A Case of Solid Pseudopapillary Neoplasm of the Pancreas Presenting with Left-sided Extrahepatic Portal Hypertension

Nakamura, Shinichi; Takayama, Yoshiaki; Kuboki, Yuko; Haruyama, H; Kishino, Maiko; Konishi, Hiroyuki; Hatori, Takashi; Furukawa, Toru; Shiratori, Keiko

doi:10.2169/internalmedicine.49.3676

Cited by 10 publications

(7 citation statements)

References 14 publications

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“…Interestingly, our study found that tumors in the pancreatic body and tail were significantly associated with low PLR. The reason may be that SPTP involving this location is more likely to result in sinistral portal hypertension presenting with a decreased platelet count . Several studies have shown that elevated PLR was superior to NLR as a prognostic indicator for many malignancies such as breast cancer, soft‐tissue sarcoma, and colorectal carcinoma .…”

Section: Discussionmentioning

confidence: 99%

“…The reason may be that SPTP involving this location is more likely to result in sinistral portal hypertension presenting with a decreased platelet count. 28 Several studies have shown that elevated PLR was superior to NLR as a prognostic indicator for many malignancies such as breast cancer, soft-tissue sarcoma, and colorectal carcinoma. [29][30][31] We were unable to demonstrate the value of PLR in predicting clinical outcomes of SPTP, probably due to the small sample size.…”

Section: Inflammatory Markers and Rfs After Surgical Resectionmentioning

confidence: 99%

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Preoperative neutrophil‐to‐lymphocyte ratio predicts malignancy and recurrence‐free survival of solid pseudopapillary tumor of the pancreas

Yang

Bao

Zhou

et al. 2019

Journal of Surgical Oncology

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Background Systemic inflammatory markers such as neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐lymphocyte ratio (PLR) have been shown to be prognostic for many types of pancreatic malignancy. The aim of this study was to evaluate the prognostic role of these markers in patients with solid pseudopapillary tumor of the pancreas (SPTP). Methods Patients who underwent surgical resection for histologically confirmed SPTP were retrospectively reviewed in our institution. Preoperative NLR and PLR were calculated. Clinicopathologic data were correlated with the presence of malignant potential and recurrence‐free survival (RFS). Results A total of 113 patients with SPTP were included in this study. Of them, 23 were men and 90 were women, with a median age of 35 years (interquartile range, 25‐44). The optimal cut‐off values for malignant SPTP were 3.22 for NLR, and 75.5 for PLR, respectively. Univariate analysis showed that high NLR (>3.22) and white blood cell count more than 9.96 × 109/L were predictive of a malignant SPTP. Meanwhile, high NLR (P = 0.001) and age more than 35 years (P = 0.026) were associated with worse RFS. On multivariable analyses, high NLR was the only independent predictor of malignant SPTP (odd ratio 6.871; 95% confidence interval [CI], 1.482‐31.864; P = 0.014) and RFS (hazard ratio 12.633; 95% CI, 1.758‐90.790; P = 0.012). Conclusions This study highlights the supportive role of preoperative NLR in predicting malignancy and RFS of SPTP patients. Further studies including a larger cohort of patients are needed to corroborate our findings.

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Section: Discussionmentioning

confidence: 99%

Section: Inflammatory Markers and Rfs After Surgical Resectionmentioning

confidence: 99%

Preoperative neutrophil‐to‐lymphocyte ratio predicts malignancy and recurrence‐free survival of solid pseudopapillary tumor of the pancreas

Yang

Bao

Zhou

et al. 2019

Journal of Surgical Oncology

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“…1–8 In those cases of pancreatitis complicated by pseudocyst formation, the pseudocyst itself can cause compression of splenic vein. 1–4,12 The neoplastic associations include not only pancreatic tumors such as panNETs, 11–21 solid pseudopapillary neoplasms, 26 mucinous 27 or serous cystadenomas, 28 and ductal adenocarcinoma 2,6 but also nonpancreatic neoplasms, for example, renal cell carcinoma 29 and colonic lymphoma, 30 and even ectopic spleen. 31 Nonetheless, pancreatic tumors, particularly panNETs tumors, 11–21 are more commonly implicated than others.…”

Section: Discussionmentioning

confidence: 99%

Pancreatic Neuroendocrine Tumors Complicated by Sinistral Portal Hypertension: Insights into Pathogenesis

