| Objective: to explore the clinical features,imaging manifestationgs and pathological characters,preoperative diagnosis,reasonable treatment and prognosis of solid pseudopapillary neoplasm of pancreas(SPN)and deepen the understanding of SPN.Methods: at The Fourth Hospital of Hebei Medical University between February 2009 to September 2016,40 SPN cases surgically treated and confirmed by postoperative pathology were analyzed retrospectively and we summarized the patients’ clinical characteristics,imaging features,surgical methods and pos toperative pathological results to analyze the related factors.Results:1 Among 40 cases,male-to-female ratio was 1:9 with the average age of28.85 years(10-53).The mean age of women(29.19±11.30)was much older than the man(25.75±16.09).In terms of the age distribution,the ages of male patients mainly focused under 20 years old,while female patients’ ages focused around 30 years old.The analysis showed that there were no significant differences in the average age of patients,age distribution by grouping the patients’ gender(P>0.05).2 There were no typical clinical symptoms in SPN patients.40% of the patients presented with epigastric pain discomfort;37.5% of the patients with no obvious symptoms were found by physical examination;the patients with back discomfort accounted for 10.0% and the proportion of patients with abdominal mass was also 10.0%.All patients had no history of abdominal trauma and pancreatic diseases.3 The preoperative laboratory examination showed no abnormalities.Preoperative imaging examination had relative characteristics.10 cases of abdominal ultrasonography showed that the neoplasms were characterized bycystic or solid mass with low echo.The neoplasms were displayed as low density space-occupying lesions with complete caplule by CT in 29 cases.Enhanced CT showed the irregular enhancement existed around the neoplasms.2 patients’ CT examinations showed that the bile duct and pancreatic duct expanded.1 cases of patients with CT showed splenic space-occupying lesions.19 cases of patients with MRI persented that the neoplasms were characterized by the cystic or solid mixed signals.4 Imaging examination had guiding significance for the diagnosis of SPN.During the operations,we found that 9 cases were located in pancreatic head,3 cases were in pancreas neck,28 cases were in the body and tail of pancreas.The localization diagnostic rate was 97.5%.23 cases were diagnosed with SPN and the qualitative diagnosis rate was 57.5%.5 The diagnosis depended on the postoperative pathologic results of the false papillary structure.The average maximum diameter of tumors was6.67±3.45cm(2.5-20cm).Immunohistochemical results showed that CD56(100%),AACT(100%),Vimentin(94.87%),PR(93.10%),Syn(89.47%),CD10(85.29%),NSE(80.95%),while the CgA was totally negative.6 All patients underwent the surgical treatments.9 cases of tumors located in the pancreatic head were performed with pancreaticoduodenectomy.6 cases performed with segmental pancreatic resection plus pancreaticojeju nostomy "Roux-en-y" were located in the neck of pancreas(3 cases)and the body of the pancreas(3 cases).18 cases of patients whose neoplasms were located in the body and tail of pancreas underwent distal pancreatectomy plus spleen resection.3 cases of tumors which were situated on the pancreatic body and tail underwent distal pancreatectomy.4 case of distal pancreatectomy plus spleen resection was completed by laparoscopy.All patients have not received chemotherapy or radiotherapy.All patients recovered well.9 cases of paitents occurred postoperative pancreatic fistula,including 2 cases of intraabdominal infection.The incidence of pancreatic leakage was 22.5%(9/40).After given somatostatoin,adequate drainage and nutritional support treatment,all patients recovered well.1 case of pancreatic pseudocyst was recorded.No death caseoccurred in the perioperative period.7 All patients were followed up with an average follow-up time of 40.45months(3-93 month).All patients were good survival.No recurrence and metastasis were found.Conclusion:1 SPN is a low-grade malignant tumor that mostly occurs in the body and tail of the pancreas and it primarily affects young females.In recent years,the incidence of it has increased.SPN has no obvious specific clinical manifestat ions and laboratory examination.2 The imaging examinations has relatively characteristic performance including pancreatic cystic or solid lesions with low density,intact capsule,clear boundaries,rare bile and pancreatic duct expansion,irregular peripheral reinforcement of neoplam.The above characeristics contribute to the preliminary diagnosis of disease and the choice of operation method.3 Preoperative diagnosis of SPN is mainly based on imaging features.If the patient is a young woman and the tumor markers are nomal,the patient is more likely to be diagnosed with SPN.It is easily confused with other pancreatic malignancy,finally the treatment is delayed.4 The diagnosis depended on the postoperative pathologic results of the false papillary structure.There is not specific immunohistochemical markers.5 SPN is mainly treated by surgery with the high resection rate and the good treatment effect.Active surgical resection is necessary even if the local tissue is being violated.It is recorded that the patients achieve long-term survival after the cytoreductive surgery.Postoperative recurrence or metastasis is rare and reoperation can still get relatively good prognosis.Because of the good biological characteristics of the disease and tumor capsule integrity,so complete resection with preservation of the surrounding tissues is an effective and safe treatment for SPN.On account of no lymph node dissection,the minimally invasive surgery of SPN is an appropriate choice.6 The prognosis is good postoperative after surgery.Due to the low-grade malignancy,patients should be followed up closely. |
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