Differential Biological Behavior And Expression Of Sex Hormone Receptors In Solid Pseudopapillary Neoplasms Of The Pancreas

Objective To investigate whether there are differences in the aggressiveness and sex hormone receptor expression among various clinicopathologic indicators in patients with solid pseudopapillary neoplasms of the pancreas,and whether the expression degree of sex hormone receptor can affect the aggressiveness of the tumor,so as to try to predict the aggressiveness of the tumor before surgery.Methods The clinical data of 54 patients who were pathologically diagnosed as solid pseudopapillary neoplasms of the pancreas from General Hospital of Ningxia Medical University from September 2009 to September 2022 were collected to investigate whether there were differences in clinical features,imaging findings,pathology,immunohistochemistry and other indicators in biological behavior and sex hormone receptor expression.Results 1.Biological behavior:Among the 54 patients,33 had high invasive SPN,with an average age of 35.45 years.There were 21 patients with low invasive SPN,with a mean age of 27.19 years,and patients with high invasive SPN were older(P=0.021).There were 6 male patients with an average age of 43.2 years old,and 48 female patients with an average age of 30.6 years old,with a male-female ratio of 1:8.There were 6 cases of high invasive SPN in males(100%)and 27 cases of high invasive SPN in females(55.1%),and the difference was not statistically significant(P=0.071).The sex age-frequency distribution map showed that males had a unimodal distribution and females had a bimodal distribution.Imaging studies suggested that patients with tumor diameter≤5cm had a higher proportion of highly invasive SPN than those with tumor diameter>5cm(45.5%vs85.7%,P=0.003).Linear regression analysis of tumor length diameter and age showed that tumor length diameter was negatively correlated with age(R~2=0.1184,P=0.005),and the tumors were smaller in older patients than in younger patients.2.Immunohistochemical staining:AR was highly expressed in 38 cases(70.4%)and low expressed in 16 cases(29.6%).All ER showed low expression.41 cases(75.9%)in the high expression group and 13 cases(24.1%)in the low expression group.The proportion of premenopausal women in high PR expression group was significantly higher than that in low PR expression group(94.6%vs 63.6%,P=0.019).In terms of biological behavior,the low expression group was more invasive(P=0.046).In terms of preoperative imaging examination of patients,24 cases(58.5%)in the highly expressed group had tumor length diameter>5cm,and 3 cases(23.1%)in the low-expressed group had tumor length diameter>5cm,which was statistically significant in the comparison between the two groups(P=0.026).The tumor components of SPN with high PR expression were mainly cyst-solid(63.4%),while the tumor components with low PR expression were mostly solid(69.2%),showing a statistical difference(P=0.030).Conclusion1.SPN is a rare low-grade malignant tumor of pancreas,mostly occurring in young women,with unique gender and age distribution characteristics.2.Risk factors for malignant biological behavior of SPN:elderly,male,postmenopausal women,tumor length≤5cm,and low expression of PR.3.SPN with high PR expression and low PR expression have different clinical characteristics,such as higher proportion of premenopausal women,larger tumor length and diameter,and cystic solid tumor composition.