BACKGROUND Solid pseudopapillary neoplasm(SPN)is an uncommon pathology of the pancreas with unpredictable malignant potential.Endoscopic ultrasound(EUS)assessment plays a vital role in lesion characterization and conf...BACKGROUND Solid pseudopapillary neoplasm(SPN)is an uncommon pathology of the pancreas with unpredictable malignant potential.Endoscopic ultrasound(EUS)assessment plays a vital role in lesion characterization and confirmation of the tissue diagnosis.However,there is a paucity of data regarding the imaging assessment of these lesions.AIM To determine the characteristic EUS features of SPN and define its role in preoperative assessment.METHODS This was an international,multicenter,retrospective,observational study of prospective cohorts from 7 large hepatopancreaticobiliary centers.All cases with postoperative histology of SPN were included in the study.Data collected included clinical,biochemical,histological and EUS characteristics.RESULTS One hundred and six patients with the diagnosis of SPN were included.The mean age was 26 years(range 9 to 70 years),with female predominance(89.6%).The most frequent clinical presentation was abdominal pain(80/106;75.5%).The mean diameter of the lesion was 53.7 mm(range 15 to 130 mm),with the slight predominant location in the head of the pancreas(44/106;41.5%).The majority of lesions presented with solid imaging features(59/106;55.7%)although 33.0%(35/106)had mixed solid/cystic characteristics and 11.3%(12/106)had cystic morphology.Calcification was observed in only 4(3.8%)cases.Main pancreatic duct dilation was uncommon,evident in only 2 cases(1.9%),whilst common bile duct dilation was observed in 5(11.3%)cases.One patient demonstrated a double duct sign at presentation.Elastography and Doppler evaluation demonstrated inconsistent appearances with no emergence of a predictable pattern.EUS guided biopsy was performed using three different types of needles:Fine needle aspiration(67/106;63.2%),fine needle biopsy(37/106;34.9%),and Sonar Trucut(2/106;1.9%).The diagnosis was conclusive in 103(97.2%)cases.Ninety-seven patients were treated surgically(91.5%)and the post-surgical SPN diagnosis was confirmed in all cases.During the 2-year follow-up period,no recurrence was observed.CONCLUSION SPN presented primarily as a solid lesion on endosonographic assessment.The lesion tended to be located in the head or body of the pancreas.There was no consistent characteristic pattern apparent on either elastography or Doppler assessment.Similarly SPN did not frequently cause stricture of the pancreatic duct or common bile duct.Importantly,we confirmed that EUS-guided biopsy was an efficient and safe diagnostic tool.The needle type used does not appear to have a significant impact on the diagnostic yield.Overall SPN remains a challenging diagnosis based on EUS imaging with no pathognomonic features.EUS guided biopsy remains the gold standard in establishing the diagnosis.展开更多
Solid pseudopapillary neoplasms are rare.This article reviews the clinical and pathologic features of solid pseudopapillary neoplasm of the pancreas,including the epidemiology,cytology,molecular pathology,differential...Solid pseudopapillary neoplasms are rare.This article reviews the clinical and pathologic features of solid pseudopapillary neoplasm of the pancreas,including the epidemiology,cytology,molecular pathology,differential diagnosis,treatment,and prognosis.Solid pseudopapillary neoplasms are low-grade malignant tumours of the pancreas characterized by poorly cohesive epithelial cells with solid and pseudopapillary patterns.Solid pseudopapillary neoplasms occur predominantly in young women.Although solid pseudopapillary neoplasms can occur throughout the pancreas,they arise slightly more frequently in the tail of the pancreas.The aetiology is unknown.Extremely rare cases have been reported in the setting of familial adenomatous polyposis.There are no symptoms unique to solid pseudopapillary neoplasms,however,the most common symptom is abdominal pain or discomfort.The features of solid pseudopapillary neoplasms on computed tomography imaging are indicative of the pathologic changes within the tumour.Typically,well-demarcated masses with variably solid and cystic appearances.Microscopically,these tumours are composed of epithelial cells forming solid and pseudopapillary structures,frequently undergoing haemorrhagic cystic degeneration.Typically,these tumours express nuclear and/or cytoplasmicβ-catenin.Almost all solid pseudopapillary neoplasms harbour mutations in exon 3 of CTNNB1,the gene encodingβ-catenin.The overall prognosis is excellent,and most patients are cured by complete surgical resection.展开更多
Solid pseudopapillary neoplasms(SPNs)of the pancreas are rare,low-grade,malignant neoplasms that are mostly seen in young women in the second and third decades of life and are quite uncommon in children.Standard resec...Solid pseudopapillary neoplasms(SPNs)of the pancreas are rare,low-grade,malignant neoplasms that are mostly seen in young women in the second and third decades of life and are quite uncommon in children.Standard resection for benign and borderline neoplasms of the pancreas is associated with a substantial risk of postoperative morbidity and long-term functional impairment,whereas enucleation leads to less morbidity and preserves healthy parenchyma as well as exocrine and endocrine function.Enucleation of SPNs has been increasingly reported to be feasible and safe for preserving the normal physiological function of the pancreas,especially in teenagers and children.This review summarizes findings published in recent years on the enucleation of SPNs as well as potential future developments and directions.Enucleation has undoubtedly come to stay as an alternative surgical procedure for SPNs.However,many questions remain unresolved,and future directions toward the best surgical indication,the prevention and intervention of complications,especially pancreatic fistula,intraoperative resection margin safety assessment,and long-term oncology prognosis remain to be evaluated and should be explored in future clinical trials.展开更多
Solid pseudopapillary neoplasm(SPN), also known as Gruber-Frantz tumor, is a rare form of neoplasm that almost exclusively occurs in the pancreas and in young females. While the potential of malignancy is low for SPN,...Solid pseudopapillary neoplasm(SPN), also known as Gruber-Frantz tumor, is a rare form of neoplasm that almost exclusively occurs in the pancreas and in young females. While the potential of malignancy is low for SPN, these tumors can mimic other diseases and require a meticulous investigation and a standard treatment by total surgical resection. We present an unusual case of SPN arising in the mesentery of a 40-year-old man with subsequent multiple metastases. Histopathological examination showed similar properties of the mesenteric neoplasm to those of SPN in pancreas. Although the mass was surgically removed, the patient died of recurrent disease 4 years after the initial presentation. We speculate that SPN originates from pancreatic progenitor cells. Further histopathological analyses are required for the prediction of SPN recurrence after resection.展开更多
