Clinical characteristics and diagnosis and treatment of benign and malignant solid pseudopapillary neoplasm of pancreas_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHU Shiyu ¹ , XU Xincai ² , CHENG Kun ¹ , Sulidankazha·Chouman ¹ , CHEN Qilong ¹ ,  LIN Hai ¹

1. Digestion and Vascular Center, Department of Pancreas Surgery, The First Affiliated Hospital to Xinjiang Medical University, Urumqi 830054, P. R. China;
2. Digestion and Vascular Center, Department of Gastrointestinal Surgery, The First Affiliated Hospital to Xinjiang Medical University, Urumqi 830054, P. R. China;

Corresponding author：

LIN Hai, Email: 13639966260@163.com

Keywords：

pancreas solid pseudopapillary neoplasm; malignant potential; surgical operation

DOI：

10.7507/1007-9424.201712053

Video：

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Objective To analyze characteristics of solid pseudopapillary neoplasm (SPN) of pancreas and to discuss it’s diagnosis and treatment. Methods The clinicopathologic data of 39 patients with pathologically diagnosed as SPN from January 2012 to July 2017 in the First Affiliated Hospital to Xinjiang Medical University were collected, the clinical characteristics, imaging features, diagnosis and treatment methods, and prognosis were analyzed. Results Among the 39 patients, there were 27 benign SPNs and 12 malignant SPNs. There were no significant differences in the gender, age, blood type, clinical manifestations, distribution of tumor sites, morphological features, and proportions of combined calcification, intracapsular hemorrhage, and pancreatic ductal dilatation between the benign and malignant SPN patients (P>0.050). The maximum diameter of the tumor, the integrity of the capsule, and the ratio of the tumor cystic solidity had significant differences (P<0.050) between the benign and malignant SPN patients. That was, in patients with benign SPN, the largest tumor diameter was less than or equal to 5 cm, and the capsule was complete, and the tumor was mainly cystic and solid. Of the 27 patients with benign SPN, 6 underwent the tumor enucleation, 7 underwent the standard pancreatoduodenectomy, 2 underwent the middle pancreas resection, 5 underwent the standard caudal pancreatectomy, and 7 underwent the spleen-preserving caudal pancreatectomy. Of the 12 patients with malignant SPN, 8 underwent the standard pancreatoduodenectomy and 4 underwent the standard caudal pancreatectomy. All the patients were discharged after surgery and no intra-abdominal infection occurred. The pancreatic leakage occurred in 4 patients and recoved after the full drainage. The average follow-up was 24.5 months, no patient had the tumor metastasis or recurrence, and no patient died. Conclusions Incomplete capsule and the largest diameter >5 cm may suggest malignancy of SPN, and near-solid tumors may be indicative of benignancy. Surgery is a crucial and most effective treatment for SPN, and it is suggested that routine radical operation is performed for malignant SPN.

Citation： ZHU Shiyu, XU Xincai, CHENG Kun, Sulidankazha·Chouman, CHEN Qilong, LIN Hai. Clinical characteristics and diagnosis and treatment of benign and malignant solid pseudopapillary neoplasm of pancreas. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(7): 825-831. doi: 10.7507/1007-9424.201712053 Copy

