Diagnosis And Treatment Of Solid-pseudopapillary Tumor Of Pancreas

Objective To explore the clinical characteristics, imaging features, biologicalcharacteristics, treatment and prognosis of solid-pseudopapillary tumor ofpancreas (SPT).Method Retrospectively reviewed and analyzed clinical and pathological data of123cases of SPT to summarize the features of imaging, clinic, diagnosis,treatment and prognosis.Results Among123SPT patients,21males and102females, male-to-female ratioabout1:4.9, with a median age of29.4years (age range10-56years), the meanage of women was28.4years, much younger than the man (34.7), the mediandiameter of the lesions was6.3cm (0.5-23cm). Most patients presented with eitherabdominal pain or discomfort, some patients are asymptomatic and the tumors areincidentally found during routine physical examinations, there is nonspecificsymptoms. Among the123cases of SPT, single tumor was found in119patients,in the rest four patients, multiple tumors were found. Our results showed that thepancreatic head and pancreatic body and tail were the preferential sites of theoccurrence of SPT. In combination with clinical findings, preoperative imaginghelp to determine the location of the tumor and make the correct diagnosis, but thenature of the tumor remains to be pathologically confirmed. All of patientsrenceived surgery,120(97.5%) patients were treated by radical tumor resection,35patients presented with postoperative complications, and the rate of complicationwas28.5%, the most common complication was pancreatic fistula, noperioperative death in our patients. Most SPNs are benign, only29tumors withmalignant behaviors, the patient’s age, gender, tumor size, the degree of tumormaker show no significant difference between the benign and malignant tumors,we found that incomplete capule was closely related to malignant potential, the results of immunohistochemistry show that the tumor cells were positive forseveral markers(CD5699.1%、Ki-6793.7%、ACT96.2%、AAT95.5%、β-Catenin100%),102patients were followed up, with a median time of36.5months(timerange6-64months), one patient with a preoperative distant metastasis died10months after total pancreatectomy, one patient with multiple metastases15months after surgry, one patient with recurrence51months after surgry, both ofthem are survive with tumors, other patients survive without tumor.Conclusions1. Solid pseudopapillary tumor (SPT) is a rare low grade malignancymore frequent in young women, the clinical characteristics and tumor makers ofSPT are non-specific, Preoperative imaging has important significance in thepreoperative and differential diagnosis.2.Preoperative imaging can help todetermine the tumor location, size, relationship with surrounding tissue anddifferentiation from other pancreatic neoplasms, ultimately help to provide thefinal treatment strategy.3. Due to well-circumscribed lesion, most of patients canreceive radical resection and have good prognosis, even the tumor is malignant,the degree of malignancy is still lower than pancreatic cancer, Recurrence andlimited metastasis are not necessarily contraindications for resection, and somepatients with cytoreductive operation may also have a long survival time.4.SPT isborderline tumor, and close follow-up is therefore necessary...