Diagnosis And Treatment Of Solid Pseudopapillary Tumor Of Pancreas

Pancreatic carcinoma is a high degree malignant disease. Most patients had been in advanced stage. Its resection rate is just 15%-30%. 5-year survival rate for pancreatic carcinoma is 5%—10%. Most of surgeons feel pessimistic for the treatment of pancreatic carcinoma.Solid pseudopapillary tumor of pancreas (SPT) is a special type of pancreatic tumor with low degree malignancy. Its resection rate is high and the prognosis is satisfactory. The purpose of this study is to analysis clinical pathology of SPT and summarize the experience to improve the diagnosis and treatment of SPT.MethodsThe clinical records of 13 SPT patients managed in Sir Run Run Shaw hospital from January 1999 to October 2006 were retrospectively analyzed, including clinical presentation, laboratory & imaging examination, surgical complications, pathological diagnosis and follow up data. Allwere resected. Operative procedure indued pancreaticoduodenectomy (6 patients), distal pancreatectomy (1), distal pancreatectomy with splenectomy (2), laparoscopic distal pancreatectomy with splenectomy (2) , pancreatic neck segmentectomy (1), distal pancreatectomy,Sigmoid colectomy and ethanol injection of liver nodulars for SPT with liver metastasis,sigmoid colon carcinoma(1) .ResultsThere are 13 female patients, the mean age of these patients is 32 years old (10—57y). Abdominal pain was the major complain in 7 cases, abdominal mass in 3 cases , the other 3 cases are symptomless. Physical examination: palpable abdominal mass 5 cases, epigastric tenderness 2 cases . Abdominal ultrasonography revealed a low echoic which composed of solid and cystic components in 10 cases。 Only 2 cases were diagnosised as SPT by abdominal ultrasonography. The other 8 cases were diagnosised as cystadenocarcinoma of pancreas (2), pancreatic carcinoma (3), retroperitoneal tumor (3). CT demonstrated a well-encapsulated mass, hypodense, with various solid and cystic components in 12 cases. Only 7 cases were diagnosised as SPT by CT. The other 5 cases were diagnosised as cystadenocarcinoma of pancreas (2), pancreatic carcinoma (2), retroperitoneal tumor(1). Diagnosis was proved by postoperative paraffin section and enzyme labeling. The mean diameter of the tumors is 7.4cm (3.5cm—13cm) . Immunohistochemically, NSE positive(11/11 cases), VM positive(8/8cases) , a-AT positive(3/3cases), a-ACT positive(4/4 cases),PR positive(4/4 cases), Syn positive(6/9cases),CgA positive(5/ll cases), CK negative (6/10cases) , ER negative (2/2cases) , Insulin negative (2/2cases) . 10 cases were followed up with a median period of 29 months (1—68m)without tumor recurrence, patients have orthobiosis and proper functioning.ConclusionsSPT is a special type of pancreatic tumor with low degree malignancy, affecting predominantly in young women. Its prognosis is satisfactory. Complete resection resulted in long-term survival even in the presence of liver metastasis.