Solid-pseudopapillary tumor of the pancreas: Clinical experience and literature review

AIM: To evaluate the clinical presentations of solidpseudopapillary tumor of the pancreas (SPT) and examine the diagnosis, treatment, low grade malignant potential of this rare disease.METHODS: We retrospectively reviewed a series of seven patients with SPT managed in our hospital between July 1990 and October 2003. Six females and one male with mean age of 31 years (range 13 to 50 years) were diagnosed with SPT at our institution.RESULTS: Clinical presentation included a palpable abdominal mass in two patients and vague abdominal discomfort in another two. Two patients were asymptomatic;their tumors were found incidentally on abdominal sonographic examination for other reasons. The final patient was admitted with hemoperitoneum secondary to tumor rupture. The mean diameter of the tumors in the seven patients was 10.5 cm (range 5 to 20 cm). The lesions were located in the body and tail in five cases and in the head of the pancreas in two. Surgical procedures included distal pancreatectomy (3), distal pancreatectomy with splenectomy (2), pancreaticoduodenectomy (1) and a pylorus-preserving Whipple procedure (1). There were gross adhesions or histological evidence of infiltration to the adjacent pancreas and/or splenic capsule in four cases. None of the patients received adjuvant therapy.The mean follow up was 7 years (range 0.5 to 14 years).One patient developed multiple liver metastases after 14 years of follow up.CONCLUSION: SPT is a rare tumor that behaves less aggressively than other pancreatic tumor. However, in cases with local invasion, long-term follow up is advisable.

Retroperitoneal congenital epidermoid cyst misdiagnosed as a solid pseudopapillary tumor of the pancreas:A case report

BACKGROUND Retroperitoneal cysts are rare and usually asymptomatic abdominal lesions.Epidermoid cysts are frequent benign cutaneous tumors,but retroperitoneal localization of these cysts does not occur very often.CASE SUMMARY We report a case report of a 25-year-old woman with a giant mass in the abdominal cavity.Because imaging examination indicated that the mass probably originated from the pancreas,the mass was considered a solid pseudopapillary tumor of the pancreas(SPTP).However,surgery revealed a retroperitoneal epidermoid cyst located behind the pancreas neck and the root of the superior mesenteric artery(SMA).We performed complete resection of the tumor.Postoperative pathology showed an epidermoid cyst.The patient fared well after two months of follow-up.CONCLUSION Surgery is the gold standard for the diagnosis and treatment of retroperitoneal epidermoid cysts.Retroperitoneal epidermoid cysts around the pancreas are easily misdiagnosed as cystic SPTPs.Surgeons should pay particular attention to preoperative diagnosis to reduce severe surgical complications and improve the quality of life of patients.

MSCT and MRCP features of intraductal papillary mucinous tumor of the pancreas

Objective:To study the multi-slice CT(MSCT) and magnetic resonance cholangio-pancreatography(MRCP) features of intraductal papillary mucinous tumor(IPMT) of the pancreas.Methods:The clinical information,laboratory val-ues,imaging features and pathological findings of 8 cases were reviewed.Results:There were 6 males and 2 females with average 71.3 years old in this series.These lesions involved pancreatic branch ducts or main duct.Among them,2 cases were involved in the pancreatic uncinate process,1 case in the pancreatic head,1 in the pancreatic body,2 in the pancreatic tail and 2 cases involved multiple pancreatic duct.The common complaint was chronic upper abdominal pain.The imaging features included cystic lesion and it's association with the dilated pancreatic main duct,and bulging of the duodenal papilla.Mucin plug,septa or mural nodule were found in these cystic lesions.5 cases were confirmed with endoscopic retrograde cholangio-pancreatography(ERCP).3 cases had undergone surgery.Pathological findings of the 3 cases were adenoma,adenocarcinoma and borderline tumor,respectively.Conclusion:The MSCT and MRCP features of IPMT are somewhat characteristic,and the correct diagnosis can be made with the combination of clinical features.Diameter of branch duct ≥ 3 cm with multiple or large mural nodules,or severe dilated main duct indicates the probability of malignant IPMT.

SOLID PSEUDOPAPILLARY TUMOR OF THE PANCREAS:CLINICAL AND COMPUTED TOMOGRAPHIC FINDINGS WITH PATHOLOGIC CORRELATION IN 21 CASES

