Clinicopathological and immunohistochemical study of 29 cases of solid-pseudopapillary neoplasms of the pancreas in patients under 20 years of age along with detailed review of literature

Abstract

Background Pancreatic Solid Pseudopapillary Neoplasms (SPNs) are rare low-grade malignant tumors with a marked preponderance for young females. Objective was to describe the morphology, differential diagnosis, and prognosis of SPNs in patients under 20 years of age and present a detailed review of literature. Methods A total of 29 cases in patients under 20 years of age reported as SPN during the period January 2014 to December 2019, were included in the study. These included 19 resection specimens, 4 incision biopsies and 6 cases received as blocks for second opinion. Hematoxylin and eosin (H&E) slides as well as immunohistochemistry (IHC) slides of all cases were retrieved and reviewed by the authors. TFE3 and Progesterone Receptor were performed retrospectively. Results Twenty-eight of the 29 patients were females. Ages of patients ranged from 12 to 19 years. Nineteen cases were resections. Tail was the commonest location. Mean tumor size was 9.5 cm. In 89.5% cases, tumor was confined to the pancreas. In 2 cases, distant metastasis was present. In 2 cases, extension beyond pancreas was seen. Solid and pseudopapillary areas were seen in all cases while other features were variable. Beta catenin and Cyclin D1 were positive in most cases while TFE3 was positive in 57% cases. Progesterone Receptor (PR) was positive in all 13 cases in which it was performed. Follow up was available in 14 patients. Follow up period ranged from 3 to 70 months. Twelve were alive and well without recurrence or metastasis while 2 were alive with recurrence and metastasis to liver and omentum respectively. Conclusions Although many studies on SPNs have been published, surgeons, oncologists and even pathologists in this part of the world are often not aware of these rare tumors leading to inaccuracies and delays in diagnosis. In addition, this paper focusses on the interesting observation that the majority of SPNs diagnosed in our department during study period occurred in patients under 20 years of age (29 versus 21 in patients over 20). However, clinico-epidemiological, morphologic and prognostic features were similar in both age groups. Possibility of SPNs should always be considered in case of pancreatic neoplasms occurring in patients under 20 years of age as well. We believe that this is a very interesting and helpful study for the clinicians as well as the pathologists.

The Sex Features of Patients With Solid Pseudopapillary Neoplasms of the Pancreas: A Retrospective Study

“…The inconsistent conclusion may be due to the small number of lymph node metastasis and positive margin status patients included in our study, and statistical bias may exist. Although numerous biomarkers over the years have been documented to have value in diagnosing SPNs (36)(37)(38), there are still no specific immunohistochemical biomarkers for SPNs at present. Only the biomarkers tested in our center were included in our study.…”

Long-term survival following resection of a solid pseudopapillary tumour of the pancreas with arterial and venous encasement

“…There seems to be no predilection for a particular site in the pancreas 8. The location of the tumour influences the type of surgical treatment, with head of pancreas tumours requiring the higher morbidity Whipple’s operation 6…”

“…The most common sites of metastatic disease reported in the literature include: liver, portal/splenic/SMVs, spleen, diaphragm, omentum, peritoneum, duodenum and stomach 6 8…”

Peculiar encounter of sarcoidosis and solid pseudopapillary tumor of the pancreas

“…Clinical presentation in SPT is non-specific and its presence might go unnoticed until routine imaging is performed. Abdominal pain or distension, nausea or vomiting can be the sole indicators of SPT [6].…”

“…Complete surgical resection is recommended and is usually curative, although metastatic disease has been observed, particularly involving the liver [6]. As of 2015, there were only approximately 800 cases of solid pseudopapillary tumors of the pancreas described in current literature [7].…”