Endoscopic ultrasound-guided radiofrequency ablation for solid pseudopapillary neoplasm of the pancreas

A solid pseudopapillary neoplasm (SPN) is considered a low-grade malignant neoplasm, more often composed of both solid and cystic components with pseudopapillary areas but predominantly solid in 15 % of cases [1]. It is estimated to account for 1 % to 3 % of all pancreatic tumors [2]. Immunostaining of SPNs for beta-catenin is specific [3]. The natural history of these lesions is unknown, but the malignant potential is demonstrated especially in large lesions. The gold standard therapy is surgical resection. Nonetheless, an alternative such as endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA), which is less invasive [4], should be discussed, especially for young patients with small lesions [5]. All cases of SPN seen and treated with EUS-RFA between 2018 and 2020 were reviewed (IRB 00010835).

Herein, we report on three women, ages 26, 27, and 63, who had pancreatic head lesions (19, 11, and 20 mm, respectively). The case of the 63-year-old woman is described ([Fig. 1]). EUS fine needle biopsy (FNB) diagnosed an SPN ([Fig. 2 a, b]). [Video 1] demonstrates the initial appearance of the lesion in B mode and contrast harmonic mode. The procedure was successfully performed (four shots) with no remaining vascularization in contrast harmonic mode after RFA. At the 3-month follow-up, EUS evidenced hyperechoic nonvascularized necrotic tissue ([Fig. 3]). No remaining lesion was seen on magnetic resonance imaging (MRI), computed tomography (CT), and EUS at 1 and 2 years.

Fig. 1 Computed tomography scan showing hypodense pancreatic head lesion (red arrow).

Fig. 2 a Biopsy showing monomorphic cells on histology. b Cells are positively stained for beta-cathenin.

Video 1 Endoscopic ultrasound-guided radiofrequency ablation for solid pseudopapillary neoplasm of the pancreas.

Video herunterladen

Fig. 3 Biopsy showing inflammatory and necrotic cells not stained for beta-cathenin (red arrow).

For the two other cases, one and two RFA sessions were respectively required to completely destroy the lesions. EUS-RFA procedures were uneventful with no post-procedural adverse events. No recurrence was noted at the 24-month follow-up. This treatment option should be considered in patients unfit for pancreatic surgery and could be discussed for small lesions ≤ 2 cm.

Endoscopy_UCTN_Code_TTT_1AS_2AD

Competing interests

Bertrand Napoleon is giving teaching sessions for TaeWong company.
Antoine Coupier: Nothing to disclose
Tawfik Khoury: Nothing to disclose
Rodica Gincul: Nothing to disclose
Fabien Fumex: Nothing to disclose
Andrea Lisotti: Nothing to disclose
Sarah Leblanc: Nothing to disclose

• References

• 1 Karsenti D, Caillol F, Chaput U. et al. Safety of endoscopic ultrasound-guided fine-needle aspiration for pancreatic solid pseudopapillary neoplasm before surgical resection: A European multicenter registry-based study on 149 patients. Pancreas 2020; 49: 34-38
• 2 Sacco Casamassima MG, Gause CD, Goldstein SD. et al. Pancreatic surgery for tumors in children and adolescents. Pediatr Surg Int 2016; 32: 779-788
• 3 Kim EK, Jang M, Park M. et al. LEF1, TFE3, and AR are putative diagnostic markers of solid pseudopapillary neoplasms. Oncotarget 2017; 8: 93404-93413
• 4 Napoleon B, Lisotti A, Caillol F. et al. Risk factors for endoscopic ultrasound-guided radiofrequency ablation adverse events in patients with pancreatic neoplasms: a large national French study (RAFPAN study). Gastrointest Endosc 2023;
• 5 Salvia R, Bassi C, Festa L. et al. Clinical and biological behavior of pancreatic solid pseudopapillary tumors: report on 31 consecutive patients. J Surg Oncol 2007; 95: 304-310

Publikationsverlauf

Artikel online veröffentlicht:
21. August 2023