Solid pseudopapillary neoplasm (SPN) is a rare and low-grade malignant pancreatic neoplasm composed of poorly cohesive monomorphic neoplastic cells forming solid and pseudopapillary structures with frequent hemorrhagi...Solid pseudopapillary neoplasm (SPN) is a rare and low-grade malignant pancreatic neoplasm composed of poorly cohesive monomorphic neoplastic cells forming solid and pseudopapillary structures with frequent hemorrhagic-cystic degeneration. Intraductal papillary mucinous neoplasm (IPMN) is a pancreatic exocrine tumor composed of intraductal papillary growth of mucin containing neoplastic cells in the main pancreatic duct or its major branches. In the case presented here, a 53-year-old, Japanese man was found to have multiple cystic lesions and dilatation of the main pancreatic duct in the neck of the pancreas. Histological examination revealed a main-duct and branch-duct type IPMN, of the gastric-type, involving the neck of the pancreas, associated with a 0.5 cm SPN in the caudal side of the IPMN. We diagnosed this case as synchronous SPN and IPMN. As far as we know, only one other case of synchronous SPN and IPMN has been reported. Both the present case and the previously reported case showed abnormal nuclear expression of β-catenin in SPN, whereas IPMN showed no abnormal nuclear expression. These results suggest that β-catenin abnormality is not a common pathogenetic factor of synchronous SPN and IPMN.展开更多
BACKGROUND Solid pseudopapillary neoplasm of the pancreas(SPN)is a rare neoplasm that mainly affects young women.AIM To evaluate the impact of parenchyma-preserving surgical methods(PPMs,including enucleation and cent...BACKGROUND Solid pseudopapillary neoplasm of the pancreas(SPN)is a rare neoplasm that mainly affects young women.AIM To evaluate the impact of parenchyma-preserving surgical methods(PPMs,including enucleation and central pancreatectomy)in the treatment of SPN patients.METHODS From 2013 to 2019,patients who underwent pancreatectomy for SPNs were retrospectively reviewed.The baseline characteristics,intraoperative index,pathological outcomes,short-term complications and long-term follow-up data were compared between the PPM group and the conventional method(CM)group.RESULTS In total,166 patients were included in this study.Of them,33 patients(19.9%)underwent PPM.Most of the tumors(104/166,62.7%)were found accidentally.Comparing the parameters between groups,the hospital stay d(12.35 vs 13.5 d,P=0.49),total expense(44213 vs 54084 yuan,P=0.21),operation duration(135 vs 120 min,P=0.71),and intraoperative bleeding volume(200 vs 100 mL,P=0.49)did not differ between groups.Regarding pathological outcomes,tumor size(45 vs 32 mm,P=0.07),Ki67 index(P=0.53),peripheral tissue invasion(11.3%vs 9.1%,P=0.43)and positive margin status(7.5%vs 6%,P=0.28)also did not differ between groups.Moreover,PPM did not increase the risk of severe postoperative pancreatic fistula(3.8%vs 3.0%,P=0.85)or tumor recurrence(3.0%vs 6.0%,P=0.39).However,the number of patients who had exocrine insufficiency during follow-up was significantly lower in the PPM group(21.8%vs 3%,P=0.024).CM was identified as an independent risk factor for pancreatic exocrine insufficiency(odds ratio=8.195,95%confident interval:1.067-62.93).CONCLUSION PPM for SPN appears to be feasible and safe for preserving the exocrine function of the pancreas.展开更多
AIM:To investigate differential points of solid-pseudo-papillary neoplasm (SPN) of the pancreas and pancre-atic endocrine tumor (PET).METHODS:Ten cases of SPN and fourteen cases of PET were studied in this retrospecti...AIM:To investigate differential points of solid-pseudo-papillary neoplasm (SPN) of the pancreas and pancre-atic endocrine tumor (PET).METHODS:Ten cases of SPN and fourteen cases of PET were studied in this retrospective study. Clinical and pathologic features,immunostaining reactions and β-catenin gene mutations were analyzed.RESULTS:The mean age of SPN patients was 25.6 years and these patients had no specific symptoms. The mean diameter of the tumors was 11.0 cm,9/10 cases were cystic or a mixture of solid and cystic structures,and there was hemorrhage and necrosis on the cut surface in 8/10 (80%) cases. Characteristic pseudo-papillary structure and discohesive appearance of the neoplastic cells were observed in all 10 (100%) cases. The results of immunostaining showed that nuclear expression of β-catenin and loss of E-cadherin in all the cases,was only seen in SPN. Molecular studies discov-ered that 9/10 (90%) cases harbored a point mutation of exon 3 in β-catenin gene. On the other hand,the mean age of PET patients was 43.1 years. Eight of 14 cases presented with symptoms caused by hypoglyce-mia,and the other 6 cases presented with symptoms similar to those of SPN. The mean size of the tumors was 2.9 cm,most of the tumors were solid,only 3/14 (21%) were a mixture of solid and cystic structures,and macroscopic hemorrhage and necrosis were much less common (3/14,21%). Histologically,tumor cells were arranged in trabecular,acinar or solid patterns and demonstrated no pseudopapillary structure and discohesive appearance in all 14 (100%) cases. The results of immunostaining and mutation detection were completely different with SPN that membrane and cytoplastic expression of β-catenin without loss of E-cadherin,as well as no mutation in β-catenin gene in all the cases. CONCLUSION:Both macroscopic and microscopic features of SPN are quite characteristic. It is not difficult to distinguish it from PET. If necessary,immunos-taining of β-catenin and E-cadherin is quite helpful to make the differential diagnosis.展开更多
Solid pseudo-papillary epithelial neoplasm(SPEN) is a rare epithelial tumor of pancreas with a low malignant potential occurs most commonly in young females. We report a case of 40 years old woman presented withextens...Solid pseudo-papillary epithelial neoplasm(SPEN) is a rare epithelial tumor of pancreas with a low malignant potential occurs most commonly in young females. We report a case of 40 years old woman presented withextensive liver metastasis from SPEN of pancreatic body for which she was operated four years ago. Due to the extensive nature of metastatic disease she was offered Transarterial chemoembolisation(TACE) using gemcitabine as chemotherapeutic agent. Short term follow up after a month of TACE with multiphase computed tomography showed > 90% resolution in the viable tumor with significant clinical improvement. TACE ensures targeted delivery of chemotherapeutic drugs in higher doses with least systemic toxicity and is more effective and safe than systemic chemotherapy. TACE with gemcitabine was found to be very effective in our patient with numerous liver metastasis.展开更多
