The importance of endoscopic ultrasound fine-needle aspiration in the diagnosis of solid pseudopapillary tumor of the pancreas: two case reports

Abstract

BackgroundSolid pseudopapillary tumor of the pancreas, otherwise known as solid and cystic tumor or Frantz tumor, is an unusual form of pancreatic carcinoma, with unknown etiopathogenesis, that accounts for 0.2 to 2.7% of all pancreatic tumors. It is defined as an exocrine pancreatic neoplasia that mainly affects women between the second and third decade of life, and its management is not well defined. Endoscopic ultrasound offers a key anatomical advantage in accessing the pancreas and endoscopic ultrasound fine-needle aspiration has become the gold standard method for the diagnosis of pancreatic lesions.Case presentationCase 1: A 31-year-old white Hispanic woman presented with epigastric pain for 5 months. An abdominal ultrasound revealed a single 2 cm nodule in the uncinate process of her pancreas. Endoscopic ultrasound showed a regular, well-defined solid lesion with alternating cystic areas at the uncinate process of her pancreas, measuring 1.7 × 1.4 cm; endoscopic ultrasound fine-needle aspiration was then performed with cytopathological analysis compatible with solid pseudopapillary tumor.Body computed tomography confirmed the absence of metastases and she underwent conventional duodenopancreatectomy. However, she died 4 days after surgery due to postoperative surgical complications.Case 2: A 35-year-old Hispanic woman presented with left upper quadrant abdominal pain for 3 months, associated with a palpable mass at this region. A computed tomography scan showed a solitary nodule in the pancreatic body. Endoscopic ultrasound showed a regular, well-defined, homogeneous lesion with small anechoic (cystic) areas, measuring 2 × 2 cm, in between the pancreatic body and neck. Endoscopic ultrasound fine-needle aspiration was performed and cytopathological analysis was suggestive of a pseudopapillary solid tumor. She underwent a body-tail laparoscopic pancreatectomy with splenectomy. Nine months after the diagnosis, she remains asymptomatic, continuing regular follow-up in the oncology out-patient clinic.ConclusionsSolid pseudopapillary tumor is a rare pancreatic malignancy. Endoscopic ultrasound fine-needle aspiration is the gold standard method to characterize and diagnose this type of pancreatic lesion, making this an invaluable tool to help guide clinical management and improve the preoperative diagnostic yield.

Endoscopic Ultrasound Fine-Needle Aspiration versus Fine-Needle Biopsy for Lymph Node Diagnosis: A Large Multicenter Comparative Analysis

“…The acquisition of histological samples that yield an adequate amount of tissue suitable for IHC staining is pivotal for 15,16 An alternative technique is to collect FNA samples in formalin for cell-block preparation and perform subsequent histological analysis. 6,9,17,18 However, this technique has demonstrated lower diagnostic rates, independent of the number of FNA passes. 19 In our study, cell- block analysis was possible in 73.15% of patients after FNA and in 84.16% after FNB.…”

The usefulness of lymphoid enhancer‐binding factor 1 and androgen receptor in diagnosing solid pseudopapillary neoplasm of the pancreas on cytopathology

“…With a strong predilection for females in their second to third decades of life, these tumors often are identified incidentally on imaging obtained for unrelated reasons . When symptomatic, abdominal pain and/or discomfort is the most frequently reported symptom …”

“…With the development of more sophisticated imaging studies, the evaluation of pancreatic masses typically is conducted via endoscopic ultrasound‐guided fine‐needle aspiration (FNA) . Thus, the initial diagnosis of SPN often is made by cytology.…”

Solid pseudopapillary neoplasm of the pancreas: a case report

“…Better imaging methods allow detection of pancreatic tumours in a stage of low advancement, when their size is 2-3 cm. Such small pancreatic tumours can be removed by laparoscopic method [2][3][4][5][6][7][8][9][10][11][12].…”

“…It is a cancer of the pancreatic exocrine portion, and although it can occur at different ages, it mainly develops in adolescents and women between 20 and 30 years of age. It is very rare in men [5]. A relationship with gender and age suggests a hormonal effect on tumour development, but such disorders have not yet been reported in its course.…”