Resection of a recurrent solid pseudopapillary neoplasm of the pancreas after duodenal sparing pancreaticoduodenectomy: A case report

Anthony Perez; Crisostomo Arcilla Jr; Maria Raisa Katrina Fontanilla; Apolinario Ericson Berberabe

doi:10.1016/j.ijscr.2021.106526

Resection of a recurrent solid pseudopapillary neoplasm of the pancreas after duodenal sparing pancreaticoduodenectomy: A case report

Int J Surg Case Rep. 2021 Nov:88:106526. doi: 10.1016/j.ijscr.2021.106526. Epub 2021 Oct 18.

Authors

Anthony Perez¹, Crisostomo Arcilla Jr², Maria Raisa Katrina Fontanilla³, Apolinario Ericson Berberabe²

Affiliations

¹ University of the Philippines Manila College of Medicine, Department of Surgery, Philippines; Manila Doctors Hospital, Philippines. Electronic address: Arperez1@up.edu.ph.
² University of the Philippines Manila College of Medicine, Department of Surgery, Philippines; Manila Doctors Hospital, Philippines.
³ Manila Doctors Hospital, Philippines.

Abstract

Introduction: Solid Pseudopapillary Neoplasm (SPN) is a rare pancreatic neoplasm with low malignant potential and a relative indolent course. Complete resection of the SPN is curative for most cases and has a high survival rate. Recurrences, though rare, can still occur despite adequate resection. Pancreaticoduodenectomy is commonly performed to treat pancreatic head SPNs. In recent years, duodenum-preserving pancreatic head resection (DPPHR) has been reported as a less radical and acceptable alternative.

Case presentation: We are reporting a case of 26-year old female who presented with a 7 month history of epigastric pain and increasing abdominal girth. She was diagnosed by MRI to have a huge but resectable pancreatic head mass and subsequently underwent duodenum-preserving pancreatic head resection (DPPHR) with pancreaticojejunostomy. Histopathologic examination revealed a solid pseudopapillary tumor (SPN) with lymphovascular invasion and negative margins of resection. The patient underwent hepaticojejunostomy 5 months after resection for biliary stricture. Surveillance imaging revealed tumor recurrence warranting re-exploration for recurrence 3 years after the initial surgery. Intraoperative findings revealed the mass at the distal pancreatic remnant, requiring distal pancreatectomy and splenectomy.

Discussion: Solid pseudopapillary neoplasms are rare pancreatic neoplasms. Surgical resection of SPNs affords long term cure with good 5-year survival rates for localized tumors Despite the low malignant potential of SPNs, relapse after resection can still occur.

Conclusion: Complete local resection of the tumor is the treatment of choice in SPNs. DPPHR should be considered as an alternative in young patients with a localized SPN in the pancreatic head.

Keywords: DPPHR; Duodenum preserving pancreatic head resection; Recurrent solid pseudopapillary tumor; Solid pseudopapillary neoplasm; Solid pseudopapillary tumor.