BACKGROUND Solid pseudopapillary neoplasm(SPN)is a rare tumor that was first described by Frantz in 1959.Although this tumor is benign,some may have malignant potential that can be predicted based on demographics,imag...BACKGROUND Solid pseudopapillary neoplasm(SPN)is a rare tumor that was first described by Frantz in 1959.Although this tumor is benign,some may have malignant potential that can be predicted based on demographics,imaging characteristics,and pathologic evaluation.This case series presents 3 SPN cases with discussion on gender differences,preoperative predictors of malignancy,and a suggested algorithm for diagnostic approach as well as post-surgical follow up.CASE SUMMARY Three adult patients in a tertiary hospital found to have SPN,one elderly male and two young females.Each of the cases presented with abdominal pain and were discovered incidentally.Two cases underwent endoscopic ultrasound with immunohistochemical staining(which were consistent with SPN before undergoing surgery),and one case underwent surgery directly after imaging.The average tumor size was 5 cm.Diagnosis was confirmed by histology.Two patients had post-surgical complications requiring intervention.CONCLUSION Demographic and imaging characteristics can be sufficient to establish diagnosis for SPN,while malignant cases require pre-operative evaluation with endoscopic ultrasound fine needle aspiration/fine needle biopsy.展开更多
BACKGROUND SMARCB1/INI1-deficient pancreatic undifferentiated rhabdoid carcinoma is a very aggressive tumor that is rarely reported in the literature.The tumor has a predominant rhabdoid cell component and different p...BACKGROUND SMARCB1/INI1-deficient pancreatic undifferentiated rhabdoid carcinoma is a very aggressive tumor that is rarely reported in the literature.The tumor has a predominant rhabdoid cell component and different patterns of growth have been reported.CASE SUMMARY A 59-year-old woman presented with diffuse abdominal pain,increasing in severity and accompanied by weight loss,nausea,and vomiting.Imaging showed a pancreatic head mass.Fine needle aspiration demonstrated atypical epithelioid cells with a pseudopapillary growth pattern suggestive of solid pseudopapillary neoplasm.The excised neoplasm showed monotonous epithelioid and focally spindle cells with pseudopapillary structures,rhabdoid features,and loss of SMARCB1 protein expression with wild-type KRAS,consistent with a SMARCB1/INI1-deficient undifferentiated rhabdoid carcinoma.The patient’s condition deteriorated rapidly following surgery and she expired 3 mo post operation.CONCLUSION In this article,we report the first case of SMARCB1/INI1-deficient undifferentiated pancreatic rhabdoid carcinoma mimicking solid pseudopapillary neoplasm.展开更多
BACKGROUND Solid pseudopapillary neoplasms(SPNs)are rare tumors of the pancreas.Typically,they occur in young females,often have characteristic imaging features,such as cystic components and calcification,and have few...BACKGROUND Solid pseudopapillary neoplasms(SPNs)are rare tumors of the pancreas.Typically,they occur in young females,often have characteristic imaging features,such as cystic components and calcification,and have few effects on the pancreatic duct.CASE SUMMARY A 31-year-old man was admitted to our hospital with the chief complaint of epigastric pain.There was only mild tenderness in his upper abdomen,and blood tests showed only a slight increase in alkaline phosphatase.Contrast-enhanced computed tomography showed a 40-mm-diameter,hypovascular mass in the head of the pancreas,and the main pancreatic duct upstream of the mass was severely dilated.Magnetic resonance imaging showed low intensity on T1-weighted images,with high intensity on T2-weighted image in some parts.Pancreatic ductal adenocarcinoma was the primary differential diagnosis.Portal vein infiltration could not be ruled out,so this case was a candidate for neoadjuvant chemotherapy.Subsequently,endoscopic ultrasound-guided fine needle aspiration was performed,and pathological evaluation and immunostaining suggested a diagnosis of SPN.Thus,pancreatoduodenectomy was performed.One year after the operation,the patient is alive with no recurrence.CONCLUSION Main pancreatic duct dilatation is usually a finding of suspected pancreatic cancer.However,pancreatic duct dilatation can occur in SPN depending on the location and growth speed.Therefore,SPN should be considered in the differential diagnosis of tumors with pancreatic duct dilatation,and pathological evaluation by endoscopic ultrasound-guided fine needle aspiration should be actively performed.展开更多
Solid pseudopapillary neoplasm(SPN) is a rare indolent pancreatic neoplasm that occurs mostly in females. Although the malignancy potential is quite limited for SPN, these tumors can sometimes be aggressive and lead t...Solid pseudopapillary neoplasm(SPN) is a rare indolent pancreatic neoplasm that occurs mostly in females. Although the malignancy potential is quite limited for SPN, these tumors can sometimes be aggressive and lead to inferior prognosis for male patients. In this case report, we present a special case of a male patient with SPN who experienced an aggressive tumor expansion after two surgical resections. For further treatment, we decided to administer chemotherapy with apatinib and S-1, and subsequent CT/MRI tumor monitoring indicated satisfactory control of tumor expansion. The effectiveness of apatinib plus the S-1 regimen should be tested for more patients with SPN in the future.展开更多
目的:胰腺实性假乳头状肿瘤是一种罕见的低度恶性肿瘤,无典型的症状和体征,术前诊断较困难。本研究总结胰腺实性假乳头状肿瘤的临床特点,探讨其诊断方式及治疗原则。方法:选取2010年1月至2023年5月在山西医科大学第一医院行手术治疗并...目的:胰腺实性假乳头状肿瘤是一种罕见的低度恶性肿瘤,无典型的症状和体征,术前诊断较困难。本研究总结胰腺实性假乳头状肿瘤的临床特点,探讨其诊断方式及治疗原则。方法:选取2010年1月至2023年5月在山西医科大学第一医院行手术治疗并经病理学证实为胰腺实性假乳头状肿瘤的42例患者。回顾性分析其人口学、影像学、病理学特征及治疗方式。结果:42例患者中男12例,女30例,主要临床表现为消化道症状。术前诊断为胰腺实性假乳头状肿瘤22例,胰腺癌1例,黏液性囊腺瘤3例,肉瘤1例,无功能胰岛细胞瘤1例,神经内分泌瘤2例,余诊断不明确。术前的影像学检查中CT及磁共振成像(magnetic resonance imaging,MRI)的诊断正确率显著高于二维超声检查。肿瘤标志物中以神经元特异性烯醇化酶(neuron specific enolase,NSE)升高最常见(8例),可能对胰腺实性假乳头状肿瘤有诊断价值。免疫组织化学检测示:β连环素、波形蛋白(Vimentin)、α1-抗胰蛋白酶(α1-antitrypsin,AAT)、分化簇10(cluster of differentiation 10,CD10)、突触素(synaptophysin,SYN)、NSE的阳性率分别为100%、93%、86%、82%、78%、66%。42例患者均随访,其中6例失访,余36例随访49.83(25.00~104.53)个月(包括1例术后4年肿瘤复发转移,2个月后死亡;1例术后2年复发,目前正接受化学治疗;余34例未见肿瘤复发及转移,均存活)。结论:胰腺实性假乳头状肿瘤好发于女性,主要以消化系统症状为主,CT及MRI诊断正确率高,明确诊断需结合镜下观察和免疫组织化学检测,手术是有效的治疗方法。展开更多
