 97 patients with SPTP accounted for 2.15% of total pancreatic surgeries (N = 4508). The mean age at diagnosis was 31.6 ± 13.92 years (range: 7–83 years), and males:females were 85:12. Chief complaints were abdominal pain or discomfort (n = 50). The mean transverse tumor diameter was 53.2 ± 2.76 mm (range: 14–170 mm). Tumors were localized to the pancreatic head (38.1%; 37/97), neck (12.4%; 12/97), body and tail (49.5%; 48/97). There were no significant differences in age of onset, presenting symptoms, and sites between males and females. A significant difference was found in the maximum diameter of SPTP across different age groups. Partial pancreatectomy was performed for patient with tumor ≥ 5 cm, and enucleation was performed when tumor was smaller than 5 cm. Pancreatic fistula was the main complication. Immunohistochemical markers for endocrine, exocrine and epithelial factors were used for a final diagnosis. During a median follow-up of 54 months (range: 7–121 months), 84 patients were alive without evidence of recurrence, and 13 patients were lost to follow-up.

Conclusion

SPTP surgical resection is a safe procedure with low morbidity and mortality, which is also effective even in the presence of invasiveness and metastases. Accurate initial diagnoses and follow up are essential.

Introduction

Solid pseudopapillary tumors of the pancreas (SPTP) are indolent, low-grade malignancies, representing only 1–2% of pancreatic neoplasms [1]. Recently, more cases of SPTP are being reported [[2], [3], [4]]. So a better understanding of diagnosis and prognosis is needed. To address this, we retrospectively analyzed clinical manifestations, surgical approaches, outcomes, and pathologic findings for 97 consecutive cases of SPTP diagnosed and treated from May 2008 to May 2016 at the Pancreas Center of Nanjing Medical University.

Section snippets

Patient population

Patients with SPTP (N = 97) at the Pancreas Center of Nanjing Medical University between May 2008 and May 2016 were included in this study. Diagnoses were confirmed by two senior pathologists using surgical specimens. Demographic data, clinical presentations, pathological features, surgical approaches and outcomes were obtained from medical records.

Operative procedures

Surgery for all cases in the series was performed by pancreatic surgeons at our center. The indication for surgery was either a clinical/imaging

Results

From May 2008 to May 2016, a total of 97 patients were confirmed to have SPTP and underwent surgical treatment at our center. Table 1 depicts patient data. CT was used for most imaging (n = 82) and MRI (n = 23) was the second most common imaging approach. The typical CT appearance of SPTP was a well-circumscribed tumor with a peripheral capsule containing areas of hemorrhage and necrotic changes, and this appeared in most cases. Abdominal CT demonstrated purely cystic (n = 16), solid-cystic

Discussion

SPTP is a rare tumor of the pancreas, accounting for 1–2% of pancreatic neoplasms [1]. First described by Frantz in 1959, these lesions are referred to as Gruber-Frantz tumors as well as “solid and cystic tumors”, “solid cystic and papillary epithelial neoplasms” and “solid and papillary tumors” prior to being defined by the World Health Organization in 1996 as a SPTP.

Previously, it was reported that ∼70–90% of patients present with symptoms [6,7]. In our study, 39.2% of tumors were discovered

Conflict of interest

No conflict of interest.

Authors' contributions

Study conceptualization and design: Miao, Wang, Wei; Data acquisition: Wei, Wang, Xu, Chen; Data analysis and interpretation: Miao, Gao, Jiang, Wu, Wei, Wang, Chen; Manuscript drafting: Wu, Wei, Wang, Xu; Critical revision of manuscript: Wei, Wang.

Acknowledgements

This work was supported by grants of Nature Science Foundation of China (No.81272239, No.30972912) and the Special Research Fund For Public Welfare Industry of Health of China (201202007).

