Case of Solid Pseudopapillary Neoplasm of Pancreas

Aim: to discuss the clinical presentation, management, and outcome of the clinical case of solid pseudopapillary tumour of the pancreas (SPTP).
Key points. SPTPs are rare tumours known for their low malignant potential. They are predominantly found in younger females, typically occurring in the tail of the pancreas. Surgical resection of SPTP with negative margins is associated with improved survival rates and lower chances of recurrence. In this study, we discuss the case of a 69-year-old woman diagnosed with an SPTP originating from the tail of the pancreas, which had spread to the hilum of the spleen. A radical resection was performed, successfully obtaining negative surgical margins. However, the patient subsequently developed metastasis to the liver and lungs, prompting the initiation of systemic chemotherapy. The patient died seven months after the development of metastasis and 39 months following the primary diagnosis. This case underscores that, despite initial successful surgical outcomes, high-risk histopathological features can lead to recurrence and metastasis, necessitating reassessment of treatment strategies.
Conclusion. Negative surgical margins are critical for a favourable prognosis in the treatment of SPTPs; however, close monitoring for potential recurrence is essential. Our findings highlight that even after achieving negative margins, patients with high-risk features should undergo rigorous follow-up and consider postoperative systemic chemotherapy. This clinical case emphasizes the complexity of managing SPTP and the need for individualized treatment strategies, as early detection of recurrence can significantly influence survival outcomes.

1. Anand G., Sharma D., Meena S., Guleria M., Nangia A. Resection of a large solid pseudopapillary neoplasm of the pancreas: A multidisciplinary feat and review of literature. Pol Przegl Chir. 2022;95(4):1–5. DOI: 10.5604/01.3001.0015.9664

2. El Abbassi T., Elazhary A., Ouchane M., El Wassi A., Lefriyekh M.R. Solid pseudopapillary tumors of the pancreas in young women: Case report. Int J Surg Case Rep. 2021;89:106592. DOI: 10.1016/j.ijscr.2021.106592

3. Lin X., Lin R., Lu F., Chen Y., Huang H. Surgical management of solid pseudopapillary neoplasms of pancreas: A single-center experience of 60 patients. Dig Surg. 2020;37(4):348–54. DOI: 10.1159/000505062

4. Cruz M.A.A., Moutinho-Ribeiro P., Costa-Moreira P., Macedo G. Solid pseudopapillary neoplasm of the pancreas: Unfolding an intriguing condition. GE Port J Gastroenterol. 2021;29(3):151–62. DOI: 10.1159/000519933

5. Nagtegaal I.D., Odze R.D., Klimstra D., Paradis V., Rugge M., Schirmacher P., et al.; WHO Classification of Tumours Editorial Board. The 2019 WHO classification of tumours of the digestive system. Histopathology. 2020;76(2):182–8. DOI: 10.1111/his.13975

6. Yasuda H., Kataoka K., Miyake H., Sogame Y., Sakagami J., Yasukawa S., et al. Spontaneous regression in solid pseudopapillary neoplasm of pancreas. Clin J Gastroenterol. 2023;16(1):105–9. DOI: 10.1007/s12328-022-01715-4

7. Yang J., Tan C.L., Long D., Liang Y., Zhou L., Liu X.B., et al. Analysis of invasiveness and tumor associated macrophages infiltration in solid pseudopapillary tumors of pancreas. World J Gastroenterol. 2022;28(34):5047–57. DOI: 10.3748/wjg.v28.i34.5047

8. Del Chiaro M., Verbeke C., Salvia R., Klöppel G., Werner J., McKay C., et al.; European Study Group on Cystic Tumours of the Pancreas. European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis. 2013;45(9):703–11. DOI: 10.1016/j.dld.2013.01.010

9. Mazzarella G., Muttillo E.M., Coletta D., Picardi B., Rossi S., Rossi Del Monte S., et al. Solid pseudopapillary tumor of the pancreas: A systematic review of clinical, surgical and oncological characteristics of 1384 patients underwent pancreatic surgery. Hepatobiliary Pancreat Dis Int. 2024;23(4):331–8. DOI: 10.1016/j.hbpd.2023.05.004

10. Sznajder Granat R., Romano A., Villard C., Lissing M., Joneberg J., Danielsson O., et al. Liver transplantation for liver metastasis of a pseudopapillary pancreatic neoplasm in a male patient. Am J Case Rep. 2023;24:e938678. DOI: 10.12659/AJCR.938678

11. Naar L., Spanomichou D.A., Mastoraki A., Smyrniotis V., Arkadopoulos N. Solid pseudopapillary neoplasms of the pancreas: A surgical and genetic enigma. World J Surg. 2017;41(7):1871–81. DOI: 10.1007/s00268-017-3921-y