Endoscopy 2019; 51(04): S132
DOI: 10.1055/s-0039-1681558
ESGE Days 2019 ePoster podium presentations
Friday, April 5, 2019 10:30 – 11:00: EUS diagnosis pancreatobiliary ePoster Podium 5
Georg Thieme Verlag KG Stuttgart · New York

EUS TISSUE DIAGNOSIS OF A MALIGNANT SOLID PSEUDOPAPILLARY TUMOR OF THE PANCREAS IN A YOUNG MALE RARE PRESENTATION OF A RARE PANCREATIC TUMOR -CASE REPORT-

M Gonzalez Haba Ruiz
1   Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
,
B Agudo Castillo
1   Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
,
F Pons Renedo
1   Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
,
E Tejerina Gonzalez
2   Pathology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
,
JL Calleja Panero
1   Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Introduction:

Solid pseudopapillary tumors (SPT) of the pancreas are rare neoplasms of uncertain origin that account for 0.2 to 2.7% of all pancreatic tumors. SPT's have an unclear malignant potential and can mimic aggressive tumors. Preoperatory EUS sampling can establish the diagnosis of these atypical tumors with an overall favorable prognosis.

We report the case of a 50 year-old man consulting for lower back pain who was found on CT scan to have a large pancreatic tail mass. Serum markers were negative and no distant metastases were present.

Procedure and Results:

EUS confirmed the presence of a 42 mm hypoechoic, heterogeneous, solid lesion with cystic components and calcifications. There was contact with the splenic vein without flow interruption. Fine needle aspiration was performed. Cytologically, minimally cohesive, uniform and monotonous cells were present, lining delicate capillary-sized blood vessels, with a pseudopapillary architecture.

Immunohistochemical study was positive for vimentin, CD56, receptor of progesterone, and focal synaptophysin.

Distal pancreatectomy with splenectomy was subsequently performed with a pathologic staging pT2 pN0 (0/6)(AJCC 2017). No adjuvant therapy was administrated as decided on multidisciplinary board.

Conclusion:

SPTs are exocrine neoplasms that mainly affects young women, rarely men. Symptoms are vague. Cross sectional imaging typically shows a well-encapsulated lesion with solid and cystic components and varying degrees of central necrosis; but none are specific.

EUS plays an important role in diagnosis and staging, providing the possibility of cytologic – histologic evaluation. Immunohistochemical pattern is critical in diagnosing these tumors for differentiating them from other pancreatic tumors with a radical different prognosis.

First line treatment is complete surgical resection given its malignant potential. Larger tumors (diameter > 5 cm), lymphovascular invasion, lymph node metastasis, synchronous metastasis and positive margin may indicate future risk of metastasis.