AIM:To sum up the clinical and pathological characte- ristics of solid pseudopapillary tumor (SPT) and the experience with it.METHODS: A total of 553 SPT patients reported in Chinese literature between January 1996 an...AIM:To sum up the clinical and pathological characte- ristics of solid pseudopapillary tumor (SPT) and the experience with it.METHODS: A total of 553 SPT patients reported in Chinese literature between January 1996 and January 2009 were retrospectively reviewed and analyzed. RESULTS: The mean age of the 553 SPT patients included in this review was 27.2 years, and the male to female ratio was 1:8.37. Their symptoms were non-specific, and nearly one third of the patients were asymptomatic. Computed tomography and ultraso-nography were performed to show the nature and location of SPT. Most of the tumors were distributed in the pancreatic head (39.8%), tail (24.1%), body andtail (19.5%). Forty-five patients (9.2%) were diagnosed as malignant SPT with metastasis or invasion. None of the clinical factors was closely related to the malignant potential of SPT. Surgery was the main therapeutic modality for SPT. Local resection, distal pancreatectomy and pancreatoduodenectomy were the most common surgical procedures. Local recurrence and hepatic metastasis were found in 11 and 2 patients, respectively, after radical resection. Four patients died of tumor progression within 4 years after palliative resection of SPT. The prognosis of SPT patients was good with a 5-year survival rate of 96.9%.CONCLUSION: SPT of the pancreas is a rare indolent neoplasm that typically occurs in young females. It is a low-grade malignancy and can be cured with extended resection. The prognosis of such patients is good although the tumor may recur and metastasize.展开更多
AIM:To investigate the clinical characteristics,surgical strategies and prognosis of solid pseudopapillary tumors(SPTs)of the pancreas in male patients.METHODS:From July 2003 to March 2013,116 patients were diagnosed ...AIM:To investigate the clinical characteristics,surgical strategies and prognosis of solid pseudopapillary tumors(SPTs)of the pancreas in male patients.METHODS:From July 2003 to March 2013,116 patients were diagnosed with SPT of the pancreas in our institution.Of these patients,16 were male.The patients were divided into two groups based on gender:female(group 1)and male(group 2).The groups were compared with regard to demographic characteristics,clinical presentations,surgical strategies,complications and follow-up outcomes.RESULTS:Male patients were older than female patients(43.1±12.3 years vs 33.1±11.5 years,P=0.04).Tumor size,location,and symptoms were comparable between the two groups.All patients,with the exception of one,underwent complete surgical resection.The patients were regularly followed up.Themean follow-up period was 58 mo.Two female patients(1.7%)developed tumor recurrence or metastases and required a second resection,and two female patients(1.7%)died during the follow-up period.CONCLUSION:Male patients with SPT of the pancreas are older than female patients.There are no significant differences between male and female patients regarding surgical strategies and prognosis.展开更多
BACKGROUND: Solid-pseudopapillary tumor of the pancreas (SPTP) is an uncommon and enigmatic pancreatic neoplasm that occurs mainly in young women. Although more and more cases have been reported in recent years, misdi...BACKGROUND: Solid-pseudopapillary tumor of the pancreas (SPTP) is an uncommon and enigmatic pancreatic neoplasm that occurs mainly in young women. Although more and more cases have been reported in recent years, misdiagnosis and incorrect treatment still frequently take place. This study was designed to stimulate consideration of this tumor. METHODS: We retrospectively reviewed the experience of diagnosis and treatment of 15 patients with SPTP and compared them with 516 patients with pancreatic cancer from January 1997 to March 2007. RESULTS: Most of the SPTP cases were asymptomatic except for one palpable mass. Almost all SPTPs demonstrated a solid structure with hypo- or isoattenuation, cystic structure with hypo-attenuation on precontrast CT scan, and enhancement of solid portions on post-contrast CT scan. By contrast, most cases of pancreatic carcinoma had multiple symptoms and abnormal blood results. The tumors showed hypo-attenuation on both precontrast and post-contrast CT scan, and only a few showed iso-attenuation on post-contrast CT scan. All cases of SPTP in our group were cured by surgical resection, while only 16.86% of patients with pancreatic carcinoma could undergo a radical resection. CONCLUSIONS: Clinical features and CT scans were helpful to differentiate SPTP from pancreatic carcinoma. Radical surgical resection was the most effective and safe method for the treatment of SPTP.展开更多
Objective:To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas(SPTP). Methods:Nine surgically treated cases of SPTP were retrospecti...Objective:To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas(SPTP). Methods:Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin(HE) staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results:Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin(9/9 cases), AAT(9/9 cases), NSE(9/9 cases), ACT(7/9 cases), CK20(2/9 cases), CgA(1/9 cases), S-100(3/gcases), PR(4/gcases), Syn(3/9 cases) and CD56(5/9cases), negative in CEA and ER. Conclusion:SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.展开更多
BACKGROUND Solid pseudopapillary neoplasms of the pancreas(SPN)share similar imaging findings with pancreatic ductal adenocarcinoma with cystic changes(PDAC with cystic changes),which may result in unnecessary surgery...BACKGROUND Solid pseudopapillary neoplasms of the pancreas(SPN)share similar imaging findings with pancreatic ductal adenocarcinoma with cystic changes(PDAC with cystic changes),which may result in unnecessary surgery.AIM To investigate the value of computed tomography(CT)in differentiation of SPN from PDAC with cystic changes.METHODS This study retrospectively analyzed the clinical and imaging findings of 32 patients diagnosed with SPN and 14 patients diagnosed with PDAC exhibiting cystic changes,confirmed through pathological diagnosis.Quantitative and qualitative analysis was performed,including assessment of age,sex,tumor size,shape,margin,density,enhancement pattern,CT values of tumors,CT contrast enhancement ratios,“floating cloud sign,”calcification,main pancreatic duct dilatation,pancreatic atrophy,and peripancreatic invasion or distal metastasis.Multivariate logistic regression analysis was used to identify relevant features to differentiate between SPN and PDAC with cystic changes,and receiver operating characteristic curves were