Clinical features and treatment of solid pseudopapillary neoplasm of the pancreas

• DOI: 10.3760/cma.j.issn.1673-9752.2017.10.006
• Publication Date: 2017-10-20
• Authors: Hanxiang Zhan; Yugang Cheng; Haifeng Han; Peng Su; Ning Zhong; Min Zhu; Zongli Zhang; Xuting Zhi; Guangyong Zhang; Sanyuan Lei; Hu Wang
• Keywords: Neoplasm

Objective To investigate the clinical features and treatment of solid pseudopapillary neoplasm (SPN) pancreas.

Methods The retrospective cross-sectional study was conducted. The clinicopathological data 69 patients with SPN pancreas who were admitted to Qilu Hospital Shandong University from January 2012 July 2017 collected. Serum tumor markers detection, enhanced computed tomography (CT) magnetic resonance imaging (MRI) abdomen carried out preoperatively for all patients, a part received endoscopic ultrasonography (EUS). Surgery plans formulated after completion examinations. Observation indicators: (1) features; (2)treatment situation; (3)results pathological examination; (4)follow-up. All followed up via outpatient examination telephone interview detect survival recurrence metastasis till 2017. Measurement normal distribution presented by ±s compared Student′s t test. Count chi-square test.

Results (1) Clinical features: ① epidemiologic ratio male female 1∶5.9; aged between 9 65 years, including 40 under 30 years 29 above or equal years. onset age (34±15)years (28±11)years respectively, no statistically significant difference (t=-1.364, P>0.05). Of located at pancreatic uncinate process in 25 neck 12 body tail 32 patients. ② Medical history: history acute chronic pancreatitis abdominal trauma denied ③ manifestation: 26 had obvious symptoms detected physical 31 discomfort upper abdomen, nausea vomiting; other hospital because mass (10 patients), jaundice (1 patient) nausea, constipation patient). ④ Laboratory examination: levels preoperative carcinoembryonic antigen (CEA) CA19-9 normal. ⑤ Imaging plane scan CT showed round round-like low-density shadows 51 cystic lesion, 13 lesion 5 lesion. Complete capsules observed 64 blurred boundary adjacent viscera calcified foci parenchyma 14 Ten MRI examination, T1-weighted images slightly lower signal, T2-weighted higher signal scan, capsule continuous non-continuous ring-like signal. results heterogeneous enhancement arterial phase, progressive venous delayed while degree than that parenchyma. cloud-, papilla-or mural nodule-like enhanced. Obvious not components. boundaries tumors clear EUS. Hypo-, iso- hyperechoic regions found masses, masses confirmed as cyst- solidary type. 1 patient. (2) Treatment outcome: twenty-seven laparoscopic surgery, expiration distal pancreatectomy preservation spleen 8 combined splenectomy 2 middle pancreaticoduodenectomy pylorus patient, head resection duodenum assistance laparoscopy Forty-two open 10 6 7 (with patients) One patient + hepatic pancreatectomy+ metastatic lesser omental bursa, then radiofrequency ablation foci. Postoperative complications: 21 postoperative complications, 17 intestinal fistulas, bleedings, incomplete obstruction, pleural effusion atelectasis, them cured symptomatic treatment. (3) Pathological margins negative. mean diameter (7±4)cm (21 <5 cm, 48 ≥5 cm). diameters 4 number 44 59 (χ2=4.828, P<0.05). 16 (χ2=4.895, Solid, pseudo-papillary tissues seen light microscope. Tumor cells surrounded blood vessels arranged nest sheet shape region; one multiple layers axis large amount mucus clusters regions. result immunohistochemistry positive rates α1-antitrypsin, vimentin, β-catenin, progesterone receptor, CD10, synaptophysin chromogranin A 100.0%(39/39), 96.6%(28/29), 95.7%(45/47), 94.4%(51/54), 92.5%(49/53), 72.9%(35/48) 5.6%(3/54), respectively. (4) Follow-up: 63 1-68 months, median time months. No detected. died lung cancer month 35 survived well.

Conclusions SPN is mostly young it could be cystic. Abdominal clarify diagnosis. EUS-fine needle aspiration provide evidence definitive Typical cellular morphology may hints diagnosis SPN, clarified when detection α1-antitrypsin indexes. ensure negative margin are fundamental principles treatment.

Key words: Solid neoplasms pancreas; Clinical characteristics; Imaging examination; Laparoscopy