Moyana

Macdonald

Martel

et al. 2017

Journal of Pancreatic Cancer

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Purpose: To investigate the association between pancreatic neuroendocrine tumors (panNETs) and sinistral portal hypertension (SPH) and provide insights into the pathogenesis.Methods: A retrospective review of panNETs was conducted from our institution for 12 years. Medical imaging findings were analyzed to determine any association with splenic vein thrombosis (SVT) at diagnosis. The cases were further selected based on the criteria for SPH, namely, (1) presence of SVT, (2) gastric varices, (3) patent portal vein, and (4) normal liver function tests.Results: There were 61 patients with panNETs and 8 (8/61) had SVT and gastric varices at diagnosis. Four (4/8) met the strict criteria for SPH while the other four had more conventional portal hypertension. The four with SPH had large tumors located in the tail with splenic vein invasion and three of four presented with bleeding gastric varices. All four patients underwent surgical resection. Mean follow-up was 8.5 years and the hematemesis never recurred. The other four patients (four of eight) with gastric varices had unresectable disease and all died after a mean survival of 29 months.Conclusion: PanNETs appear to be more commonly associated with SVT and SPH compared with other tumors. This could be related to their relatively indolent nature and their intrinsic vascularity. From a surgical viewpoint, the decision to operate depends on many factors including but not limited to the size/stage, grade, and functionality of the tumor and comorbidities. These considerations notwithstanding, the association between panNETs and SPH suggests that there is benefit in timely resection of panNETs located in the tail.

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“…Obstruction of the bile duct or intestine, jaundice, pancreatitis, or spontaneous tumor rupture are rare occurrences. Nakamura et al 10 described a rare case of SPT, which resulted in occlusion of the splenic vein, leading to the development of gastric varices and left-sided extrahepatic portal hypertension.…”

Section: Discussionmentioning

confidence: 99%

A Persistent Solid Pseudopapillary Tumor of the Pancreas: Case Report and Brief Literature Review

Zhang

Shang

Yeo

et al. 2015

Case Reports in Pancreatic Cancer

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Background: Solid pseudopapillary tumors (SPTs) of the pancreas are uncommon neoplasms, first reported in 1934, well described by Frantz in 1959, and later further characterized by Hamoudi in 1970. Ninety percent of these tumors occur in young females in their second to third decade of life. An interesting case of a persistent solid pseudopapillary neoplasm is described in this report. Case presentation: A 24-year-old woman from a Middle Eastern country presented with an 8.2 · 7.6 cm heterogeneous-enhancing lesion growing within the uncinate process of the pancreas. She had first experienced symptoms at the age of 12 years. Imaging studies showed that the mass closely abutted the superior mesenteric vein as well as the superior mesenteric artery (SMA). The patient underwent an open cholecystectomy and a classic pancreaticoduodenectomy. During the resection, the SMA was transected due to tumor adherence. The vessel was subsequently reapproximated in an end-to-end manner. On the first postoperative day, thrombosis of the SMA occurred and a bile leak developed. The patient returned to the operating room for SMA embolectomy and for repair of a hepaticojejunostomy leak, with redo of the biliary-enteric anastomosis. Histopathological examination showed solid pseudopapillary-arranged cells and cystic areas, showing strong cellular immunoreactivity for CD56, CD10, vimentin, and b-catenin, and weak diffuse staining for synaptophysin. The tumor stained negative for chromogranin A, trypsin, AE1/AE3, and E-cadherin. Molecular genetic analysis was negative for the MYB gene deletion. At nearly 1 year of follow-up, the patient is well with no evidence of tumor recurrence. Conclusion: SPTs of the pancreas should be included in the differential diagnosis of pancreatic tumors, especially in young women.

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A Case of Solid Pseudopapillary Neoplasm of the Pancreas Presenting with Left-sided Extrahepatic Portal Hypertension

Cited by 10 publications

References 14 publications

Preoperative neutrophil‐to‐lymphocyte ratio predicts malignancy and recurrence‐free survival of solid pseudopapillary tumor of the pancreas

Preoperative neutrophil‐to‐lymphocyte ratio predicts malignancy and recurrence‐free survival of solid pseudopapillary tumor of the pancreas

Pancreatic Neuroendocrine Tumors Complicated by Sinistral Portal Hypertension: Insights into Pathogenesis

A Persistent Solid Pseudopapillary Tumor of the Pancreas: Case Report and Brief Literature Review

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