obtained to evaluate the diagnostic performance of each variable and their combination.RESULTS When compared to PDAC with cystic changes,SPN had a lower age(32 years vs 64 years,P<0.05)and a slightly larger size(5.41 cm vs 3.90 cm,P<0.05).SPN had a higher frequency of“floating cloud sign”and peripancreatic invasion or distal metastasis than PDAC with cystic changes(both P<0.05).No significant difference was found with respect to sex,tumor location,shape,margin,density,main pancreatic duct dilatation,calcification,pancreatic atrophy,enhancement pattern,CT values of tumors,or CT contrast enhancement ratios between the two groups(all P>0.05).The area under the receiver operating characteristic curve of the combination was 0.833(95%confidence interval:0.708-0.957)with 78.6%sensitivity,81.3%specificity,and 80.4%accuracy in differentiation of SPN from PDAC with cystic changes.CONCLUSION A larger tumor size,“floating cloud sign,”and peripancreatic invasion or distal metastasis are useful CT imaging features that are more common in SPN and may help discriminate SPN from PDAC with cystic changes.展开更多
文摘BACKGROUND Solid pseudopapillary neoplasm(SPN)is an uncommon pathology of the pancreas with unpredictable malignant potential.Endoscopic ultrasound(EUS)assessment plays a vital role in lesion characterization and confirmation of the tissue diagnosis.However,there is a paucity of data regarding the imaging assessment of these lesions.AIM To determine the characteristic EUS features of SPN and define its role in preoperative assessment.METHODS This was an international,multicenter,retrospective,observational study of prospective cohorts from 7 large hepatopancreaticobiliary centers.All cases with postoperative histology of SPN were included in the study.Data collected included clinical,biochemical,histological and EUS characteristics.RESULTS One hundred and six patients with the diagnosis of SPN were included.The mean age was 26 years(range 9 to 70 years),with female predominance(89.6%).The most frequent clinical presentation was abdominal pain(80/106;75.5%).The mean diameter of the lesion was 53.7 mm(range 15 to 130 mm),with the slight predominant location in the head of the pancreas(44/106;41.5%).The majority of lesions presented with solid imaging features(59/106;55.7%)although 33.0%(35/106)had mixed solid/cystic characteristics and 11.3%(12/106)had cystic morphology.Calcification was observed in only 4(3.8%)cases.Main pancreatic duct dilation was uncommon,evident in only 2 cases(1.9%),whilst common bile duct dilation was observed in 5(11.3%)cases.One patient demonstrated a double duct sign at presentation.Elastography and Doppler evaluation demonstrated inconsistent appearances with no emergence of a predictable pattern.EUS guided biopsy was performed using three different types of needles:Fine needle aspiration(67/106;63.2%),fine needle biopsy(37/106;34.9%),and Sonar Trucut(2/106;1.9%).The diagnosis was conclusive in 103(97.2%)cases.Ninety-seven patients were treated surgically(91.5%)and the post-surgical SPN diagnosis was confirmed in all cases.During the 2-year follow-up period,no recurrence was observed.CONCLUSION SPN presented primarily as a solid lesion on endosonographic assessment.The lesion tended to be located in the head or body of the pancreas.There was no consistent characteristic pattern apparent on either elastography or Doppler assessment.Similarly SPN did not frequently cause stricture of the pancreatic duct or common bile duct.Importantly,we confirmed that EUS-guided biopsy was an efficient and safe diagnostic tool.The needle type used does not appear to have a significant impact on the diagnostic yield.Overall SPN remains a challenging diagnosis based on EUS imaging with no pathognomonic features.EUS guided biopsy remains the gold standard in establishing the diagnosis.
文摘Solid pseudopapillary neoplasms are rare.This article reviews the clinical and pathologic features of solid pseudopapillary neoplasm of the pancreas,including the epidemiology,cytology,molecular pathology,differential diagnosis,treatment,and prognosis.Solid pseudopapillary neoplasms are low-grade malignant tumours of the pancreas characterized by poorly cohesive epithelial cells with solid and pseudopapillary patterns.Solid pseudopapillary neoplasms occur predominantly in young women.Although solid pseudopapillary neoplasms can occur throughout the pancreas,they arise slightly more frequently in the tail of the pancreas.The aetiology is unknown.Extremely rare cases have been reported in the setting of familial adenomatous polyposis.There are no symptoms unique to solid pseudopapillary neoplasms,however,the most common symptom is abdominal pain or discomfort.The features of solid pseudopapillary neoplasms on computed tomography imaging are indicative of the pathologic changes within the tumour.Typically,well-demarcated masses with variably solid and cystic appearances.Microscopically,these tumours are composed of epithelial cells forming solid and pseudopapillary structures,frequently undergoing haemorrhagic cystic degeneration.Typically,these tumours express nuclear and/or cytoplasmicβ-catenin.Almost all solid pseudopapillary neoplasms harbour mutations in exon 3 of CTNNB1,the gene encodingβ-catenin.The overall prognosis is excellent,and most patients are cured by complete surgical resection.
基金Supported by the Key Research and Development Projects in Sichuan Province,No.2019YFS0043the 1·3·5 Project for Disciplines of Excellence,West China Hospital,Sichuan University,No.ZY2017302-1.3.5.
文摘Solid pseudopapillary neoplasms(SPNs)of the pancreas are rare,low-grade,malignant neoplasms that are mostly seen in young women in the second and third decades of life and are quite uncommon in children.Standard resection for benign and borderline neoplasms of the pancreas is associated with a substantial risk of postoperative morbidity and long-term functional impairment,whereas enucleation leads to less morbidity and preserves healthy parenchyma as well as exocrine and endocrine function.Enucleation of SPNs has been increasingly reported to be feasible and safe for preserving the normal physiological function of the pancreas,especially in teenagers and children.This review summarizes findings published in recent years on the enucleation of SPNs as well as potential future developments and directions.Enucleation has undoubtedly come to stay as an alternative surgical procedure for SPNs.However,many questions remain unresolved,and future directions toward the best surgical indication,the prevention and intervention of complications,especially pancreatic fistula,intraoperative resection margin safety assessment,and long-term oncology prognosis remain to be evaluated and should be explored in future clinical trials.
