| Background:Four patients with solid-pseudopapillary tumor of the pancreas(SPT) were first reported by Frantz.So SPT also was called Frantz tumor. All the patients were misdiagnosed as non-functional islet cell tumorpreoperatly. Scholars according to the characteristics of solid, cystic and pseudopapillary structure of the pathology, the diagnosis has been labeled many different names,e.g. solid papillary epithelial tumor, solid-cystic tumor, papillary cystic tumor, solid cystic papillary tumor of acinar cells, etc. In 1996, World Health Organization named it as solid-pseudopapillary tumor of the pancreas, which is defined as a more consistent form of cell nests and the formation of solid pseudopapillary structure of epithelial tumors, often with bleeding and cystic change. SPT generally is benign, it rarely behave as malignant. Prevalence of SPT in all pancreatic tumor account for 0.13%to 2.7%. Clinical manifestations and pathology of SPT has different characteristics from other pancreatic tumors. In recent years, because of the in-depth understanding of the disease, clinical diagnosis of SPT has gradually increased.But it is still easily misdiagnosed preoperatively. Clinical data of seventeen patients with SPT treated at Qilu Hospital of Shandong University in nearly 4 years were reviewed, in order to improve the preoperative diagnosis of SPT rate and cure rate.Objective:To explore the clinical presentations of solid-pseudopapillary tumor of the pancreas and the diagnosis, treatment and prognosis of SPT, to improve the diagnostic rate and cure rate of SPT.Methods:Clinical data of the seventeen patients with SPT treated at Qilu Hospital of Shandong University from January 2006 to December 2009 were reviewed.Results:17 patients on average age of 24.3 years(ranged from 15-43 years), one was male, the other were femal, male to female ratio was 1:16 in this series. Clinical presentation included a palpable abdominal mass in five patients and abdominal distention and pain in another eight. Four patients were asymptomatic; their tumors were found incidentally on abdominal ultrasonic examination for other reasons. Ultrasonography revealed solid and solid-cystic masses of low echo in pancreas. CT scan found masses of low density in pancreas, while irregular enhancement appeared in the circumference or parenchyma of all tumors in enhanced CT scan sequences. Tumor markers in patients, serum were all negative. Four patients were diagnosed as SPT by B ultrasound guided preoperative abdominal fine-needle aspirates biopsy. The location of the tumors was:7 in the head and 10 in the body and tail of the pancreas. All the patients were treated surgically. Five patients underwent pancreaticoduodenectomy. Four patients underwent distal pancreatectomy. Six patients underwent distal pancreatectomy plus spleen resection. These two patients underwent simple tumor resection. The average diameter of the tumors in the seventeen patiens was 8.2cm(ranged from 3-20cm). All patients recovered well, and two cases had postoperative pancreatic fistula.The two patiets were treated by Somatostatin, then they recovered well. None of the patients received adjuvant therapy. All the patients were followed up. The average time was 21.6 months(ranged from 3-47 months). No evidence of recurrence and metastasis was found during the follow up period.Conclusions:Solid-pseudopapillary tumor of the pancreas is a rare tumor with low malignant potential, affecting primarily young women. Tumor of the pancreas which in children and young women shoul be suspected. Imaging techniques including B ultrasound, CT and MRI have comparative characteristics and are extremely important for the early diagnosis of SPT. B ultrasound or CT guided preoperative abdominal fine-needle aspirates biopsy could confirm the diagnosis. Surgical resection is generally curative and the prognosis is excellent. Postoperative patients should be closely followed, especially for pathological examination show invasion significantly. |
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