Objective To correlate the clinical and imaging features of the solid pseudopapillary tumor (SPPT) of the pancreas with the pathologic diagnosis. Methods The computed tomographic findings in 21 patients (18 women and 3 men) with pathologically proven solid pseudopapillary tumor of the pancreas were reviewed retrospectively. Two radiologists reviewed images for location, size and morphology, capsule and margin, density, enhancement pattern, calcification, dilatation of pancreatic duct, lymphadenopathy, vascular invasion, distant metastasis, and recurrence. Results On CT, the lesion presented as solitary, round (28.57%), oval (57.14%), or lobulated (14.28%) mass in pancreatic head (47.62%) with complete capsule (85.71%). Lesions smaller than 4cm in maximum diameter (47.62%) presented as predominantly solid mass whereas lesions greater than 4cm in diameter (52.28%) presented as heterogenous mass. On contrast administration, the viable solid portion of the tumor showed mild peripheral enhancement in arterial phase [enhancement degree<20Hounsfield unit (HU)] with progressive fill in during the portal and hepatic parenchyma phase (enhancement degree 20-40HU). Eighteen lesions (85.7%) had complete capsule. Two lesions (9.5%) had areas of high density (>60HU) on plain CT which due to hemorrhage. Dilatation of the pancreatic duct was rare (25%), and distant metastasis, regional lymphadenopathy, and tumor recurrence were absent. Nine patients (42.85%) had an abdominal CT follow-up for 24.55months (range, 2-60months) post-surgery without recurrence or distant metastasis. Conclusion Solid pseudopapillary tumor of the pancreas usually occurs in young females in the pancreatic head or tail. On CT, they manifest as moderate vascular mixed tumor, progressive enhancement of the viable solid portion, distinct tumor margin with capsule formation, and absence of regional lymphadenopathy.

A gastrointestinal stromal tumor of the duodenum masquerading as a pancreatic head tumor

Gastrointestinal stromal tumor (GIST) represents the most common kind of mesenchymal tumor that arises from the alimentary tract. GIST is currently defined as a gastrointestinal tract mesenchymal tumor showing CD117 (c-kit protein) positivity at immunohistochemistry. Throughout the whole length of the gastrointestinal tract, GIST arises most commonly from the stomach followed by the small intestine, the colorectum, and the esophagus. Only 3%-5% of GISTs occur in the duodenum, and especially, if GIST arises from the C loop of the duodenum, it can be difficult to differentiate from the pancreas head mass because of its anatomical proximity. Here, we report a case of duodenal GIST, which was assessed as a pancreatic head tumor preoperatively.

Pregnancy Complicated With a Giant Pancreatic Tumor and Decompensation of Liver Cirrhosis:A Case Report and Literature Review

Pregnancy with solid pseudopapillary tumor of the pancreas(SPTP)is rare.Because pregnancy hormones may cause tumor progression,the management and treatment of SPTP need to balance the safety of pregnant women and fetuses with surgical treatment.We reported a case of a giant pancreatic tumor diagnosed during pregnancy that was considered to be SPTP.Examinations also showed hepatitis B virus infection and severe decompensation of liver cirrhosis.Medical termination of pregnancy was performed.The patient has lived with the tumor until now without surgery.We retrieved the published case reports,summarized the clinical characteristics of pregnancy with SPTP,and explored its management during the perinatal period.Most patients with SPTP have a good prognosis with good maternal and fetal outcomes,and it is important to choose an appropriate treatment method and timing.However,pregnancy combined with decompensated liver cirrhosis needs to be terminated in a timely manner because of its high-risk status.

超声检查对于胰腺实性假乳头状瘤诊断的价值

目的:探讨超声检查对于胰腺实性假乳头状瘤(solid-pseudopapillary tumor of the pancreas,SPTs)的诊断价值.方法:回顾性分析经病理证实的30例胰SPTs的超声及超声造影(contrast enhanced ultrasonography,CEUS)表现.将病例分为常规超声组和超声造影两组,利用SPSS18.0软件,用两独立样本2检验的Fisher确切概率法,计算两组方法是否有统计学差异.结果:30例患者中,男性1例,女性29例,年龄30.5岁,其中肿块位于胰头有14例、胰体有4例、胰尾有12例,肿物大小约1.5cm×1.1cm×1.8cm-21cm×11cm×15cm.常规超声组诊断17例,漏诊1例,误诊为胰腺其他肿瘤8例.超声造影组诊断4例,误诊为胰腺其他肿瘤1例.诊断符合率方面:常规超声组65.4%(17/26);超声造影组75%(3/4).两组数据统计结果:P=0.593,说明两种方法之间还不具有统计学差异.结论:SPTs具有一定的声像图定特点及临床特点,特别是CEUS后,了解这些能提高超声对SPTs的诊断水平.