文摘Solid pseudopapillary neoplasm(SPN), also known as Gruber-Frantz tumor, is a rare form of neoplasm that almost exclusively occurs in the pancreas and in young females. While the potential of malignancy is low for SPN, these tumors can mimic other diseases and require a meticulous investigation and a standard treatment by total surgical resection. We present an unusual case of SPN arising in the mesentery of a 40-year-old man with subsequent multiple metastases. Histopathological examination showed similar properties of the mesenteric neoplasm to those of SPN in pancreas. Although the mass was surgically removed, the patient died of recurrent disease 4 years after the initial presentation. We speculate that SPN originates from pancreatic progenitor cells. Further histopathological analyses are required for the prediction of SPN recurrence after resection.
文摘Solid pseudopapillary neoplasm (SPN) is a rare and low-grade malignant pancreatic neoplasm composed of poorly cohesive monomorphic neoplastic cells forming solid and pseudopapillary structures with frequent hemorrhagic-cystic degeneration. Intraductal papillary mucinous neoplasm (IPMN) is a pancreatic exocrine tumor composed of intraductal papillary growth of mucin containing neoplastic cells in the main pancreatic duct or its major branches. In the case presented here, a 53-year-old, Japanese man was found to have multiple cystic lesions and dilatation of the main pancreatic duct in the neck of the pancreas. Histological examination revealed a main-duct and branch-duct type IPMN, of the gastric-type, involving the neck of the pancreas, associated with a 0.5 cm SPN in the caudal side of the IPMN. We diagnosed this case as synchronous SPN and IPMN. As far as we know, only one other case of synchronous SPN and IPMN has been reported. Both the present case and the previously reported case showed abnormal nuclear expression of β-catenin in SPN, whereas IPMN showed no abnormal nuclear expression. These results suggest that β-catenin abnormality is not a common pathogenetic factor of synchronous SPN and IPMN.
文摘BACKGROUND Solid pseudopapillary neoplasm of the pancreas(SPN)is a rare neoplasm that mainly affects young women.AIM To evaluate the impact of parenchyma-preserving surgical methods(PPMs,including enucleation and central pancreatectomy)in the treatment of SPN patients.METHODS From 2013 to 2019,patients who underwent pancreatectomy for SPNs were retrospectively reviewed.The baseline characteristics,intraoperative index,pathological outcomes,short-term complications and long-term follow-up data were compared between the PPM group and the conventional method(CM)group.RESULTS In total,166 patients were included in this study.Of them,33 patients(19.9%)underwent PPM.Most of the tumors(104/166,62.7%)were found accidentally.Comparing the parameters between groups,the hospital stay d(12.35 vs 13.5 d,P=0.49),total expense(44213 vs 54084 yuan,P=0.21),operation duration(135 vs 120 min,P=0.71),and intraoperative bleeding volume(200 vs 100 mL,P=0.49)did not differ between groups.Regarding pathological outcomes,tumor size(45 vs 32 mm,P=0.07),Ki67 index(P=0.53),peripheral tissue invasion(11.3%vs 9.1%,P=0.43)and positive margin status(7.5%vs 6%,P=0.28)also did not differ between groups.Moreover,PPM did not increase the risk of severe postoperative pancreatic fistula(3.8%vs 3.0%,P=0.85)or tumor recurrence(3.0%vs 6.0%,P=0.39).However,the number of patients who had exocrine insufficiency during follow-up was significantly lower in the PPM group(21.8%vs 3%,P=0.024).CM was identified as an independent risk factor for pancreatic exocrine insufficiency(odds ratio=8.195,95%confident interval:1.067-62.93).CONCLUSION PPM for SPN appears to be feasible and safe for preserving the exocrine function of the pancreas.
基金Supported by Department of Pathology, Xiangya Basic Medical School, Central-south University
文摘AIM:To investigate differential points of solid-pseudo-papillary neoplasm (SPN) of the pancreas and pancre-atic endocrine tumor (PET).METHODS:Ten cases of SPN and fourteen cases of PET were studied in this retrospective study. Clinical and pathologic features,immunostaining reactions and β-catenin gene mutations were analyzed.RESULTS:The mean age of SPN patients was 25.6 years and these patients had no specific symptoms. The mean diameter of the tumors was 11.0 cm,9/10 cases were cystic or a mixture of solid and cystic structures,and there was hemorrhage and necrosis on the cut surface in 8/10 (80%) cases. Characteristic pseudo-papillary structure and discohesive appearance of the neoplastic cells were observed in all 10 (100%) cases. The results of immunostaining showed that nuclear expression of β-catenin and loss of E-cadherin in all the cases,was only seen in SPN. Molecular studies discov-ered that 9/10 (90%) cases harbored a point mutation of exon 3 in β-catenin gene. On the other hand,the mean age of PET patients was 43.1 years. Eight of 14 cases presented with symptoms caused by hypoglyce-mia,and the other 6 cases presented with symptoms similar to those of SPN. The mean size of the tumors was 2.9 cm,most of the tumors were solid,only 3/14 (21%) were a mixture of solid and cystic structures,and macroscopic hemorrhage and necrosis were much less common (3/14,21%). Histologically,tumor cells were arranged in trabecular,acinar or solid patterns and demonstrated no pseudopapillary structure and discohesive appearance in all 14 (100%) cases. The results of immunostaining and mutation detection were completely different with SPN that membrane and cytoplastic expression of β-catenin without loss of E-cadherin,as well as no mutation in β-catenin gene in all the cases. CONCLUSION:Both macroscopic and microscopic features of SPN are quite characteristic. It is not difficult to distinguish it from PET. If necessary,immunos-taining of β-catenin and E-cadherin is quite helpful to make the differential diagnosis.
文摘Solid pseudo-papillary epithelial neoplasm(SPEN) is a rare epithelial tumor of pancreas with a low malignant potential occurs most commonly in young females. We report a case of 40 years old woman presented withextensive liver metastasis from SPEN of pancreatic body for which she was operated four years ago. Due to the extensive nature of metastatic disease she was offered Transarterial chemoembolisation(TACE) using gemcitabine as chemotherapeutic agent. Short term follow up after a month of TACE with multiphase computed tomography showed > 90% resolution in the viable tumor with significant clinical improvement. TACE ensures targeted delivery of chemotherapeutic drugs in higher doses with least systemic toxicity and is more effective and safe than systemic chemotherapy. TACE with gemcitabine was found to be very effective in our patient with numerous liver metastasis.