1.	Naar L, Spanomichou DA, Mastoraki A, et al. Solid pseudopapillary neoplasms of the pancreas: a surgical and genetic enigma. World J Surg, 2017, 41(7): 1871-1881.
2.	Bosman FT, Carneiro F, Hruban RH, et al. WHO classification of tumors of the digestive system. 4th edition. Lyon: IARC Press, 2010.
3.	Kang CM, Kim KS, Choi JS, et al. Solid pseudopapillary tumor of the pancreas suggesting malignant potential. Pancreas, 2006, 32(3): 276-280.
4.	Yin Q, Wang M, Wang C, et al. Differentiation between benign and malignant solid pseudopapillary tumor of the pancreas by MDCT. Eur J Radiol, 2012, 81(11): 3010-3018.
5.	Hwang J, Kim DY, Kim SC, et al. Solid-pseudopapillary neoplasm of the pancreas in children: can we predict malignancy? J Pediatr Surg, 2014, 49(12): 1730-1733.
6.	Chung YE, Kim MJ, Choi JY, et al. Differentiation of benign and malignant solid pseudopapillary neoplasms of the pancreas. J Comput Assist Tomogr, 2009, 33(5): 689-694.
7.	Frantz VK. Papillary tumors of the pancreas: benign or malignant? Tumor of the pancreas//Atlas of tumor pathology. Washington, DC: Armed Forces Institute of Pathology, 1959: 32-33.
8.	Kloppel G, Solcia E, Longnecker DS, et al. Histological typing of tumors of the exocrine pancreas//World Health Organisation International histological classification of tumors. 2nd ed. Berlin: Springer, 1996: 8452/1.
9.	Law JK, Ahmed A, Singh VK, et al. A systematic review of solid-pseudopapillary neoplasms: are these rare lesions? Pancreas, 2014, 43(3): 331-337.
10.	Kang CM, Choi SH, Kim SC, et al. Predicting recurrence of pancreatic solid pseudopapillary tumors after surgical resection: a multicenter analysis in Korea. Ann Surg, 2014, 260(2): 348-355.
11.	Vassos N, Agaimy A, Klein P, et al. Solid-pseudopapillary neoplasm (SPN) of the pancreas: case series and literature review on an enigmatic entity. Int J Clin Exp Pathol, 2013, 6(6): 1051-1059.
12.	Kosmahl M, Seada LS, Jänig U, et al. Solid-pseudopapillary tumor of the pancreas: its origin revisited. Virchows Arch, 2000, 436(5): 473-480.
13.	Ansari NA, Ramalho M, Semelka RC, et al. Role of magnetic resonance imaging in the detection and characterization of solid pancreatic nodules: An update. World J Radiol, 2015, 7(11): 361-374.
14.	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(10): 1209-1214.
15.	Butte JM, Brennan MF, Gönen M, et al. Solid pseudopapillary tumors of the pancreas. Clinical features, surgical outcomes, and long-term survival in 45 consecutive patients from a single center. J Gastrointest Surg, 2011, 15(2): 350-357.
16.	徐明月, 史宪杰, 何蕾, 等. 直径≤5 cm 与直径>5 cm 的胰腺实性假乳头状瘤的临床病理特点及预后比较. 南方医科大学学报, 2016, 36(6): 780-784.
17.	曹文新, 夏进东, 许凡勇. 不同性别胰腺实性假乳头状瘤的 CT 表现. 临床放射学杂志, 2015, 34(11): 1762-1765.
18.	Marchegiani G, Andrianello S, Massignani M, et al. Solid pseudopapillary tumors of the pancreas: Specific pathological features predict the likelihood of postoperative recurrence. J Surg Oncol, 2016, 114(5): 597-601.
19.	Huang YS, Chen JL, Chang CC, et al. Solid pseudopapillary neoplasms of the pancreas: imaging differentiation between benignity and malignancy. Hepatogastroenterology, 2014, 61(131): 809-813.
20.	Tang SS, Huang LP, Wang Y, et al. Solid pseudopapillary tumors of the pancreas: contrast-enhanced sonographic features. J Ultrasound Med, 2012, 31(2): 257-263.
21.	Khashab MA, Kim K, Lennon AM, et al. Should we do EUS/FNA on patients with pancreatic cysts? The incremental diagnostic yield of EUS over CT/MRI for prediction of cystic neoplasms. Pancreas, 2013, 42(4): 717-721.
22.	Law JK, Stoita A, Wever W, et al. Endoscopic ultrasound-guidedfine needle aspiration improves the preoperative diagnostic yield of solid-pseudopapillary neoplasm of the pancreas: an international muhicenter case series (with video). Surg Endosc, 2014, 28(9): 2592-2598.
23.	中华医学会外科学分会胰腺外科学组. 胰腺囊性疾病诊治指南 (2015). 中华外科杂志, 2015, 53(9): 641-645.
24.	Farrell JJ. Pancreatic cysts and guidelines. Dig Dis Sci, 2017, 62(7): 1827-1839.
25.	Tajima Y, Kohara N, Maeda J, et al. Peritoneal and nodal recurrence 7 years after the excision of a ruptured solid pseudopapillary neoplasm of the pancreas: report of a case. Surg Today, 2012, 42(8): 776-780.
26.	Lubezky N, Papoulas M, Lessing Y, et al. Solid pseudopapillary neoplasm of the pancreas: Management and long-term outcome. Eur J Surg Oncol, 2017, 43(6): 1056-1060.
27.	Divarcı E, Dökümcü Z, Çetingül N, et al. Radical resection of the pancreas should not always be necessary in the surgical management of pancreatic solid pseudopapillary tumor in children. Turk J Gastroenterol, 2017, 28(3): 214-218.
28.	杨含, 李宁, 邓文英, 等. 胰腺实性假乳头状肿瘤的临床特征手术策略及预后. 中华肿瘤杂志, 2017, 39(3): 211-215.
29.	Jutric Z, Rozenfeld Y, Grendar J, et al. Analysis of 340 patients with solid pseudopapillary tumors of the pancreas: a closer look at patients with metastatic disease. Ann Surg Oncol, 2017, 24(7): 2015-2022.
30.	Tesaříková J, Loveček M, Neoral Č, et al. Solid pseudopapillary neoplasms of the pancreas. Rozhl Chir, 2017, 96(4): 163-167.
31.	Xu Y, Zhao G, Pu N, et al. One hundred twenty-one resected solid pseudopapillary tumors of the pancreas: an 8-year single-institution experience at Zhongshan Hospital, Shanghai, China. Pancreas, 2017, 46(8): 1023-1028.
32.	Bochis OV, Bota M, Mihut E, et al. Solid pseudopapillary tumor of the pancreas: clinical-pathological features and management of 13 cases. Clujul Med, 2017, 90(2): 171-178.

