J Pathol Transl Med.  2017 Jan;51(1):87-91. 10.4132/jptm.2016.06.16.

A Rare Case of Recurrent Metastatic Solid Pseudopapillary Neoplasm of the Pancreas

• Lee HS
• Kim HK
• Shin BK
• Choi JH
• Choi YJ
• Kim HY

• KMID: 2367684
• DOI: http://doi.org/10.4132/jptm.2016.06.16

Abstract

A 61-year-old woman visited our hospital for bilateral multiple lung nodules and a mass in her thorax. She had a long history of multiple metastatic recurrences of solid pseudopapillary neoplasm (SPN); 24 years previously, the patient had undergone pylorus-preserving pancreaticoduodenectomy for a 9.9 × 8.6 cm mass in the pancreatic head. The tumor was diagnosed as an SPN. Nine years later, metastatic nodules were found on computed tomography in the patient's liver and peritoneum and were excised. She subsequently underwent an additional eight metastatectomy procedures in diverse organs. For the presented event, the lung nodules were removed. The prevalence of malignant SPN in the general population is 5%-15%. However, multiple metastatic recurrence of malignant SPN is rare; the lung is a particularly rare site of metastasis, found in only three cases in the literature. Here, we describe this exceptional case and provide a literature review.

Keyword

Solid pseudopapillary neoplasm; Lung; Neoplasm metastasis

MeSH Terms

Female
Head
Humans
Liver
Lung
Middle Aged
Neoplasm Metastasis
Pancreas*
Pancreaticoduodenectomy
Peritoneum
Prevalence
Recurrence
Thorax

Figure

• 

  Fig. 1. Gross specimen of the patient’s lung metastasis. A solid, well-demarcated and cystic mass with hemorrhage is seen.

• 

  Fig. 2. Microscopic findings. (A) A loosely cohesive pseudopapillary pattern. (B) Capsular invasion with a cord or glandular pattern is visible in the intermediate and late metastatic lesions. (C) Necrobiotic nests are present in the intermediate lesions. (D) Distinct nuclear atypia is seen in the late lesions.

Reference

1. Papavramidis T, Papavramidis S. Solid pseudopapillary tumors of the pancreas: review of 718 patients reported in English literature. J Am Coll Surg. 2005; 200:965–72.

2. Yu PF, Hu ZH, Wang XB, et al. Solid pseudopapillary tumor of the pancreas: a review of 553 cases in Chinese literature. World J Gastroenterol. 2010; 16:1209–14.

3. Hosokawa I, Shimizu H, Ohtsuka M, et al. Preoperative diagnosis and surgical management for solid pseudopapillary neoplasm of the pancreas. J Hepatobiliary Pancreat Sci. 2014; 21:573–8.

4. Xu M, Shi X, Wan T, et al. Treatment and prognosis of solid pseudopapillary neoplasms with metastases or recurrence. Zhonghua Wai Ke Za Zhi. 2015; 53:685–9.

5. Takahashi Y, Fukusato T, Aita K, et al. Solid pseudopapillary tumor of the pancreas with metastases to the lung and liver. Pathol Int. 2005; 55:792–6.

6. El Nakeeb A, Abdel Wahab M, Elkashef WF, Azer M, Kandil T. Solid pseudopapillary tumour of the pancreas: incidence, prognosis and outcome of surgery (single center experience). Int J Surg. 2013; 11:447–57.

7. Nishihara K, Nagoshi M, Tsuneyoshi M, Yamaguchi K, Hayashi I. Papillary cystic tumors of the pancreas. Assessment of their malignant potential. Cancer. 1993; 71:82–92.

8. Tipton SG, Smyrk TC, Sarr MG, Thompson GB. Malignant potential of solid pseudopapillary neoplasm of the pancreas. Br J Surg. 2006; 93:733–7.

9. Yu P, Cheng X, Du Y, et al. Solid pseudopapillary neoplasms of the pancreas: a 19-year multicenter experience in China. J Gastrointest Surg. 2015; 19:1433–40.

10. Ansari D, Elebro J, Tingstedt B, et al. Single-institution experience with solid pseudopapillary neoplasm of the pancreas. Scand J Gastroenterol. 2011; 46:1492–7.

11. Kim SA, Kim MS, Kim MS, et al. Pleomorphic solid pseudopapillary neoplasm of the pancreas: degenerative change rather than high-grade malignant potential. Hum Pathol. 2014; 45:166–74.

12. Kloppel G, Hruban RH, Klimstra DS, et al. Solid-pseudopapillary tumor of pancreas. In : Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. World Health Organization classification of tumours of the digestive system. Lyon: IARC Press;2010. p. 327–30.