文摘BACKGROUND Solid pseudopapillary neoplasm(SPN)is a rare tumor that was first described by Frantz in 1959.Although this tumor is benign,some may have malignant potential that can be predicted based on demographics,imaging characteristics,and pathologic evaluation.This case series presents 3 SPN cases with discussion on gender differences,preoperative predictors of malignancy,and a suggested algorithm for diagnostic approach as well as post-surgical follow up.CASE SUMMARY Three adult patients in a tertiary hospital found to have SPN,one elderly male and two young females.Each of the cases presented with abdominal pain and were discovered incidentally.Two cases underwent endoscopic ultrasound with immunohistochemical staining(which were consistent with SPN before undergoing surgery),and one case underwent surgery directly after imaging.The average tumor size was 5 cm.Diagnosis was confirmed by histology.Two patients had post-surgical complications requiring intervention.CONCLUSION Demographic and imaging characteristics can be sufficient to establish diagnosis for SPN,while malignant cases require pre-operative evaluation with endoscopic ultrasound fine needle aspiration/fine needle biopsy.
文摘BACKGROUND SMARCB1/INI1-deficient pancreatic undifferentiated rhabdoid carcinoma is a very aggressive tumor that is rarely reported in the literature.The tumor has a predominant rhabdoid cell component and different patterns of growth have been reported.CASE SUMMARY A 59-year-old woman presented with diffuse abdominal pain,increasing in severity and accompanied by weight loss,nausea,and vomiting.Imaging showed a pancreatic head mass.Fine needle aspiration demonstrated atypical epithelioid cells with a pseudopapillary growth pattern suggestive of solid pseudopapillary neoplasm.The excised neoplasm showed monotonous epithelioid and focally spindle cells with pseudopapillary structures,rhabdoid features,and loss of SMARCB1 protein expression with wild-type KRAS,consistent with a SMARCB1/INI1-deficient undifferentiated rhabdoid carcinoma.The patient’s condition deteriorated rapidly following surgery and she expired 3 mo post operation.CONCLUSION In this article,we report the first case of SMARCB1/INI1-deficient undifferentiated pancreatic rhabdoid carcinoma mimicking solid pseudopapillary neoplasm.
文摘BACKGROUND Solid pseudopapillary neoplasms(SPNs)are rare tumors of the pancreas.Typically,they occur in young females,often have characteristic imaging features,such as cystic components and calcification,and have few effects on the pancreatic duct.CASE SUMMARY A 31-year-old man was admitted to our hospital with the chief complaint of epigastric pain.There was only mild tenderness in his upper abdomen,and blood tests showed only a slight increase in alkaline phosphatase.Contrast-enhanced computed tomography showed a 40-mm-diameter,hypovascular mass in the head of the pancreas,and the main pancreatic duct upstream of the mass was severely dilated.Magnetic resonance imaging showed low intensity on T1-weighted images,with high intensity on T2-weighted image in some parts.Pancreatic ductal adenocarcinoma was the primary differential diagnosis.Portal vein infiltration could not be ruled out,so this case was a candidate for neoadjuvant chemotherapy.Subsequently,endoscopic ultrasound-guided fine needle aspiration was performed,and pathological evaluation and immunostaining suggested a diagnosis of SPN.Thus,pancreatoduodenectomy was performed.One year after the operation,the patient is alive with no recurrence.CONCLUSION Main pancreatic duct dilatation is usually a finding of suspected pancreatic cancer.However,pancreatic duct dilatation can occur in SPN depending on the location and growth speed.Therefore,SPN should be considered in the differential diagnosis of tumors with pancreatic duct dilatation,and pathological evaluation by endoscopic ultrasound-guided fine needle aspiration should be actively performed.
文摘Solid pseudopapillary neoplasm(SPN) is a rare indolent pancreatic neoplasm that occurs mostly in females. Although the malignancy potential is quite limited for SPN, these tumors can sometimes be aggressive and lead to inferior prognosis for male patients. In this case report, we present a special case of a male patient with SPN who experienced an aggressive tumor expansion after two surgical resections. For further treatment, we decided to administer chemotherapy with apatinib and S-1, and subsequent CT/MRI tumor monitoring indicated satisfactory control of tumor expansion. The effectiveness of apatinib plus the S-1 regimen should be tested for more patients with SPN in the future.
文摘目的:胰腺实性假乳头状肿瘤是一种罕见的低度恶性肿瘤,无典型的症状和体征,术前诊断较困难。本研究总结胰腺实性假乳头状肿瘤的临床特点,探讨其诊断方式及治疗原则。方法:选取2010年1月至2023年5月在山西医科大学第一医院行手术治疗并经病理学证实为胰腺实性假乳头状肿瘤的42例患者。回顾性分析其人口学、影像学、病理学特征及治疗方式。结果:42例患者中男12例,女30例,主要临床表现为消化道症状。术前诊断为胰腺实性假乳头状肿瘤22例,胰腺癌1例,黏液性囊腺瘤3例,肉瘤1例,无功能胰岛细胞瘤1例,神经内分泌瘤2例,余诊断不明确。术前的影像学检查中CT及磁共振成像(magnetic resonance imaging,MRI)的诊断正确率显著高于二维超声检查。肿瘤标志物中以神经元特异性烯醇化酶(neuron specific enolase,NSE)升高最常见(8例),可能对胰腺实性假乳头状肿瘤有诊断价值。免疫组织化学检测示:β连环素、波形蛋白(Vimentin)、α1-抗胰蛋白酶(α1-antitrypsin,AAT)、分化簇10(cluster of differentiation 10,CD10)、突触素(synaptophysin,SYN)、NSE的阳性率分别为100%、93%、86%、82%、78%、66%。42例患者均随访,其中6例失访,余36例随访49.83(25.00~104.53)个月(包括1例术后4年肿瘤复发转移,2个月后死亡;1例术后2年复发,目前正接受化学治疗;余34例未见肿瘤复发及转移,均存活)。结论:胰腺实性假乳头状肿瘤好发于女性,主要以消化系统症状为主,CT及MRI诊断正确率高,明确诊断需结合镜下观察和免疫组织化学检测,手术是有效的治疗方法。
文摘AIM:To sum up the clinical and pathological characte- ristics of solid pseudopapillary tumor (SPT) and the experience with it.METHODS: A total of 553 SPT patients reported in Chinese literature between January 1996 and January 2009 were retrospectively reviewed and analyzed. RESULTS: The mean age of the 553 SPT patients included in this review was 27.2 years, and the male to female ratio was 1:8.37. Their symptoms were non-specific, and nearly one third of the patients were asymptomatic. Computed tomography and ultraso-nography were performed to show the nature and location of SPT. Most of the tumors were distributed in the pancreatic head (39.8%), tail (24.1%), body andtail (19.5%). Forty-five patients (9.2%) were diagnosed as malignant SPT with metastasis or invasion. None of the clinical factors was closely related to the malignant potential of SPT. Surgery was the main therapeutic modality for SPT. Local resection, distal pancreatectomy and pancreatoduodenectomy were the most common surgical procedures. Local recurrence and hepatic metastasis were found in 11 and 2 patients, respectively, after radical resection. Four patients died of tumor progression within 4 years after palliative resection of SPT. The prognosis of SPT patients was good with a 5-year survival rate of 96.9%.CONCLUSION: SPT of the pancreas is a rare indolent neoplasm that typically occurs in young females. It is a low-grade malignancy and can be cured with extended resection. The prognosis of such patients is good although the tumor may recur and metastasize.