胰岛细胞瘤的CT和MRI表现

目的:探讨胰岛细胞瘤的CT和MRI表现。方法:对9例手术证实的胰岛细胞瘤的CT和MRI表现进行回顾性分析,其中功能性胰岛细胞瘤7例,无功能性胰岛细胞瘤2例。结果:9例胰岛细胞瘤均富血供,边界清楚,与周围胰腺分界清楚,无血管、胰管侵犯。功能性胰岛细胞瘤多较小,无功能性胰岛细胞瘤较大。结论:胰岛细胞瘤有典型的CT和MRI表现,CT和MR增强扫描能准确诊断胰岛细胞瘤。

新肿瘤标志CA_（242）对胆胰恶性肿瘤诊断意义

应用免疫放射分析（ＩＲＭＡ）糖类抗原２４２（ＣＡ＿（２４２））在胆胰恶性肿瘤诊断中的价值，检测６６例胆胰恶性肿瘤患者，７４例胆胰良性疾病患者血清中ＣＡ＿（２４２）含量。其结果ＣＡ＿（２４２）分别为３３．５２７±１９．９８２Ｕ／ｍｌ，８．４３７±５．９８７Ｕ／ｍｌ，恶性肿瘤值显著高于良性疾病组（Ｐ＜０．０１）．以１２Ｕ／ｍｌ为界值，诊断胆胰恶性肿瘤灵敏度为８０．３％，特异度８２．４％，为临床较早的诊断胆胰恶性肿瘤提供了重要依据。

Early detection and prevention of pancreatic cancer:Is it really possible today?

Pancreatic cancer is the 4th leading cause of cancer-related death in Western countries. Considering the low incidence of pancreatic cancer, population-based screening is not feasible. However, the existence of a group of individuals with an increased risk to develop pancreatic cancer has been well established. In particular, individuals suffering from a somatic or genetic condition associated with an increased relative risk of more than 5- to 10-fold seem to be suitable for enrollment in a surveillance program for prevention or early detection of pancreatic cancer. The aim of such a program is to reduce pancreatic cancer mortality through early or preemptive surgery. Considering the risk associated with pancreatic surgery, the concept of preemptive surgery cannot consist of a prophylactic removal of the pancreas in high-risk healthy individuals, but must instead aim at treating precancerous lesions such as intraductal papillary mucinous neoplasms or pancreatic intraepithelial neoplasms, or early cancer. Currently, results from clinical trials do not convincingly demonstrate the efficacy of this approach in terms of identification of precancerous lesions, nor do they define the outcome of the surgical treatment of these lesions. For this reason, surveillance programs for individuals at risk of pancreatic cancer are thus far generally limited to the setting of a clinical trial. However, the acquisition of a deeper understanding of this complex area, together with the increasing request for screening and treatment by individuals at risk, will usher pancreatologists into a new era of preemptive pancreatic surgery. Along with the growing demand to treat individuals with precancerous lesions, the need for low-risk investigation, low-morbidity operation and a minimally invasive approach becomes increasingly pressing. All of these considerations are reasons for preemptive pancreatic surgery programs to be undertaken in specialized centers only.

Synchronous intraoperative radiofrequency ablation for multiple liver metastasis and resection of giant solid pseudopapillary tumors of the pancreas

The solid pseudopapillary tumors of the pancreas （SPTP） are rare tumors, which are commonly found in adolescent women. Radical surgical resection of the primary tumor or metastases is the standard treatment for SPTP and could achieve long-term survival. We reported a case of a 20-year-old female with multiple liver metastases of SPTP, and performed surgical resection for primary tumor 14 cm in diameter and 2 major liver metastases （both 5 cm in diameter）, radiofrequency ablation （RFA） for small lesions and one major liver metastase 6 cm in diameter successfully. No evidence of recurrence in situ or in the liver was found by computed tomography （CT） scan 3 months after the operation. RFA is a safe and effective treatment for unresectable multiple liver metastases of SPTP.

Endoscopic therapy in acute recurrent pancreatitis

Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a largely diagnostic to a largely therapeutic modality. Cross-sectional imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), and less invasive endoscopy, especially endoscopic ultrasound (EUS), have largely taken over from ERCP for diagnosis. However, ERCP remains the "first line" therapeutic tool in the management of mechanical causes of acute recurrent pancreatitis, including bile duct stones (choledocholithiasis), ampullary masses (benign and malignant), congenital variants of biliary and pancreatic anatomy (e.g. pancreas divisum, choledochoceles), sphincter of Oddi dysfunction (SOD), pancreatic stones and strictures, and parasitic disorders involving the biliary tree and/or pancreatic duct (e.g Ascariasis, Clonorchiasis).

