Combined pancreatic solid-pseudo-papillary tumor and spleen lesions: diagnosis complexities in determining treatment tactics

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Solid pseudopapillary tumors (SPTs) are rare neoplasms, which account for less than 2% of exocrine pancreatic tumors. These are low-grade epithelial malignancies. Currently, there are no data on SPT metastasis to the spleen in the literature. However, due to the rare SPT incidence and the ongoing accumulation and data analysis on these type of tumors globally, the presence of a combined cystic-solid structure lesion in the spleen does not allow us to exclude such a situation.

Two clinical cases of SPT combined with focal spleen lesions are presented. The first one is with a cystic lesion verified as cavernous spleen lymphangioma according to the morphology of the removed lesion. Despite the fact that the splenic lesions included in the differential series during examination were benign, the size of the lesion and the risk of its rupture demonstrated the advisability of spleen resection performing.

The second one is combined with multiple spleen hemangiomas verified by preoperative MSCT, which allowed performing a sparing operation - median resection (tumor enucleation) of the pancreatic head.

Thus, а thorough examination of patients with combined focal lesions, one of which being SPT, a tumor with malignant potential, allows us to clearly determine the entire volume of the lesion and determine the correct surgical tactics.

Full Text

Restricted Access

About the authors

Yulia Alexandrovna Stepanova

A.V. Vishnevsky National Medical Research Center of Surgery

Author for correspondence.
Email: stepanovaua@mail.ru

M.D., Prof., Senior Researcher, Department of Ultrasound department

Russian Federation, Moscow

Dmitry Anatolevich Ionkin

A.V. Vishnevsky National Medical Research Center of Surgery

Email: da.ionkin@gmail.com

PhD, Associate Professor of the Educational Department, Surgeon of the Department of Abdominal Surgery

Russian Federation, Moscow

Maksalina Zakaryaevna Alimurzaeva

Dagestan State Medical University

Email: maksalina1992@yandex.ru

assistant at Radiology Diagnostics and Radiation Therapy Department with a course in Ultrasound Diagnostics

Russian Federation, Makhachkala

Ovanes Robertovich Arutyunov

A.V. Vishnevsky National Medical Research Center of Surgery

Email: arutyunov_ovanes@mail.ru

surgeon of Abdominal Surgery Department

Russian Federation, Moscow

Pavel Viktorovich Markov

A.V. Vishnevsky National Medical Research Center of Surgery

Email: pvmarkov@mail.ru

Doct. of Med. Scien., Head of Abdominal Surgery Department

Russian Federation, Moscow

Vadim Sergeevich Shirokov

A.V. Vishnevsky National Medical Research Center of Surgery

Email: vadimshirokov@yandex.ru

radiologist of Roentgenology and Magnetic Resonance Department

Russian Federation, Moscow

Anastasia Igorevna Spitsyna

A.V. Vishnevsky National Medical Research Center of Surgery

Email: vostri2013@yandex.ru

1st year resident in the specialty «radiology»

