Solid pseudopapillary neoplam of the pancreas (SPNP) is a rare tumour, making up approximately 1 % to 3 % of pancreatic tumours [1, 2]. About 90 % of SPNPs occur in young women (mean age 35 years) [3, 4]. SPNP rarely causes symptoms and is usually detected incidentally [4]. Differentiating SPNP from other pancreatic tumours is very important, because surgical resection may provide favourable outcomes [4, 5]. Metastases or invasion to other organs has been reported in 15 % to 20 % of patients with SPNP [1, 2, 5]. Histologically, the uniform, bland-appearing, epithelial cells of SPNP are similar to the cells making up other pancreatic endocrine neoplasms [4]. However, SPNP cannot be regarded as a pure pancreatic endocrine neoplasm because of the absence of chromogranin A expression and low expression of other endocrine markers [6]. SPNP has not been associated with specific serum tumour markers [7].
CT and MRI are used for the diagnosis and staging of SPNP [1, 2]. On contrast-enhanced CT, SPNP shows isoattenuation on precontrast CT, weak enhancement during the arterial phase and gradually increased enhancement during the portal venous phase [2]. SPNP can appear as an encapsulated lesion with cystic degeneration, necrosis, haemorrhage or calcification [2, 4]. MRI can characterise internal signal intensities, including a blood component, which is helpful in making a differential diagnosis [5]. Dong et al. [2] analysed CT and MRI findings from eight patients with SPNP and reported that four lesions showed mixed solid and cystic components, and the others appeared almost completely solid [2].
Stoita et al. [8] reported that EUS–guided fine-needle aspiration was a minimally invasive, safe and reliable diagnostic method for SPNP. They reported that all seven lesions examined were hypoechoic, heterogeneous and well circumscribed [8]. Their findings are very similar to the findings in our patient. In addition, it is clear from the EUS images of our patient that EUS provides better images for evaluating SPNP lesions than US of the pancreas (Figs. 1e and f and 2).
Fig. 1.
A 42-year-old woman underwent total hysterectomy because of myoma. Before the operation, contrast-enhanced abdominal CT (a to d) was done and an incidental pancreatic mass was found. Therefore, pancreatic ultrasonography (e) and endoscopic ultrasonography (f) were done. Arrows indicate a mass in the pancreatic tail (a-f). On CT, a mass was found in the pancreatic tail (a-d). The mass showed isoattenuation on the non-contrast-enhanced scan (a), weak enhancement during the arterial phase (b) and slightly increased enhancement during the portal venous phase (c and d). Ultrasonography of the pancreas showed a hypoechoic lesion (e). EUS revealed an inhomogeneous, honeycomb-like mass in the pancreatic tail (f)
Fig. 2.
F-18 FDG PET/CT was performed to identify areas of elevated glucose metabolism that might indicate malignant tumour and metastasis (a, oblique view of maximum intensity projection; b, axial fusion image; c, coronal fusion image). A focal hypermetabolic mass is seen in the pancreatic tail (arrows). Focal hypermetabolic activity with a SUVmax of 6.8 is shown in the lesion in the pancreatic tail (a-c), suggesting malignancy. There was no other lesion showing abnormal hypermetabolism. The patient underwent laparoscopic distal pancreatectomy. A 1.7 × 1.5 × 1.5-cm3, well-marginated and whitish-gray-coloured mass was found in the pancreatic tail. There was no communication with the pancreatic duct. Pathological examination confirmed that the lesion was SPNP
F-18 FDG PET/CT imaging findings of SPNP are rarely reported. Dong et al. [2] reported varying SUVmax values ranging from 2.5 to 29.1 in eight patients with SPNP. They reported that tumours with high cellularity were associated with increased SUVmax [2].
In our report, we described a patient with SPNP who was evaluated using multiple diagnostic imaging modalities, including PET/CT, CT, ultrasonography and endoscopic ultrasonography.
Acknowledgments
Conflict of Interest
None
Footnotes
This study was supported by research funding from Chosun University, 2011
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