Solid pseudopapillary neoplasm of the pancreas: an enigmatic entity

IntroductionSolid pseudopapillary neoplasm (SPN) of pancreas is infrequently-encountered tumor, typically affects young women without significant clinical symptoms. SPN usually show indolent behaviour; only rare cases recur and/or metastasize after complete resection. Material and methods: Clinical, pathological and immunohistochemical parameters of SPN as well as the treatment and follow-up of patients were investigated in retrospective analysis. Results: All four patients were female with mean age of 24.5 (range:15-42) years. Patients were presented with abdominal pain (n=2), abdominal mass (n=1) and with acute abdominal signs following blunt trauma (n=1). Mean size of tumor was 5.5cm (range:1-16cm). Two tumors were diagnosed preoperatively through percutaneous-core-needle biopsy and the other two underwent surgery without preoperative histological diagnosis because of high suspicion of SPN. By immunohistochemistry, all cases strongly stained for vimentin, progesterone-receptor and beta-catenin (nuclear) and variably with pankeratin and neuroendocrine markers. Proliferation index (Ki-67) was less than 2% in all cases. Patients underwent R0-resection of tumor and after median follow-up of 60 months (range: 41-80 months) were alive with no evidence of recurrent or metastatic disease.Conclusion: SPN of pancreas should be considered in differential diagnosis of any solid or partly cystic pancreatic or upper abdominal mass, particularly in young females. SPN possesses low malignant potential and complete surgical resection with clear margins is treatment of choice. Adequate surgical intervention is associated with excellent prognosis.