Multiple liver metastases of pancreatic solid pseudopapillary tumor treated with resection following chemotherapy and transcatheter arterial embolization: A case report

Abstract

A 33-year-old female was diagnosed with a solid pseudopapillary tumor (SPT) of the pancreas and multiple liver metastases at the Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital (Kanazawa, Japan). Distal pancreatectomy and postoperative systemic chemotherapy with gemcitabine (GEM) and S-1, an oral fluoropyrimidine derivative, was administered, however, liver metastases became enlarged and local recurrence occurred. Therefore, the patient was referred to the Department of Gastroenterologic Surgery at the Graduate School of Medicine (Kanazawa, Japan) for hepatic arterial infusion (HAI) chemotherapy. Oral S-1 (80 mg/m2) was administered as well as HAI chemotherapy with GEM (1,000 mg/standard liver volume). Following 18 cycles, tumor sizes were reduced and 18-fluorodeoxyglucose positron emission tomography (18FDG-PET) examination revealed obvious reduction of tumor FDG uptake. Transarterial tumor embolization (TAE) was performed for the previously unresectable right subphrenic liver tumor, and the other tumors were surgically resected. The resected tumors were diagnosed as liver metastases and a local recurrence of SPT in the postoperative pathological examination, which revealed that the resected tumors were composed of sheets of bland cells, which were positive for CD10, CD56, vimentin, neuron-specific enolase and α-antitrypsin. The postoperative course was uneventful, and the patient is currently under observation at an outpatient clinic; postoperative adjuvant chemotherapy with oral S-1 has continued, and additional TAE is planned. In the future, if the middle segment of the liver becomes enlarged, surgery for the residual right lobe tumor may be possible. This case demonstrates one method of SPT treatment: Preoperative HAI chemotherapy with GEM, plus oral S-1 and TAE. If complete resection can be achieved, the majority of patients with SPT have a favorable prognosis. In patients with unresectable metastases from SPT, it is crucial to conduct systematic multimodal treatment to maximize treatment success.

Prediction of malignancy and adverse outcome of solid pseudopapillary tumor of the pancreas

“…Patients with benign SPTP are still at risk of tumor recurrence or metastasis after surgical resection. Contemporary evidence supports surgery as the primary treatment for patients with operable metastatic SPTP[ 48 , 66 ]. One obstacle to better management of patients is the lack of a predictive classification that accurately describes the complexity and heterogeneity of this disease.…”

Solid pseudopapillary tumor of the pancreas: A case report

“…Since it is a low-grade malignancy and surgical resection of the tumor is the only curative option, data regarding the impact of adjuvant chemotherapy on the outcomes are limited and con-troversial. However, systemic multimodal treatment may benefit when metastatic disease is present (7).…”

Solid pseudopapillary tumour (Frantz’s tumour) of the pancreas in childhood: successful management of late liver metastases with sunitinib and chemoembolisation

“…The reported follow-up was relatively brief (3 months), but no recurrence was noted on CT during that interval. However, Tajima et al 15 caution incomplete RFA may induce dedifferentiation27 and epithelial-mesenchymal transition of the tumour28 as noted in hepatocellular carcinoma when reviewing the report by Li et al .…”

“…Recently, Tajima et al described the use of chemoembolisation in metastatic and recurrent SPT in a woman aged 33 years 15. The patient was diagnosed with metastatic SPT and underwent distal pancreatectomy and adjuvant gemcitabine and S-1, an oral fluoropyrimidine derivative.…”