Multiple liver metastases of pancreatic solid pseudopapillary tumor treated with resection following chemotherapy and transcatheter arterial embolization: A case report

Tajima,Hidehiro; Takamura,Hiroyuki; Kitagawa,Hirohisa; Nakayama,Akira; Shoji,Masatoshi; Watanabe,Toshifumi; Tsukada,Tomoya; Nakanuma,Shinichi; Okamoto,Koichi; Sakai,Seisho; Kinoshita,Jun; Makino,Isamu; Nakamura,Keishi; Hayashi,Hironori; Oyama,Katsunobu; Inokuchi,Masafumi; Nakagawara,Hisatoshi; Miyashita,Tomoharu; Ninomiya,Itasu; Fushida,Sachio; Fujimura,Takashi; Wakayama,Tomohiko; Iseki,Shoichi; Ikeda,Hiroko; Ohta,Tetsuo

doi:10.3892/ol.2015.2967

Multiple liver metastases of pancreatic solid pseudopapillary tumor treated with resection following chemotherapy and transcatheter arterial embolization: A case report

Authors:
- Hidehiro Tajima
- Hiroyuki Takamura
- Hirohisa Kitagawa
- Akira Nakayama
- Masatoshi Shoji
- Toshifumi Watanabe
- Tomoya Tsukada
- Shinichi Nakanuma
- Koichi Okamoto
- Seisho Sakai
- Jun Kinoshita
- Isamu Makino
- Keishi Nakamura
- Hironori Hayashi
- Katsunobu Oyama
- Masafumi Inokuchi
- Hisatoshi Nakagawara
- Tomoharu Miyashita
- Itasu Ninomiya
- Sachio Fushida
- Takashi Fujimura
- Tomohiko Wakayama
- Shoichi Iseki
- Hiroko Ikeda
- Tetsuo Ohta
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Affiliations: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920‑8641, Japan, Department of Histology and Embryology, Kanazawa University, Graduate School of Medical Science, Kanazawa 920‑8641, Japan, Division of Pathology, Kanazawa University, Graduate School of Medical Science, Kanazawa 920‑8641, Japan
Published online on: February 16, 2015 https://doi.org/10.3892/ol.2015.2967
Pages: 1733-1738

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Abstract

A 33‑year‑old female was diagnosed with a solid pseudopapillary tumor (SPT) of the pancreas and multiple liver metastases at the Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital (Kanazawa, Japan). Distal pancreatectomy and postoperative systemic chemotherapy with gemcitabine (GEM) and S‑1, an oral fluoropyrimidine derivative, was administered, however, liver metastases became enlarged and local recurrence occurred. Therefore, the patient was referred to the Department of Gastroenterologic Surgery at the Graduate School of Medicine (Kanazawa, Japan) for hepatic arterial infusion (HAI) chemotherapy. Oral S‑1 (80 mg/m2) was administered as well as HAI chemotherapy with GEM (1,000 mg/standard liver volume). Following 18 cycles, tumor sizes were reduced and 18‑fluorodeoxyglucose positron emission tomography (18FDG‑PET) examination revealed obvious reduction of tumor FDG uptake. Transarterial tumor embolization (TAE) was performed for the previously unresectable right subphrenic liver tumor, and the other tumors were surgically resected. The resected tumors were diagnosed as liver metastases and a local recurrence of SPT in the postoperative pathological examination, which revealed that the resected tumors were composed of sheets of bland cells, which were positive for CD10, CD56, vimentin, neuron‑specific enolase and α‑antitrypsin. The postoperative course was uneventful, and the patient is currently under observation at an outpatient clinic; postoperative adjuvant chemotherapy with oral S‑1 has continued, and additional TAE is planned. In the future, if the middle segment of the liver becomes enlarged, surgery for the residual right lobe tumor may be possible. This case demonstrates one method of SPT treatment: Preoperative HAI chemotherapy with GEM, plus oral S‑1 and TAE. If complete resection can be achieved, the majority of patients with SPT have a favorable prognosis. In patients with unresectable metastases from SPT, it is crucial to conduct systematic multimodal treatment to maximize treatment success.