1. Naar L, Spanomichou DA, Mastoraki A, et al. Solid pseudopapillary neoplasms of the pancreas: a surgical and genetic enigma. World J Surg, 2017, 41(7): 1871-1881.
2. Bosman FT, Carneiro F, Hruban RH, et al. WHO classification of tumors of the digestive system. 4th edition. Lyon: IARC Press, 2010.
3. Kang CM, Kim KS, Choi JS, et al. Solid pseudopapillary tumor of the pancreas suggesting malignant potential. Pancreas, 2006, 32(3): 276-280.
4. Yin Q, Wang M, Wang C, et al. Differentiation between benign and malignant solid pseudopapillary tumor of the pancreas by MDCT. Eur J Radiol, 2012, 81(11): 3010-3018.
5. Hwang J, Kim DY, Kim SC, et al. Solid-pseudopapillary neoplasm of the pancreas in children: can we predict malignancy? J Pediatr Surg, 2014, 49(12): 1730-1733.
6. Chung YE, Kim MJ, Choi JY, et al. Differentiation of benign and malignant solid pseudopapillary neoplasms of the pancreas. J Comput Assist Tomogr, 2009, 33(5): 689-694.
7. Frantz VK. Papillary tumors of the pancreas: benign or malignant? Tumor of the pancreas//Atlas of tumor pathology. Washington, DC: Armed Forces Institute of Pathology, 1959: 32-33.
8. Kloppel G, Solcia E, Longnecker DS, et al. Histological typing of tumors of the exocrine pancreas//World Health Organisation International histological classification of tumors. 2nd ed. Berlin: Springer, 1996: 8452/1.
9. Law JK, Ahmed A, Singh VK, et al. A systematic review of solid-pseudopapillary neoplasms: are these rare lesions? Pancreas, 2014, 43(3): 331-337.
10. Kang CM, Choi SH, Kim SC, et al. Predicting recurrence of pancreatic solid pseudopapillary tumors after surgical resection: a multicenter analysis in Korea. Ann Surg, 2014, 260(2): 348-355.
11. Vassos N, Agaimy A, Klein P, et al. Solid-pseudopapillary neoplasm (SPN) of the pancreas: case series and literature review on an enigmatic entity. Int J Clin Exp Pathol, 2013, 6(6): 1051-1059.
12. Kosmahl M, Seada LS, Jänig U, et al. Solid-pseudopapillary tumor of the pancreas: its origin revisited. Virchows Arch, 2000, 436(5): 473-480.
13. Ansari NA, Ramalho M, Semelka RC, et al. Role of magnetic resonance imaging in the detection and characterization of solid pancreatic nodules: An update. World J Radiol, 2015, 7(11): 361-374.
14. 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(10): 1209-1214.
15. Butte JM, Brennan MF, Gönen M, et al. Solid pseudopapillary tumors of the pancreas. Clinical features, surgical outcomes, and long-term survival in 45 consecutive patients from a single center. J Gastrointest Surg, 2011, 15(2): 350-357.
16. 徐明月, 史宪杰, 何蕾, 等. 直径≤5 cm 与直径>5 cm 的胰腺实性假乳头状瘤的临床病理特点及预后比较. 南方医科大学学报, 2016, 36(6): 780-784.
17. 曹文新, 夏进东, 许凡勇. 不同性别胰腺实性假乳头状瘤的 CT 表现. 临床放射学杂志, 2015, 34(11): 1762-1765.
