A Rare Case of Solid Pseudopapillary Tumor of the Pancreas in a Male Patient

Document Type

Conference Proceeding

Publication Date

10-25-2023

Publication Title

Am J Gastroenterol

Abstract

Introduction: Solid pseudopapillary tumors (SPTs) of the pancreas only represent approximately 1% of all pancreatic neoplasms with less than 10% reported in male patients. Per literature review, male patients may have more aggressive disease and may require more radical resection1. Given the scarcity of reported cases, especially in males, it is important evaluate all cases for distinct features in presentation and surgical approach. Case Description/Methods: A 25-year-old man with no significant family history and a personal history of alcohol use presented to the hospital with 5 days of epigastric abdominal pain. His laboratory workup was unremarkable. Computed tomography of the abdomen and pelvis with intravenous contrast revealed a 5.1 x 5.7 x 5.2 cm slightly lobulated rounded mass in the tail of the pancreas with central lucency likely representing central necrosis (1A, 1B). The remainder of the pancreas appeared normal. The patient underwent endoscopic ultrasound which revealed a hypoechoic, heterogeneous mass/cavity in the pancreatic tail measuring 70mm x 47mm in the maximal cross-sectional diameter (1C). Fine needle biopsy was performed (1D). The remainder of the pancreas was characterized by hyperechoic foci and strands but was otherwise normal. Final cytopathological diagnosis was consistent with pancreatic SPT. Immunohistochemical staining was strongly positive for Beta-Catenin and diffusely positive for CD10, Vimetin, CD56, and LEF-1. The patient was referred to surgical oncology and underwent a robot-assisted distal pancreatectomy and splenectomy. There were no metastases or ascites identified intra-operatively. The primary tumor did not abut the splenic artery or splenic vein. Surgery was overall uncomplicated and the post-operative course was uneventful. Surgical pathology confirmed the diagnosis of pancreatic SPT (Figure 1). Discussion: Differences in histology, recurrence, and survival of pancreatic SPTs between males and females are not well understood. Surgical resection significantly improves survival, even in metastatic disease. Minimally invasive techniques can be used if complete resection can be achieved safely. Given the potential for more aggressive disease in male patients with pancreatic SPTs, they must be considered for surgery early and treated by a multidisciplinary team to improve outcomes.

Volume

118

Issue

10

First Page

S1437

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