基金Supported by Special Fund of Ministry of Health for Medical Research in the Public Interest,No.201202007
文摘AIM:To investigate the clinical characteristics,surgical strategies and prognosis of solid pseudopapillary tumors(SPTs)of the pancreas in male patients.METHODS:From July 2003 to March 2013,116 patients were diagnosed with SPT of the pancreas in our institution.Of these patients,16 were male.The patients were divided into two groups based on gender:female(group 1)and male(group 2).The groups were compared with regard to demographic characteristics,clinical presentations,surgical strategies,complications and follow-up outcomes.RESULTS:Male patients were older than female patients(43.1±12.3 years vs 33.1±11.5 years,P=0.04).Tumor size,location,and symptoms were comparable between the two groups.All patients,with the exception of one,underwent complete surgical resection.The patients were regularly followed up.Themean follow-up period was 58 mo.Two female patients(1.7%)developed tumor recurrence or metastases and required a second resection,and two female patients(1.7%)died during the follow-up period.CONCLUSION:Male patients with SPT of the pancreas are older than female patients.There are no significant differences between male and female patients regarding surgical strategies and prognosis.
文摘BACKGROUND: Solid-pseudopapillary tumor of the pancreas (SPTP) is an uncommon and enigmatic pancreatic neoplasm that occurs mainly in young women. Although more and more cases have been reported in recent years, misdiagnosis and incorrect treatment still frequently take place. This study was designed to stimulate consideration of this tumor. METHODS: We retrospectively reviewed the experience of diagnosis and treatment of 15 patients with SPTP and compared them with 516 patients with pancreatic cancer from January 1997 to March 2007. RESULTS: Most of the SPTP cases were asymptomatic except for one palpable mass. Almost all SPTPs demonstrated a solid structure with hypo- or isoattenuation, cystic structure with hypo-attenuation on precontrast CT scan, and enhancement of solid portions on post-contrast CT scan. By contrast, most cases of pancreatic carcinoma had multiple symptoms and abnormal blood results. The tumors showed hypo-attenuation on both precontrast and post-contrast CT scan, and only a few showed iso-attenuation on post-contrast CT scan. All cases of SPTP in our group were cured by surgical resection, while only 16.86% of patients with pancreatic carcinoma could undergo a radical resection. CONCLUSIONS: Clinical features and CT scans were helpful to differentiate SPTP from pancreatic carcinoma. Radical surgical resection was the most effective and safe method for the treatment of SPTP.
文摘Objective:To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas(SPTP). Methods:Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin(HE) staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results:Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin(9/9 cases), AAT(9/9 cases), NSE(9/9 cases), ACT(7/9 cases), CK20(2/9 cases), CgA(1/9 cases), S-100(3/gcases), PR(4/gcases), Syn(3/9 cases) and CD56(5/9cases), negative in CEA and ER. Conclusion:SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.
基金Supported by the National Natural Science foundation of China,No.82202135,No.82371919,No.82372017 and No.82171925Project funded by China Postdoctoral Science Foundation,No.2023M741808+4 种基金Jiangsu Provincial Key research and development program,No.BE2023789Young Elite Scientists Sponsorship Program by Jiangsu Association for Science and Technology,No.JSTJ-2023-WJ027Foundation of Excellent Young Doctor of Jiangsu Province Hospital of Chinese Medicine,No.2023QB0112Project funded by Nanjing Postdoctoral Science Foundation,Natural Science Foundation of Nanjing University of Chinese Medicine,No.XZR2023036,No.XZR2021003 and No.XZR2021050Medical Imaging Artificial Intelligence Special Research Fund Project,Nanjing Medical Association Radiology Branch,Project of National Clinical Research Base of Traditional Chinese Medicine in Jiangsu Province,China,No.JD2023SZ16.
文摘BACKGROUND Solid pseudopapillary neoplasms of the pancreas(SPN)share similar imaging findings with pancreatic ductal adenocarcinoma with cystic changes(PDAC with cystic changes),which may result in unnecessary surgery.AIM To investigate the value of computed tomography(CT)in differentiation of SPN from PDAC with cystic changes.METHODS This study retrospectively analyzed the clinical and imaging findings of 32 patients diagnosed with SPN and 14 patients diagnosed with PDAC exhibiting cystic changes,confirmed through pathological diagnosis.Quantitative and qualitative analysis was performed,including assessment of age,sex,tumor size,shape,margin,density,enhancement pattern,CT values of tumors,CT contrast enhancement ratios,“floating cloud sign,”calcification,main pancreatic duct dilatation,pancreatic atrophy,and peripancreatic invasion or distal metastasis.Multivariate logistic regression analysis was used to identify relevant features to differentiate between SPN and PDAC with cystic changes,and receiver operating characteristic curves were obtained to evaluate the diagnostic performance of each variable and their combination.RESULTS When compared to PDAC with cystic changes,SPN had a lower age(32 years vs 64 years,P<0.05)and a slightly larger size(5.41 cm vs 3.90 cm,P<0.05).SPN had a higher frequency of“floating cloud sign”and peripancreatic invasion or distal metastasis than PDAC with cystic changes(both P<0.05).No significant difference was found with respect to sex,tumor location,shape,margin,density,main pancreatic duct dilatation,calcification,pancreatic atrophy,enhancement pattern,CT values of tumors,or CT contrast enhancement ratios between the two groups(all P>0.05).The area under the receiver operating characteristic curve of the combination was 0.833(95%confidence interval:0.708-0.957)with 78.6%sensitivity,81.3%specificity,and 80.4%accuracy in differentiation of SPN from PDAC with cystic changes.CONCLUSION A larger tumor size,“floating cloud sign,”and peripancreatic invasion or distal metastasis are useful CT imaging features that are more common in SPN and may help discriminate SPN from PDAC with cystic changes.