Solid pseudopapillary neoplasm of the pancreas. Case report.

Abstract

Introduction: Solid pseudopapillary neoplasm ofthe pancreas (SPN) is a rare, low-grade malignanttumour that accounts for approximately 1–3% of allexocrine tumours. It usually occurs in teenagers oryoung women below 40 years. Most SPNs areasymptomatic or minimally symptomatic andincidentally found by imaging. The most commonclinical symptoms are abdominal pain andabdominal tumour.Case presentation: A 41-year-old woman withmorbid obesity and type 2 diabetes was admitted tothe hospital with upper abdominal pain, vomiting,and diarrhoea. The ultrasound found a cystic lesionin the tail of the pancreas. Subsequent MRIexamination revealed polycyclic litho cystic tumour63x 52 mm, 72mm c-c within the tail of the pancreas.Afterwards, the pancreatic tail with the tumour waslaparoscopically resectioned. Histopathologicalevaluation of collected tumour tissues found a solidpseudopapillary neoplasm (SPN) in those pancreaticcells. Subsequently, the patient was prescribed anadditional 2U of Lispro insulin before each andCreon enzyme replacement therapy for the SPN. Amonth after the procedure, the patient was admittedto the ICU with sharp abdominal pain, abdominalcramps, and high inflammatory markers. She wassuccessfully treated for acute pancreatitis anddischarged after ten days. The patient is in stablecondition and continues the Creon treatment.Conclusions: SPN can be detected by ultrasound,computed tomography, magnetic resonanceimaging, and positron emission tomography. SPN isa type of cancer with low malignancy potential dueto the low metastasis and vascular invasionprobability. Metastases to other organs have beenreported in 15% to 20% of SPN. Distant metastasesare typically found in the liver and lymph nodes, butthe peritoneum, omentum, and lungs can also beinvolved. The treatment of choice is pancreaticsurgery, including resection of distant metastases.The 10-year disease-specific survival rate is 96%.