Clin Endosc.  2020 Sep;53(5):615-619. 10.5946/ce.2019.158.

An Unusual Presentation of a Solid Pseudopapillary Tumor of the Pancreas Mimicking Adenocarcinoma

• Chon HK
• Choi KH
• Kim TH

• KMID: 2507597
• DOI: http://doi.org/10.5946/ce.2019.158

Abstract

Solid pseudopapillary tumors of the pancreas are rare and typically occur in young women. Compared with pancreatic adenocarcinoma, solid pseudopapillary tumors are characterized by notable indolent biological behavior associated with a favorable prognosis. Despite their large size, these tumors rarely metastasize. Even in cases of hepatic metastasis, most lesions are usually solitary in distribution and are amenable to resection. We report a case of a 55-year-old man with a small solid pseudopapillary tumor (≤3-cm diameter) mimicking a pancreatic adenocarcinoma, with multiple hepatic metastases. The diagnosis was confirmed by endoscopic ultrasound-guided fine-needle biopsy using a 22-G core needle. Unfortunately, rapid tumor progression led to patient mortality 5 months after diagnosis. To our knowledge, this is the first case report that describes a small solid pseudopapillary tumor of the pancreas with multiple hepatic metastasis and poor prognosis in a patient who was diagnosed with this condition at the time of initial diagnosis.

Keyword

Pancreatic neoplasm; Neoplasm metastasis; Endoscopic ultrasound-guided fine-needle biopsy

Figure

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  Fig. 1. Abdomen computed tomography scan showing (A) a 2.5 cm low attenuating mass (black open arrow) in the pancreatic head and (B) a less-enhancing lesion in the hepatic lobe (black arrows). Magnetic resonance imaging scans (arterial phase of an axial T-1 weighted image) showing ill-defined low signal intensity in the pancreatic head and (C) multiple hepatic lesions (black arrows). (D) Delayed phase of a coronal T-1 weighted image showing heterogenous echogenic lesions (white arrow) in the pancreatic head without main pancreatic duct dilatation or pancreatic parenchymal atrophy. An ill-defined low signal intensity (black arrow) is observed in the right hepatic lobe. Endoscopic ultrasound showing (E) an ill-defined mixed echogenic mass in the pancreatic head and (F) irregular margins with low, dense lesions in the right hepatic lobes.

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  Fig. 2. Histopathological examination of a biopsy specimen showing (A) monomorphic cells with delicate papillary fronds (white arrows) without a fibrovascular core (black circles; hematoxylin & eosin stain, ×200). (B) Neoplastic cells are diffusely and strongly stained with beta-catenin (immunohistochemical staining, ×200).

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  Fig. 3. Abdominal computed tomography scan showing an enlarged pancreatic mass (white arrow), multiple hepatic masses (red arrows), and massive ascites.

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