Russian Federation, Moscow

Andrey Vyacheslavovich Glotov

A.V. Vishnevsky National Medical Research Center of Surgery

Email: andrew.glotov@mail.ru

pathologist of pathological department

Russian Federation, Moscow

References

  1. Frantz V.K. Tumors of the pancreas. Atlas of tumor pathology. VII. Fascicles 27 and 28. Washington: Armed Forced Institute of Pathology; 1959; 32–33.
  2. Kloppel G, Solcia E, Longnecker DS, Capella C, Sobin LH. World Health Organization. World Health Organization International histological classification of tumours. 2nd ed. Berlin. Springer. 1996; 8452/1.
  3. Klöppel G, Hruban RH, Klimstra DS, Bosman FT, Carneiro F, Hruban RH, Theise ND. Solid-pseudopapillary neoplasm. WHO Classification of Tumours of the Digestive System. Lyon: International Agency for Research on Cancer. 2010; 327–330.
  4. Ye JH, Ma MZ, Cheng DF, Yuan F, Deng X, Zhan Q, Shen B, Peng C. Solid-pseudopapillary tumor of the pancreas: clinical features, pathological characteristics, and origin. J Surg Oncol. 2012; 106: 728–735. doi: 10.1002/jso.23195.
  5. Kim MJ, Choi DW, Choi SH, Heo JS, Sung JY. Surgical treatment of solid pseudopapillary neoplasms of the pancreas and risk factors for malignancy. Br J Surg. 2014; 101: 1266–1271. doi: 10.1002/bjs.9577.
  6. Lee SE, Jang JY, Hwang DW, Park KW, Kim SW. Clinical features and outcome of solid pseudopapillary neoplasm: differences between adults and children. Arch Surg. 2008; 143: 1218–1221. doi: 10.1001/archsurg.143.12.1218.
  7. Huang HL, Shih SC, Chang WH, Wang TE, Chen MJ, Chan YJ. Solid-pseudopapillary tumor of the pancreas: Clinical experience and literature review. World J Gastroenterol. 2005; 11: 1403–1409. doi: 10.3748/wjg.v11.i9.1403.
  8. Uguz A, Unalp OV, Akpınar G, Karaca CA, Oruc N, Nart D, Yılmaz F, Aydın A, Coker A. Solid pseudopapillary neoplasms of the pancreas: Case series with a review of the literature. Turk J Gastroenterol. 2020; 31(12): 930-935. doi: 10.5152/tjg.2020.19227.
  9. Byron EC. Solid and papillary epithelial neoplasm of the pancreas, diagnosis by cytology. South Med. J. 1998; 91: 973–977.
  10. Papavramidis T, Papavramidis S. Solid pseudopapillary tumors of the pancreas: review of 718 patients reported in the English literature. J Am Coll Surg. 2005; 2: 965–972. doi: 10.1016/j.jamcollsurg.2005.02.011.
  11. McCluney S, Wijesuriya N, Sheshappanavar V, Chin-Aleong J, Feakins R, Hutchins R, Abraham A, Bhattacharya S, Valente R, Kocher H. Solid pseudopapillary tumour of the pancreas: clinicopathological analysis. ANZ J Surg. 2018; 88(9): 891-895. doi: 10.1111/ans.14362.
  12. Martin RC, Klimstra DS, Brennan MF, Conlon KC. Solid-pseudopapillary tumor of pancreas: a surgical enigma? Ann Surg Oncol. 2002; 9: 35–40. doi: 10.1245/aso.2002.9.1.35.
  13. Santini D, Poli F, Lega S. Solid-papillary tumors of the pancreas: histopatology. JOP. 2006; 7(1): 131-136.
  14. Liu Q, Dai M, Guo J, Wu H, Wang W, Chen G, Hu Y, Han X, Xu Q, Zhang X, Yang S, Zhang Y, Kleeff J, Liao Q, Wu W, Liang Z, Zhang T, Zhao Y. Long-term Survival, Quality of Life, and Molecular Features of the Patients With Solid Pseudopapillary Neoplasm of the Pancreas: A Retrospective Study of 454 Cases. Ann Surg. 2023; 278(6): 1009-1017. doi: 10.1097/SLA.0000000000005842.
  15. Volk M, Strotzer M. Diagnostic imaging of splenic disease. Radiologe. 2006; 46: 229–243. doi: 10.1007/s00117-005-1333-8
  16. Caremani M, Occhini U, Caremani A, Tacconi D, Lapini L, Accorsi A, Mazzarelli C. Focal splenic lesions: US findings. J Ultrasound. 2013; 16(2): 65-74. doi: 10.1007/s40477-013-0014-0.
  17. Barat M, Hoeffel C, Aissaoui M, Dohan A, Oudjit A, Dautry R, Paisant A, Malgras B, Cottereau AS, Soyer P. Focal splenic lesions: Imaging spectrum of diseases on CT, MRI and PET/CT. Diagn Interv Imaging. 2021; 102(9): 501-513. doi: 10.1016/j.diii.2021.03.006.
  18. Comperat E, Bardier-Dupas A, Camparo P, Capron F, Charlotte F. Splenic metastases: clinicopathologic presentation, differential diagnosis, and pathogenesis. Arch Pathol Lab Med. 2007; 131(6): 965-969. doi: 10.5858/2007-131-965-SMCPDD.
  19. Ionkin DA, Karmazanovsky GG, Stepanova YuA, Shurakova AB, Zhurenkova TV, Shchegolev AI, Dubova EA. Rare malignant lesions of the spleen: malignancy of epidermoid cyst and metastases to the spleen. Vestnik Natsional'nogo mediko-khirurgicheskogo Tsentra im. N.I. Pirogova. 2011; 6(4): 137-143.
  20. Sufficool K, Wang J, Doherty S. Isolated splenic metastasis from carcinoma of the breast: a case report. Diagn Cytopathol. 2013; 41: 914–916. doi: 10.1002/dc.22860
  21. Lee HJ, Kim JW, Hong JH, Kim GS, Shin SS, Heo SH, Lim HS, Hur YH, Seon HJ, Jeong YY. Cross-sectional Imaging of Splenic Lesions: RadioGraphics Fundamentals. Online Presentation. Radiographics. 2018; 38(2): 435-436. doi: 10.1148/rg.2018170119.
  22. Lam KY. Metastatic tumors to the spleen: A 25 year clinicopathologic study. Arch Pathol Lab Med. 2000; 124: 526–530. doi: 10.5858/2000-124-0526-MTTTS.
  23. Berge T. Splenic metastases Frequencies and patterns. Acta Pathol Microbiol Scand. 1974; 82: 499–506.
  24. Hajjar R, Plasse M, Vandenbroucke-Menu F, Schwenter F, Sebajang H. Giant splenic cyst and solid pseudopapillary tumour of the pancreas managed with distal pancreatectomy and splenectomy. Ann R Coll Surg Engl. 2020; 102(4): e1-e3. doi: 10.1308/rcsann.2020.0010.
  25. Paramasivam S, Murali M, Rajappa P. Obstructed ileocaecal tuberculosis with splenic tuberculosis and solid pseudopapillary tumour of tail of pancreas in an immunocompetent woman. BMJ Case Rep. 2020; 13(9): e235195. doi: 10.1136/bcr-2020-235195.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Ultrasound image of the pancreatic tail lesion, B-mode.