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Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare pancreatic tumor, usually affecting young females. It is categorized as a low-grade malignant tumor without any specific epithelial differentiation, which can occur anywhere in the pancreas.
Here, we present the case of a 35-year-old lady who presented to us with abdominal pain and a pancreatic mass. She had a prior laparotomy at a different center without any specific intervention for the lump. After presenting to our center, she was managed through proper evaluation and adequate preparation for surgery. The diagnosis was challenging, and so was the surgery. We had enucleated the lesion completely. Histopathology confirmed the diagnosis of SPN. There are no signs of recurrence after two years.
Patients are either asymptomatic or usually present with abdominal pain, a large abdominal lump, or some vague symptoms. A high index of suspicion is the key to diagnosis. Complete resection is the gold standard of treatment. Enucleation is also a good option in difficult cases. The prognosis after surgery is excellent.
Total enucleation of the SPN of the pancreas is a reasonable alternative in selected cases when performed by experienced hepatobiliary-pancreatic surgeons.
Minimally-invasive versus open pancreatic enucleation: systematic review and metanalysis of short-term outcomes
2023, HPB
Minimally Invasive Pancreatic Enucleation, either laparoscopic or robot-assisted, is rarely performed. The aim of this study was to offer the current available evidence about the outcomes of minimally invasive pancreatic enucleations and explore the possible advantage of this approach over traditional surgery.
PubMed (MEDLINE), Cochrane Library and Embase (ELSEVIER) medical databases were searched for articles published from January 1990 to March 2022. Studies which included more than 10 cases of minimally-invasive pancreatic enucleation were included. Data on the outcomes were synthetized and meta-analyzed when appropriate.
Twenty studies published between 2009 and 2022 with a total of 552 patients were included in the systematic review: three hundred fifty-one patients (63.5%) had a laparoscopic intervention, two hundred and one (36.5%) robot-assisted with a cumulative incidence of conversion rate of 5%.
Minimally-invasive surgery was performed in 63% of cases on the body/tail of the Pancreas and in 37% of the cases on the head/uncinate process of the Pancreas. The cumulative post-operative 30 days - mortality rate was 0.2% and the major postoperative morbidity (Clavien-Dindo III-IV-V) 35%. Clinically relevant pancreatic fistula was observed in 17% of the patients.
Compared with the standardized open approach (n: 366 patients), mean length of hospital stay was significantly reduced in patients undergoing minimally invasive pancreatic enucleation (2.45 days, p = 0.003) with a favorable trend for post-operative major morbidity (Clavien-Dindo III-IV) (- 24% RR, p: 0.13). Operative time, blood loss and clinically relevant pancreatic fistula rate were comparable between the two groups. One hundred and fourteen robot-assisted enucleations entered in a subgroup analysis with comparable results to open surgery.
Minimally-Invasive approach for pancreatic enucleation is safe, feasible and offers short-term clinical outcomes comparable with open surgery. The potential benefit of robotic surgery will need to be verified in further studies.
Histogram array and convolutional neural network of DWI for differentiating pancreatic ductal adenocarcinomas from solid pseudopapillary neoplasms and neuroendocrine neoplasms
2023, Clinical Imaging
This study aimed to investigate the diagnostic performance of the histogram array and convolutional neural network (CNN) based on diffusion-weighted imaging (DWI) with multiple b-values under magnetic resonance imaging (MRI) to distinguish pancreatic ductal adenocarcinomas (PDACs) from solid pseudopapillary neoplasms (SPNs) and pancreatic neuroendocrine neoplasms (PNENs).
This retrospective study consisted of patients diagnosed with PDACs (n = 132), PNENs (n = 45) and SPNs (n = 54). All patients underwent 3.0-T MRI including DWI with 10 b values. The regions of interest (ROIs) of pancreatic tumor were manually drawn using ITK-SNAP software, which included entire tumor at DWI (b = 1500 s/m²). The histogram array was obtained through the ROIs from multiple b-value data. PyTorch (version 1.11) was used to construct a CNN classifier to categorize the histogram array into PDACs, PNENs or SPNs.
The area under the curves (AUCs) of the histogram array and the CNN model for differentiating PDACs from PNENs and SPNs were 0.896, 0.846, and 0.839 in the training, validation and testing cohorts, respectively. The accuracy, sensitivity and specificity were 90.22%, 96.23%, and 82.05% in the training cohort, 84.78%, 96.15%, and 70.0% in the validation cohort, and 81.72%, 90.57%, and 70.0% in the testing cohort. The performance of CNN with AUC of 0.865 for this differentiation was significantly higher than that of f with AUC = 0.755 (P = 0.0057) and α with AUC = 0.776 (P = 0.0278) in all patients.
The histogram array and CNN based on DWI data with multiple b-values using MRI provided an accurate diagnostic performance to differentiate PDACs from PNENs and SPNs.
Solid pseudopapillary tumor of the pancreas: A systematic review of clinical, surgical and oncological characteristics of 1384 patients underwent pancreatic surgery
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Pancreatic solid pseudopapillary tumors (SPTs) are rare clinical entity, with low malignancy and still unclear pathogenesis. They account for less than 2% of exocrine pancreatic neoplasms. This study aimed to perform a systematic review of the main clinical, surgical and oncological characteristics of pancreatic SPTs.
MEDLINE/PubMed, Web of Science and Scopus databases were systematically searched for the main clinical, surgical and oncological characteristics of pancreatic SPTs up to April 2021, in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) standards. Primary endpoints were to analyze treatments and oncological outcomes.
A total of 823 studies were recorded, 86 studies underwent full-text reviews and 28 met inclusion criteria. Overall, 1384 patients underwent pancreatic surgery. Mean age was 30 years and 1181 patients (85.3%) were female. The most common clinical presentation was non-specific abdominal pain (52.6% of cases). Mean overall survival was 98.1%. Mean recurrence rate was 2.8%. Mean follow-up was 4.2 years.
Pancreatic SPTs are rare, and predominantly affect young women with unclear pathogenesis. Radical resection is the gold standard of treatment achieving good oncological impact and a favorable prognosis in a yearly life-long follow-up.
Non-gaussian models of 3-Tesla diffusion-weighted MRI for the differentiation of pancreatic ductal adenocarcinomas from neuroendocrine tumors and solid pseudopapillary neoplasms
2021, Magnetic Resonance Imaging
Citation Excerpt :
Surgery is the only cure, with a postoperative 5-year survival rate of 10%–20% [3]. Compared with PDACs, PNETs and SPNs have a relatively favorable prognosis, lower mortality rates, and higher resectability rates [4,5]. The therapeutic strategies differ significantly between PDACs, and SPNs and PNETs.
To assess the MRI performance in differentiating pancreatic ductal adenocarcinomas (PDACs), from solid pseudopapillary neoplasms (SPNs) and pancreatic neuroendocrine tumors (PNETs) using non-gaussian diffusion-weighted imaging models.
This was a retrospective study of patients diagnosed with PDACs (01/2015–06/2019) or with PNETs or SPNs diagnosed (01/2011–12/2019) at our hospital. The lesions were randomized 1:1 to the primary and validation cohorts. The regions of interest (ROIs) were manually drawn on each slice at DWI (b = 1500 s/mm²) from 3 T MRI. D (diffusion coefficient), D* (pseudodiffusion coefficient), f (perfusion fraction), distributed diffusion coefficient (DDC), α (diffusion heterogeneity index), mean diffusivity (MD) and mean kurtosis (MK) were obtained. The parameters with largest performance for differentiation were used to establish a diagnostic model.
There were 148, 56, and 60 patients with PDAC, PNET, and SPN, respectively. For differentiating PDACs from SPNs, f and MK values were used to establish a diagnostic model with areas under the receiver operating characteristic curves (AUCs) of 0.92 and 0.89 in the primary and validation groups, respectively. For distinguishing PDACs from PNETs, α and MK values were used to establish a diagnostic model with AUCs of 0.87 and 0.86 in the primary and validation groups, respectively. The accuracy rate of the subjective evaluation with the assistance of non-gaussian DWI models for differentiating PDAC from SPNs and PNETs were higher than that of subjective diagnosis alone (P < 0.05).
The non-gaussian DWI models could assist radiologists in accurately differentiating PDACs from PNETs and SPNs.
answer for the “Diagnosis and staging of solid pseudopapillary neoplasms of the pancreas: the role of 18 1 F-FDG PET/CT scan”
2018, Pancreatology

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¹: Peng Wang and Jishu Wei contributed equally this study.

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Diagnosis and treatment of solid-pseudopapillary tumors of the pancreas: A single institution experience with 97 cases

Abstract

Background/objectives

Methods

Results

Conclusion

Introduction

Section snippets

Patient population

Operative procedures

Results

Discussion

Conflict of interest

Authors' contributions

Acknowledgements

J Am Coll Surg

Surgery

J Am Coll Surg

Am J Surg

Surgery

Ann Diagn Pathol

HPB (Oxford)

Surgery

Ann Diagn Pathol

Eur J Surg Oncol

Hum Pathol

Lancet Oncol

J Gastrointest Surg

Surgical and molecular pathology of pancreatic neoplasms

Diagn Pathol