Clinical Diagnosis And Treatment Research Of Solid-pseudopapillary Tumor Of Pancreas

Background:Solid-pseudopapillary tumor of the pancreas (SPTP) is a rare borderline tumor or neoplasm with a low potential, usually affecting young women in the second or third decade of life. It was first described by Franz in 1959 and posteriously characterized by Hamoudi in 1970, resulted in either "Franz" or "Hamoudi" tumors. Various names have been used to describe this unusual lesion, such as solid and cystic tumor of the pancreas, papillary-cystic tumor, papillary epithelial tumor, solid and papillary epithelial neoplasm, and solid cystic papillary acinar cell tumor. SPT of the pancreas is the most recently accepted term, which was defined by the World Health Organization (WHO) in 1996. With the increases in recognition of SPTP, worldwide scholars further describe the malignant potential of it. SPT is the most recently accepted term (WHO,2004) according to International Histological Classification Tumours, which is defined as a more consistent of cell nests and the formation of solid-pseudopapillary structure of epithelial tumors, often with bleeding and cystic change. SPTP is a very rare entity, accounting for 0.13% to 2.7% of all pancreatic tumors. Because clinical symptoms and signs are nonspecific, imaging and pathological features are not very obvious and biological behaviors are different, misdiagnosis and mistreatment of SPTP was frequent. A series of thirty patients with SPTP managed in Shandong Provincial Hospital between June 2003 and December 2010 were retrospectively reviewed and analyzed, in order to sum up the clinical characteristics and surgical treatment experience and improve the preoperative diagnosis and treatment level of SPTP.Objective:TO sum up the clinical characteristics and surgical treatment experience and improve the preoperative diagnosis and treatment level of SPTP.Methods:A series of thirty patients with SPTP managed in Shandong Provincial Hospital between June 2003 and December 2010 were retrospectively reviewed and analyzed.Results:Among 30 patients,2 were men and 28 were women. The male to female ratio was 1:14. The mean age of the 30 patients in this research was 23.7 years (ranging from 11 to 48 years). Clinical presentation included abdominal discomfort, pain or diarrhea in ten patients and a palpable abdominal mass in another 17 patients. Obstructive jaundice was the first symptom in three patients. Preoperative laboratory tests of all patients were negative. Ultrasonographically, the tumors were well-defined hypoechoic solid masses, solid masses containing cystic areas. CT scan founded masses of low density in pancreas. The solid portions enhanced irregularly on contrast-enhanced CT, while the cystic areas both appeared low density on plain and contrast-enhanced CT. There may be calcifications at the periphery or centre of the mass. Liver metastasis was found in one patient. All patients were treated surgically. Surgical procedures included local resection (17), distal pancreatectomy with splenectomy (6), distal pancreatectomy (1), central pancreatectomy+distal Roux-en-Y pancreatico-jejunostomy (3), pancreatico-duodenectomy (1), DPPHR+pancreaticojejunostomy (1), and distal pancreatectomy with splenectomy+hepatic metastasis resection (1). None of the patients were received postoperative radiation and chemotherapy. The sites of the tumors were the head (17), the neck (3), the body (1), the body and tail (5), and the tail (4). The mean diameter of the tumors was 7.9cm (range 3 to 19cm). Postopterative complications occurred in 7 cases, including pancreatic fistula in five cases, gastroparesis in two cases, whom all recovered from symptomatic treatment. The mean follow up was 39 months (range 2 to 87 months), and no evidence of recurrence and metastasis was found during the follow up period.Conclusions:Solid-pseudopapillary tumor of the pancreas (SPTP) is a rare borderline tumor or neoplasm with a low potential, usually affecting young women in the second or third decade of life. Preoperative diagnosis of SPTP mainly depends on B-ultrasound and CT tests because of nonspecific clinical manifestation and lack of tumor and immunohistochemical markers. To combine the clinical symptoms, imaging examination with pathological features and immunohistochemistry can degrade the misdiagnosis rate effectively. Local infiltration and metastasis was not the contraindication for SPTP on account of its pathological features. Surgical resection is generally curative and the prognosis is excellent.