Solid Pseudopapillary Tumor of the Pancreas: Typical and Atypical Manifestations

Abstract

Solid pseudopapillary tumor of the pancreas is a rare neoplasm usually found in young women. Typical solid pseudopapillary tumor is characterized by a well-encapsulated mass with varying amounts of intratumoral hemorrhage. However, the tumor can have an atypical appearance, such as metastasis, ductal obstruction, parenchymal and extracapsular invasion, simulation of islet cell tumor, intratumoral calcification, and occurrence in a male patient. The typical and atypical manifestations of solid pseudopapillary tumor can be visualized with cross-sectional imaging.

Solid pseudopapillary neoplasm of the pancreas: CT imaging features and radiologic-pathologic correlation

“…Buetow et al (5) described peripheral calcification as a feature of SPNs. However, other patterns such as coarse central (from dystrophic calcification), stippled, and eggshell calcifications have also been reported (15,16). A variety of patterns of calcifications were noted in our study as well.…”

“…These lesions were also large, measuring between 7.7 and 21.4 cm. There is limited data on the incidence of splenic invasion in SPNs, although it has been described as an infrequent feature, which may be associated with an increased potential for malignant behavior (15,17). In Papavramidis's review, it was only seen in 17 of 497 adequately described cases (3.4%) (4).…”

“…The presence of solid enhancing components and absence of stigmata of pancreatitis differentiates the large solid-cystic SPNs from pancreatic pseudocysts and walled-off collections (19), while the younger age at presentation may help in distinguishing them from mucinous cystic neoplasms of the pancreas (15,20). With early hyperenhancement in smaller lesions and lack of solid components in the larger ones, serous cystadenomas are unlikely to mimic SPNs (11,15,21). Compared with adenocarcinomas, SPNs have welldefined margins with no ductal dilatation or upstream pancreatic atrophy.…”

A Case of Solid Pseudopapillary Neoplasm of the Pancreas Presenting with Left-sided Extrahepatic Portal Hypertension

“…It is likely that the splenic phlebitis resulted in various compensatory changes including collateral drainage through the short gastric veins, which subsequently resulted in engorgement of the vessels along the gastric body wall and the formation of gastric varices. The present patient had a typical SPN based on both imag-ing and pathological findings (11,15,16). The CT showed a large encapsulated mass with variable solid and cystic components caused by hemorrhagic degeneration.…”

Invisible fat on CT: making it visible by MRI

“…Differentiation from malignant cystic carcinoma is challenging unless fluid-fluid level or fat component is revealed. However, fluid-fluid level may also be seen with metastatic pancreatic masses as a result of hemorrhage (26). Thus, the key to diagnose lymphangioma is to reveal the fat content, which is frequently invisible on CT (Fig.…”