18. Marchegiani G, Andrianello S, Massignani M, et al. Solid pseudopapillary tumors of the pancreas: Specific pathological features predict the likelihood of postoperative recurrence. J Surg Oncol, 2016, 114(5): 597-601.
19. Huang YS, Chen JL, Chang CC, et al. Solid pseudopapillary neoplasms of the pancreas: imaging differentiation between benignity and malignancy. Hepatogastroenterology, 2014, 61(131): 809-813.
20. Tang SS, Huang LP, Wang Y, et al. Solid pseudopapillary tumors of the pancreas: contrast-enhanced sonographic features. J Ultrasound Med, 2012, 31(2): 257-263.
21. Khashab MA, Kim K, Lennon AM, et al. Should we do EUS/FNA on patients with pancreatic cysts? The incremental diagnostic yield of EUS over CT/MRI for prediction of cystic neoplasms. Pancreas, 2013, 42(4): 717-721.
22. Law JK, Stoita A, Wever W, et al. Endoscopic ultrasound-guidedfine needle aspiration improves the preoperative diagnostic yield of solid-pseudopapillary neoplasm of the pancreas: an international muhicenter case series (with video). Surg Endosc, 2014, 28(9): 2592-2598.
23. 中华医学会外科学分会胰腺外科学组. 胰腺囊性疾病诊治指南 (2015). 中华外科杂志, 2015, 53(9): 641-645.
24. Farrell JJ. Pancreatic cysts and guidelines. Dig Dis Sci, 2017, 62(7): 1827-1839.
25. Tajima Y, Kohara N, Maeda J, et al. Peritoneal and nodal recurrence 7 years after the excision of a ruptured solid pseudopapillary neoplasm of the pancreas: report of a case. Surg Today, 2012, 42(8): 776-780.
26. Lubezky N, Papoulas M, Lessing Y, et al. Solid pseudopapillary neoplasm of the pancreas: Management and long-term outcome. Eur J Surg Oncol, 2017, 43(6): 1056-1060.
27. Divarcı E, Dökümcü Z, Çetingül N, et al. Radical resection of the pancreas should not always be necessary in the surgical management of pancreatic solid pseudopapillary tumor in children. Turk J Gastroenterol, 2017, 28(3): 214-218.
28. 杨含, 李宁, 邓文英, 等. 胰腺实性假乳头状肿瘤的临床特征手术策略及预后. 中华肿瘤杂志, 2017, 39(3): 211-215.
29. Jutric Z, Rozenfeld Y, Grendar J, et al. Analysis of 340 patients with solid pseudopapillary tumors of the pancreas: a closer look at patients with metastatic disease. Ann Surg Oncol, 2017, 24(7): 2015-2022.
30. Tesaříková J, Loveček M, Neoral Č, et al. Solid pseudopapillary neoplasms of the pancreas. Rozhl Chir, 2017, 96(4): 163-167.
31. Xu Y, Zhao G, Pu N, et al. One hundred twenty-one resected solid pseudopapillary tumors of the pancreas: an 8-year single-institution experience at Zhongshan Hospital, Shanghai, China. Pancreas, 2017, 46(8): 1023-1028.
32. Bochis OV, Bota M, Mihut E, et al. Solid pseudopapillary tumor of the pancreas: clinical-pathological features and management of 13 cases. Clujul Med, 2017, 90(2): 171-178.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical characteristics and diagnosis and treatment of benign and malignant solid pseudopapillary neoplasm of pancreas

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