A solid pseudopapillary neoplasm without cysts that occurred in a patient diagnosed by endoscopic ultrasound-guided fine-needle aspiration: a case report

Journal of Medical Case Reports

Junji Shiode²  Soichiro Nose¹  Toru Kojima³  Hiroaki Saito²  Takefumi Niguma³  Masao Yoshioka²  Masakuni Fujii² 

[1] Anatomic Pathology, Okayama Saiseikai General Hospital, 1-17-18 Ifuku-cho, Okayama 700-8511, Japan;Department of Internal Medicine, Okayama Saiseikai General Hospital, 1-17-18 Ifuku-cho, Okayama 700-8511, Japan;Department of Surgery, Okayama Saiseikai General Hospital, 1-17-18 Ifuku-cho, Okayama 700-8511, Japan

关键词: Solid pseudopapillary neoplasm;    Positron emission tomography/computed tomography;    Minimally invasive surgery;    Endoscopic ultrasound-guided fine-needle aspiration;    Atypical;   

Others  :  829266
DOI  :  10.1186/1752-1947-8-243

 received in 2014-04-02, accepted in 2014-05-19,  发布年份 2014

【 摘 要 】

Introduction

Solid pseudopapillary neoplasm of the pancreas is a rare neoplasm that has been reported to account for between 0.17% and 2.7% of all non-endocrine tumors of the pancreas. It is usually seen in young women. Because solid pseudopapillary neoplasms are rarely aggressive and have low-grade malignant potential and an excellent prognosis after complete resection, it is an ideal pancreatic tumor for treatment by minimally invasive surgery. Therefore, making an accurate pre-operative diagnosis is very important.

Case presentation

A 24-year-old Japanese man who had been found to have mild transaminase elevations at a medical check-up visited our hospital for further examination. Abdominal computed tomography showed a 40mm-diameter tumor in the pancreatic tail and mild fatty liver. He was admitted to our hospital for additional examination. The abdominal contrast-enhanced computed tomography scan taken at our institution showed an increasingly enhanced mass of 40mm diameter in the pancreatic tail. Ultrasonography showed a low-level echoic mass of 35mm diameter in the pancreatic tail. T1-weighted magnetic resonance imaging showed low signal intensity in the tail of the pancreas. T2-weighted magnetic resonance imaging showed high signal intensity there. Diffusion magnetic resonance imaging showed high signal intensity. An endoscopic ultrasound yielded the same results as the abdominal ultrasonogram. In addition, [¹⁸F]-fluorodeoxyglucose positron emission tomography/computed tomography showed abnormal accumulation (maximum standardized uptake value, 6.53). This finding raised our suspicion of a pancreatic malignant tumor. However, the patient could not be confidently diagnosed solely on the basis of imaging. Endoscopic ultrasound-guided fine-needle aspiration was performed, which led us to a diagnosis of solid pseudopapillary neoplasm. On that basis, we performed minimally invasive surgery (spleen-preserving laparoscopic distal pancreatectomy).

Conclusion

Atypical solid pseudopapillary neoplasm without cysts should be considered when diagnosing pancreatic tumors. A definitive pre-operative diagnosis of solid pseudopapillary neoplasm made on the basis of endoscopic ultrasound-guided fine-needle aspiration can guide the surgical approach used.

【 授权许可】

   
2014 Fujii et al.; licensee BioMed Central Ltd.

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