Diagnosis And Surgical Management Of Solid-pseudopapillary Tumor Of Pancreas

Solid-pseudopapillary tumor of pancreas (SPTP) is a rare primary neoplasm of the pancreas. It is classified to be a kind of boundary malignant tumor.SPTP has been described by many other synonyms, such as solid-cystic tumor, papillary-cystic tumor , solid and papillary epithelial neoplasm, low-grade papillary tumor. In 2004 the World Health Organization formally named it as SPT . The tumors contain a mixture of solid, cystic, and pseudopapillary patterns.In current years, its reporting both at home and abroad is on the rise . A possible explanation is a greater awareness of this disease and a better understanding of its diagnosis, with being named by WHO as well.But no consensus has been reached regarding diagnostic or therapeutic strategies. In order to study the methods of preoperative diagnosis and surgical treatment of SPTP,and improve the diagnostic or therapeutic efficacy,we retrospectively analyzed 19 cases of SPTP diagnoised between July 1998 and March 2008 in the second affiliated hospital of JILIN university and other several hospitals.Mean age of the 19 patients was 29.8years(range from 14 years to 58 years).Clinical presentation included a palpable abdominal mass in 5 patients (26.3%), abdominal pain in 6 cases(31.6%),and 7 patients (36.8%)were asymptomatic. One patient became much thinner in short period.(16.3%)Imageology check might accurately locate,but it is difficult to qualitation. The imaging appearance of SPTP is determined by the radio and distribution of the solid or cystic cells.Sonographic features and CT scans were similar in all patients: solid or cystic solid, few of SPTP might be organized completely in solid or cystic cells. 6 cases located in the head of pancreas, 11 in the body and the tail of pancreas,and 2 in the neck of pancreas.In our 19 cases , 2 cases were primarily organized in solid cells,14cases primarily in cystic cells,and 3cases were similar in the radio of solid or cystic cells. calcification was found in the margins in 2 patients.In our study,all the cases was operated successfully. Radical resection was performed in 5 patients, simple enucleation in 14 patients.Pancreatic fistula was found in 4 cases, and edematous pancreatitis in 2 cases. All of 19 patients was followed-up with the average time of 40months,one case died because of acute leukemia,18 cases were survived,without evidence of relapses and metastasis.At present,most of scholars think that the only one method of preoperative final diagnosis is puncturation and biopsy with sonography and CT scans to guide. However we think that sample originated from preoperative fine needle aspiration usually is too less to satisfy pathologic diagnosis.We tried to draw a qualitation with preoperative fine needle aspiration,but we failed due to the less sample.In my opinion,As for the objective condition of most of our Chinese hospitals,when we are faced with a patient with disease of pancreas,we should aggregately analyze his clinical feature and imaging characteristic,but not puncture.As long as we master the clinical feature and the imaging characteristic of SPTP,we could get a correct preoperative diagnosis.I believe that with the improvement of imageology and puncturation and pathology, fine needle aspiration and biopsy must become a major means about preoperative diagnosis of SPTP.Conclusion:(1) SPTP is a tumor having a strong tendency to appear in young women. Most of clinical presentation included a Palpable abdominal mass,abdominal pain,and being asymptomatic. (2) it is difficult to draw a preoperative qualitation for patients of SPTP .Usually when we are faced with a patient whose sonography advise that solid or cystic solid occupying lesion lies in the pancreas without cholangiectasis or broaden canal of Wirsung,we must consider whether its diagnosis is SPTP.(3)the judgement on the capsular integrality of the tumor , tumorous location and frozen section could effect adoptable operative types.Postoperative complication is mostly pancreatic fistula and edematous pancreatitis which relate with operative course.(4) SPTP is classified to be a kind of boundary malignant tumor. its only one effective therapy is operation, most of patients are eusemia, with little evidence of relapses and metastasis.