Solid Pseudopapillary Neoplasm of the Pancreas: Unraveling Insights from a Single Institutional Study Emphasizing Preoperative Diagnosis of a Rare Tumor

Loganathan Jayapal; Santhosh R Kumar; Gilbert Samuel Jebakumar; Siddesh S Tasgaonkar; Sudeepta Kumar Swain; Venkatesh Munikrishnan; Tirupporur Govindaswamy Balachandar

doi:10.5005/jp-journals-10018-1394

Solid Pseudopapillary Neoplasm of the Pancreas: Unraveling Insights from a Single Institutional Study Emphasizing Preoperative Diagnosis of a Rare Tumor

Euroasian J Hepatogastroenterol. 2023 Jul-Dec;13(2):50-54. doi: 10.5005/jp-journals-10018-1394.

Authors

Loganathan Jayapal¹, Santhosh R Kumar¹, Gilbert Samuel Jebakumar¹, Siddesh S Tasgaonkar¹, Sudeepta Kumar Swain¹, Venkatesh Munikrishnan¹, Tirupporur Govindaswamy Balachandar¹

Affiliation

¹ Department of Surgical Gastroenterology, Apollo Hospitals, Chennai, Tamil Nadu, India.

Abstract

Aim: Solid pseudopapillary neoplasm (SPN), a slow-growing pancreatic tumor with a vague clinical presentation and non-specific radiological features, is rather uncommon. We share our experience emphasizing on preoperative diagnosis and the correlation with final histopathological examination.

Materials and methods: This is a retrospective analysis of the 468 patients who underwent pancreas-related surgery at our institution between January 2013 and July 2022. Demographic characteristics, symptoms at presentation, preoperative serum calcium carbohydrate antigen (CA 19-9), lesion characteristics on cross-sectional diagnostic imaging, surgical technique, complications in postoperative period, length of stay, histopathological features, and 3-year follow-up findings of the patients with SPN of pancreas were evaluated.

Results: The male-to-female ratio was 1:11 and the mean age at presentation was 33.3 ± 9.5 years. Upper abdomen discomfort was the most common presenting complaint (91%). And five patients had findings suggestive of SPN on preoperative CECT abdomen, and the remaining six individuals were diagnosed solely based on final histological examination. The tumor's median diameter was 5.6 cm (range, 4.1-7.9). The distal body and tail of pancreas was the most common location (63%), followed by the head (36%), and was managed with distal pancreatectomy with or without spleen preservation and Whipple's procedure, respectively. One patient developed grade III Clavien-Dindo complication. The average length of in-hospital stay was 8.27±2.72 days. None of the patients had recurrence on follow-up.

Conclusion: Solid pseudopapillary neoplasm of the pancreas is often misdiagnosed preoperatively. Endoscopic ultrasound-guided FNA with IHC will be beneficial to diagnose it preoperatively especially in small-sized tumors with atypical features. Complete surgical resection with adequate margins without routine lymphadenectomy is curative in resectable tumors.

How to cite this article: Jayapal L, Kumar SR, Jebakumar GS, et al. Solid Pseudopapillary Neoplasm of the Pancreas: Unraveling Insights from a Single Institutional Study Emphasizing Preoperative Diagnosis of a Rare Tumor. Euroasian J Hepato-Gastroenterol 2023;13(2):50-54.

Keywords: Diagnosis; Endoscopic ultrasound; Fine needle aspiration cytology (FNAC); Immunohistochemistry; Retrospective; Solid pseudopapillary neoplasm.