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Arch Surg. 2005;140:1224.

Answer: Solid Pseudopapillary Tumor of the Pancreas
Solid pseudopapillary tumor of the pancreas (SPT) is an extremely rare neoplasm of the pancreas, accounting for only 1% to 2% of pancreatic neoplasms. An SPT is a tumor of the primitive pancreatic epithelial cells, with predominance of exocrine features but having the capacity for dual (exocrine and endocrine) differentiation.¹ Solid pseudopapillary tumor of the pancreas usually occurs in young girls, with more than 50% of patients younger than 19 years,² and are more common among black and Asian populations.³ Many of these tumors are asymptomatic and present as mild abdominal pain and a lump.

The characteristic sonographic findings of SPT are a well-encapsulated, cystic, and solid mass. Sometimes the mass looks solid, or it may have internal septations or calcifications.⁴ Contrast-enhanced computed tomography will show a large, hypodense lesion with a few low-attenuation areas. Because of such findings, these lesions are often mistaken for pseudocysts.⁵

Treatment of SPT includes the Whipple procedure for masses found at the head of the pancreas and distal pancreatectomy for distal growth.³ Solid pseudopapillary tumors of the pancreas usually grow slowly; however, metastasis to the liver and peritoneum has been described.^6-7 The most distinctive feature on histopathologic examination is pseudopapillae covered by several layers of epithelial cells. Nuclei are ovoid and folded, with indistinct nucleoli and few mitoses. Hyaline globules and a collection of foam cells may be present.⁸ Solid pseudopapillary tumors of the pancreas show strong cellular immunoreactivity for vimentin and focal, weak keratin reactivity. Neuron-specific enolase, ₁-antitrypsin, and ₁-antichymotrypsin stains are also positive.⁹

AUTHOR INFORMATION

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Correspondence: Chirag S. Desai, MS, DNB, Department of Surgery, Seth G. S. Medical College and King Edward Memorial Hospital, Acharya Donde Marg, Parel, Mumbai 400 012, India (csdesai{at}gmail.com).

Accepted for Publication: April 27, 2005.

REFERENCES

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1. Pettinato G, Manivel JC, Ravetto C, et al. Papillary cystic tumor of the pancreas: a clinicopathologic study of 20 cases with cytologic, immunohistochemical, ultrastructural, and flow cytometric observations, and a review of literature. Am J Clin Pathol. 1992;98:478-488. [published correction appears in Am J Clin Pathol. 1993;99:764]. PUBMED 2. Todani T, Shimada K, Watanabe Y, Toki A, Fujii T, Urushihara N. Frantz’s tumor: a papillary and cystic tumor of the pancreas in girls. J Pediatr Surg. 1988;23:116-121. FULL TEXT | PUBMED 3. Jeng LB, Chen MF, Tang RP. Solid and papillary neoplasm of the pancreas: emphasis on surgical treatment. Arch Surg. 1993;128:433-436. FREE FULL TEXT 4. Lee DH, Yi BH, Lim JW, Ko YT. Sonographic findings of solid and papillary epithelial neoplasm of the pancreas. J Ultrasound Med. 2001;20:1229-1232. FREE FULL TEXT 5. Patel VG, Fortson JK, Weaver WL, Hammami A. Solid-pseudopapillary tumor of the pancreas masquerading as a pancreatic pseudocyst. Am Surg. 2002;68:631-632. PUBMED 6. Lee YR, Kim Y, Koh BH, et al. Solid and papillary epithelial neoplasm of the pancreas with peritoneal metastasis and its recurrence: a case report. Abdom Imaging. 2003;28:96-98. PUBMED 7. Horisawa M, Niinomi N, Sato T, et al. Frantz’s tumor (solid and cystic tumor of the pancreas) with liver metastasis: successful treatment and long-term follow-up. J Pediatr Surg. 1995;30:724-726. FULL TEXT | PUBMED 8. Lieber MR, Lack EE, Roberts JR Jr, et al. Solid and papillary epithelial neoplasm of the pancreas: an ultrastructural and immunocytochemical study of six cases. Am J Surg Pathol. 1987;11:85-93. FULL TEXT | WEB OF SCIENCE | PUBMED 9. Bardales RH, Centeno B, Mallery JS, et al. Endoscopic ultrasound-guided fine-needle aspiration cytology diagnosis of solid-pseudopapillary tumor of the pancreas: a rare neoplasm of elusive origin but characteristic cytomorphologic features. Am J Clin Pathol. 2004;121:654-662. FREE FULL TEXT

SECTION EDITOR: GRACE S. ROZYCKI, MD

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