胰腺实性假乳头状瘤超声诊断分析

目的分析胰腺实性假乳头状瘤(SPTP)超声表现及术前诊断情况,探讨SPTP的诊断模式,提高对该病的超声诊断准确度。方法选择40例SPTP患者,其中男性11例,女性29例;年龄7-64岁,平均年龄35.5岁。均行手术治疗和病理诊断,其中32例术前行超声检查,分析超声表现及超声诊断情况。结果 40例SPTP均为单发。术前超声检查漏诊3例,29例SPTP超声多表现为形态较规则,边界较清晰的实性或实性为主病灶,回声不均,缺乏血液供应。24例超声定位诊断正确,15例提示定性诊断,考虑1种疾病者7例(其中1例诊断为SPTP),2种疾病者7例(6例诊断为SPTP),3种疾病者1例(诊断为SPTP)。结论超声诊断SPTP应密切结合临床及流行病学资料,多方位、多切面扫查,诊断结论提示2种可能的疾病,有助于提高诊断符合率,为临床诊疗提供有价值的影像学依据。

超声内镜对胃异位胰腺与间质瘤的鉴别诊断价值

目的探讨超声内镜在胃异位胰腺与间质瘤鉴别诊断中的价值。方法回顾分析经病理证实的40例胃异位胰腺与141例间质瘤患者的临床资料和超声检查结果，包括病变的部位、大小、起源层次、生长方式、内部回声等。结果胃异位胰腺最常位于胃窦部（92．5％），胃间质瘤多位于胃体（45．4％）、胃窦（23．4％）和胃底（22．0％），两者病变部位差异有统计学意义（P〈0．001）。胃异位胰腺与间质瘤在最长／最短直径比值方面差异无统计学意义（P=0．057）。间质瘤与异位胰腺大小差异有统计学意义[（19．98±12．80）mm对（11．25±3．61）mm，P〈0．001）]。异位胰腺多起源于第3层（黏膜下层，75％），间质瘤常起源于第4层（固有肌层，54．6％）和第2层（黏膜肌层，34．0％），两者起源层次差异有统计学意义（P〈0．001）。异位胰腺以肌壁内生长为主（82．5％），问质瘤以肌壁内生长（37．6％）、腔外生长（24．8％）和腔内生长（22．7％）为主，两者生长方式差异有统计学意义（P〈0．001）。内部回声方面，异位胰腺以低回声（32．5％）、中等回声（27．5％）和混合回声（27．5％）为主，间质瘤多为均匀低回声（72．3％）。结论超声内镜下异位胰腺与间质瘤在病变部位、大小、起源层次、生长方式和回声方式上差异有统计学意义，对胃异位胰腺和问质瘤的鉴别有重要价值。

异位胰腺误诊为胃肠间质瘤的临床分析

目的提高对异位胰腺与胃肠问质瘤的鉴别诊断水平。方法回顾性分析2007年1月至2013年6月于上海交通大学医学院附属仁济医院收治的14例术前诊断为胃肠间质瘤而术后病理证实为异位胰腺组织患者的临床资料及随访资料。结果本组病例男9例，女5例，年龄26，69岁。其中8例有上腹隐痛不适症状，2例为肠梗阻表现，4例为体检偶然发现。12例术前影像学检查及内镜检查均提示胃肠间质瘤。所有患者均行手术治疗，其中11例病变发生于胃，l例发生于十二指肠，2例发生于空肠；术后病理证实均为异位胰腺，其中10例以胰腺腺泡和胰腺导管混合存在为主要成分，同时含有平滑肌组织以及少量胃黏膜组织；3例以胰腺腺泡为主；1例以胰腺导管及平滑肌为主。随访时间为（26．5±5．1）月，均无复发和死亡者。结论异位胰腺缺乏特征性的临床表现和有效的术前辅助检查手段，易与胃肠间质瘤混淆。手术切除是治愈异位胰腺的唯一有效手段，而术后病理是鉴别两种疾病最可靠的诊断方法。

胰血管活性肠肽瘤1例报告并国内文献复习

目的探讨胰血管活性肠肽瘤(VIPoma)诊断和治疗方法。方法报告中国医科大学附属第一医院2010年2月收治1例VIPoma的临床资料,并检索国内1993年1月至2009年12月间文献报道的24例。对25例VIPoma临床表现、实验室检查、影像学检查、手术方式及随访资料进行分析。结果有记载的24例中22例有周期性发作的水样泻;22例检测血清钾,21例有低钾血症。13例血浆血管活性肠肽(vasoactive intestinal peptide,VIP)测定均高于正常。行B超检查15例中13例发现病变,10例病变于胰腺内。行CT检查22例中18例胰腺内发现病变,其中7例发现肝脏转移性病灶。25例中24例行手术治疗,行胰体尾切除术13例中11例术前有水样泻,术后7例水样泻消失,1例好转,另3例无记载。行肿瘤摘除术3例中1例术后水样泻消失,1例明显好转。1例胰头部VIPoma并发肝转移,行扩大的胰十二指肠切除术后水样泻消失。行胰体尾切除术13例,获得远期随访8例,随访3个月至3.5年,1例术后3个月大出血死亡,1例术后3.5年复发、肝转移,另6例无复发。结论 VIPoma诊断依赖于典型的临床症状和血浆VIP测定;B超及CT是胰腺VIPoma定位诊断的可靠方法。手术切除为胰腺VIPoma有效治疗手段,即使是姑息性切除亦可改善病人生活质量,延长存活时间。