SOLID AND CYSTIC PSEUDOPAPILLARY TUMOUR OF PANCREAS - A RARE SURGICAL ENIGMA

Abstract

Solid-pseudopapillary neoplasms (SPNs) of the pancreas are rare neoplasms, comprising only 1 to 2 of all pancreatic tumors. There is a strong female preponderance, and most SPNs present in the third and fourth decade of life. The first published description of an SPN was by Frantz in 1959. This report consisted of a pathologic description of three patients with SPN. Hamoudi and colleagues added an additional patient to the literature in 1970 and detailed the electron microscopic appearance of the tumor. The first report in the surgical literature of an SPN was by Sanfey and            associates in 1983. SPNs are also called solid and papillary tumors, papillary cystic tumors, solid cystic tumors, Frantz tumors, and Hamoudi tumors. SPN is synonymous with the preceding names and is the preferred terminology. SPNs are defined by their gross and histologic appearance. They are composed of discohesive polygonal cells that surround             delicate blood vessels and form a solid mass, with frequent cystic degeneration and intracystic hemorrhage. The             neoplastic cells have uniform nuclei, finely stippled chromatin, and nuclear grooves. Eosinophilic globules, foam cells, and cholesterol clefts are often present. Symptoms of SPN are often nonspecific and include abdominal pain, dyspepsia, early satiety, and nausea and vomiting (41 to 64).SPNs are usually localized pancreatic neoplasms, although 10 to 15 of patients will develop metastases.These metastases are often amenable to resection, and complete extirpation is associated with long term survival. Reported clinical and histopathologic features predictive of recurrence or metastases include tumor size greater than 5 cm, venous invasion, nuclear grade, and prominent necrobiotic nests, but these features are not           consistently reported in all large series.