Solid, infiltrating variety of papillary cystic neoplasm of the pancreas

Abstract

Four tumors with histologic, histochemical, and ultrastructural characteristics of papillary cystic neoplasm of the pancreas but lacking the capsule commonly observed in papillary cystic neoplasm and infiltrating interiorly into the pancreatic parenchyma were seen in two men and two women who were 39 to 51 years old. These tumors contrasted with typical encapsulated papillary cystic neoplasms that show extrapancreatic growth and that are detected as a palpable abdominal mass in young women. These four tumors, although unpalpable, were all detected by nodular images of calcification in abdominal plain radiography. The tumors had a mean diameter of 3.1 cm (range, 1.7 to 4.5 cm), were confined within the pancreatic parenchyma, and showed central fibrosis accompanied by dystrophic changes such as calcification and ossification. A small necrotic cyst contiguous to the fibrous focus also was observed in the tumor in three patients. Tumor cells similar to those of a papillary cystic neoplasm had infiltrated among the pancreatic parenchyma in solid and pseudopapillary patterns, and pleomorphic atypism was observed in some parts of the tumor in three patients. These tumors were tentatively designated solid, infiltrating variety of papillary cystic neoplasms to differentiate them from ordinary encapsulated papillary cystic neoplasms. Although no signs of recurrence have been noticed after surgical treatment in these patients, the infiltrating growth pattern and the presence of pleomorphic atypism suggest higher malignancy than the ordinary papillary cystic neoplasm. The contrasting growth pattern and possible malignancy may warrant establishment of these tumors as a papillary cystic neoplasm subclass. Materials and MethodsClinical records and follow-up information were reviewed in the four patients with unusual PCN. All resected tumors were fixed in 10% neutral buffered formalin and embedded in paraffin. The specimens were stained with hematoxylin and eosin, periodic acid-Schiff (PAS) with and without diastase digestion, alcian blue, and Grimelius argyrophil staining and examined immunohistochemically for the localization of hormones, enzymes, and tumor-associated antigens. The immunohistochemical 2747

Peritoneal and nodal recurrence 7 years after the excision of a ruptured solid pseudopapillary neoplasm of the pancreas: report of a case

“…On the other hand, recurrence of the disease, including hepatic metastasis and local recurrence, develops in 4.3-6.6 % of patients with SPN even after a radical resection [11,12]. Clinicopathological features such as vascular or perineural invasion, capsular and pancreatic parenchyma involvement, increased nuclear atypia and pleomorphism, a high mitotic rate, prominent necrobiotic nests, a diffuse growth pattern and spindle sarcomatoid cells, and bizarre giant tumor cells may be associated with malignant behavior of SPNs [3,[19][20][21][22][23]. Moreover, DNA aneuploidy, Ki-67 overexpression, and an elevated proliferative index may indicate malignant SPNs [22,24].…”

Nonductal neoplasms of the pancreas

“…4,169,170 These tumors predominantly affect females (89% female), with a mean age of 28 years (range of 7-79 years). Most patients present with nonspecific symptoms related to the intra-abdominal mass, 169,[171][172][173] and a palpable mass or incidental radiographic finding may be the route of tumor discovery in asymptomatic individuals. Rarely solid-pseudopapillary neoplasms rupture, causing potentially life-threatening hemoperitoneum.…”

Solid pseudopapillary tumor of the pancreas: a multicenter study of 23 pediatric cases

“…Unlike other childhood pancreatic malignancies, the prognosis after surgical resection is quite favorable. A survival rate higher than 95% has been report ed in severa l studies [2][3][4] . The rarity of this tumor makes a large-scale study impossible; therefore, we decided to perform a multicenter study of this unusual neoplasm.…”