Download (102KB)
Indexing metadata
3. Fig. 2. Ultrasound image of a cystic spleen lesion (marked), B-mode: a – cystic lesion; b – solid inclusion in the structure (marked).

Download (142KB)
Indexing metadata
4. Fig. 3. MRI images of the pancreatic tail (thin arrow) and spleen (thick arrow) lesion: a – T1 WI; b – T2 WI; c – native phase; g – arterial phase; d – venous phase; e – delayed phase of the study.

Download (431KB)
Indexing metadata
5. Fig. 4. Ultrasound image of the pancreatic head lesion, duplex scanning.

Download (130KB)
Indexing metadata
6. Fig. 5. MSCT images of the pancreatic cystic-solid head lesion (indicated by an arrow): a – native phase; b – arterial phase; c – venous phase; d – delayed phase of the study.

Download (314KB)
Indexing metadata
7. Fig. 6. MSCT image of the spleen hemangiomas, venous phase of the study.

Download (104KB)
Indexing metadata
8. Fig. 7. MRI images of the pancreatic head lesion (indicated by the arrow): a – T1 WI; b – T2 WI.

Download (153KB)
Indexing metadata
9. Fig. 8. MRI images of the focal spleen lesions: a, b – T2 WI slices at different levels.

Download (146KB)
Indexing metadata
10. Fig. 9. Surgical photos: a – pancreatic head tumor; b – bed of the removed tumor.

Download (374KB)
Indexing metadata
11. Fig. 10. Removed pancreatic head lesion: a – general view; b, c – in section at different levels.

Download (772KB)
Indexing metadata

Copyright (c) 2025 Stepanova Y.A., Ionkin D.A., Alimurzaeva M.Z., Arutyunov O.R., Markov P.V., Shirokov V.S., Spitsyna A.I., Glotov A.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies