CCK-2/Gastrin-R Immunodistribution in a Solid Pseudopapillary Pancreatic Tumor: A Case Report of a 28-Years-Old North African Woman

Abstract

The presence of a large bulky pancreatic tumour in a young female should raise suspicions of the diagnosis of solid-pseduopapillary tumour of the pancreas.Solid pseudopapillary neoplasms of the pancreas are uncommon, accounting for only 1-2% of all pancreatic neoplasms. These tumors are being detected at an increased rate, probably due to the increased awareness and the liberal use of imaging.We report a case of a 28-year-old North African woman with no prior medical or surgical history diagnosed with solid pseudopapillary pancreatic tumor. Our immunohistochemical study demonstrated that the tumor cells were positive for CCK-2/gastrin receptors and that were highly expressed within the cytoplasmic area of the cells. Hence we attempted to raise a hypothesis and to establish a link between some female hormones which represents powerful regulators of the expression of CCK and their possible impact on the development of solid pseudopapillary pancreatic tumours in young women.were unremarkable. Laboratory data including hematology, blood chemistry including amylase and lipase, as well as tumor markers were within the reference limits (CEA = 0.692 ng/ml, CA 125 = 12.27 Ul/ml, and CA 19-9 = 22.59 Ul/ml).Ultrasound imaging (Figure 1) showed a solid heterogeneous mass at the level of left quadrant measuring 124 mm.CT scan of the abdomen ( Figure 2) revealed a voluminous hypoattenuating mass in the tail and the body of the pancreas, measuring 127mm x 87mm with multiple intratumoral vessels.After a surgical biopsy was performed; histological examination demonstrated a solid pattern with non infiltrant pseudopapillary cores; the tumor was found to be confined to the pancreas ( Figure 3). Our immunohistochemical analysis revealed that the tumor cells IntroductionSolid Pseudopapillary Tumor (SPT) of the pancreas is a very rare entity with a reported incidence of 0.13% to 2.7% of all pancreatic tumors [1], this tumor was once described in many other terms, such as Frantz's tumor, solid and cystic tumor, papillary cystic neoplasm, and solid and papillary epithelial neoplasm [2].It is almost exclusively seen in females and occurs in the second or third decades of life [3], suggesting that this tumor is associated with some female hormones and their receptors such as estrogen, progesterone and opioids [4,5]. Several lines of evidence support the role of G protein-coupled receptor cholecystokinin 2 and gastrin (CCK-2R/gastrin-R) in pancreatic cancer development [6,7].In order to study immunohistochemical features of G protein coupled CCK2/gatrin receptors in this kind of rare tumors, we herein present a case of solid pseudopapillary pancreatic tumor associated with a positive CCK-2/gastrin-R reactivity. Case ReportA 28-year-old North African woman with no prior medical or surgical history presented with complaints of epigastric and right upper quadrant (RUQ) pain and decreased appetite during one month. Her pulse rate was 72 min-1 and her blood pressure was 110/60 mmHg. There was no precipitating or aggravating factor and...