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1	Sperti C, Berselli M, Paasquali C, Pastorelli D and Pedrazzoli S: Aggressive behavior of solid-pseudopapillary tumor of pancreas in adults: a case report and review of the literature. World J Gastroenterol. 14:960–965. 2008. View Article : Google Scholar : PubMed/NCBI
2	Frantz VK: Tumor of the pancreas. blumerg CW: atlas of tumor pathology Washington, DC: US Armed Forces Institute of Pathology; pp. 32–33. 1959
3	Cantisani KM, Mortele KJ, Levy A, et al: MR imaging features of solid pseudopapillary tumor of the pancreas in adult and pediatric patients. AJR Am J Roentogenol. 181:395–401. 2003. View Article : Google Scholar
4	Coleman KM, Doherty MC and Bigler SA: Solid-pseudopapillary tumor of the pancreas. Radiographics. 23:1644–1648. 2003. View Article : Google Scholar : PubMed/NCBI
5	Vargas-Serrano B, Dominguez-Ferreras E and Chinchon-Espino D: Four cases of solid pseudopapillary tumor of pancreas: imaging findings and pathological correlations. Eur J Radiol. 58:132–139. 1993. View Article : Google Scholar
6	Kloppel G, Solcia E, Longnecker DS, et al: Histological typing of tumors of the exocrine pancreas. sobin LH: world health organization international histological classification of rumors. 2nd ed. Berlin, Heidelberg, New York: Springer; pp. 15–22. 1996
7	Tajima H, Ohta T, Kitagawa H, et al: Pilot study of hepatic arterial infusion chemotherapy with gemcitabine and 5-fluorouracil for patients with postoperative liver metastases from pancreatic cancer. Exp Ther Med. 2:265–269. 2011. View Article : Google Scholar : PubMed/NCBI
8	Eisenhauer EA, Therasse P, Bogaerts J, et al: New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 45:228–247. 2009. View Article : Google Scholar
9	Martin RC, Klimstra DS, Brennan MF and Conlon KC: Solid pseudopapillary tumor of the pancreas: a surgical enigma? Ann Surg Oncol. 9:35–40. 2002. View Article : Google Scholar : PubMed/NCBI
10	Pettinato G, Manivel JC, Ravetto C, et al: Papillary cystic tumor of the pancreas. a clinicopathologic study of 20 cases with immunohistochemical, ultrastructual and flow cytometric observations and a review of the literature. Am J Clin Pathol. 98:478–488. 1992.PubMed/NCBI
11	Tang LH, Aydin H, Brennaan MF and Klimstra DS: Clinically aggressive solid pseudopapillary tumor of the pancreas: a report of two cases with components of undifferentiated carcinoma and a comparative clinicopathologic analysis of 34 conventional cases. Am J Surg Pathol. 29:512–519. 2005. View Article : Google Scholar : PubMed/NCBI
12	Mao C, Guvendi M, Demenico DR, Kim K, Thomford NR and Howard JM: Papillary cystic and solid tumors of the pancreas: a pancreatic embryonic tumor? studies of three cases and cumulative review of the worlds’ literature. Surgery. 118:821–828. 1995. View Article : Google Scholar : PubMed/NCBI
13	Matsunou H and Konishi F: Papillary-cystic neoplasm of the pancreas. A clinicopathologic study concerning the tumor aging and malignancy of nine cases. Cancer. 65:283–291. 1990. View Article : Google Scholar : PubMed/NCBI
14	Goh BK, Tan YM, Cheow PC, et al: Solid pseudopapillary neoplasms of the pancreas: an updated experiences. J Surg Oncol. 95:640–644. 2007. View Article : Google Scholar : PubMed/NCBI
15	Ueda N, Nagakawa T, Ohta T, et al: Clinicopathological studies on solid and cystic tumors of the pancreas. Gastroenterol Jpn. 26:497–502. 1991.PubMed/NCBI
16	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. 95:304–310. 2007. View Article : Google Scholar : PubMed/NCBI
17	Nguyen QN, Johns LA, Gill JA, et al: Clinical and immunohistochemical features of 34 solid pseudopapillary tumors of the pancreas. J Gastroenterol Hepatol. 26:267–274. 2011. View Article : Google Scholar : PubMed/NCBI
18	Shimizu M, Matsumoto T, Hirokawa M, Monobe Y, Iwamoto S, Tsunoda T and Manabe T: Solid-pseudopapillary carcinoma of the pancreas. Pathol Int. 49:231–234. 1999. View Article : Google Scholar : PubMed/NCBI
19	Strauss JF, Hirsch VJ, Rubey CN and Pollock M: Resection of a solid and papillary epithelial neoplasm of the pancreas following treatment with CIS-platinum and 5-fluorouracil: a case report. Med Pediatr Oncol. 21:365–367. 1993. View Article : Google Scholar : PubMed/NCBI
20	Maffuz A, Bustamante FT, Silva JA and Torres-Vargas S: Preoperative gemcitabine for unresectable solid pseudopapillary tumor of the pancreas. Lancet Oncol. 6:185–186. 2005. View Article : Google Scholar : PubMed/NCBI
21	Matsuda Y, Imai Y, Kawata S, Nisikawa M, Miyoshi S, Saito R, Minami Y and Tarui S: Papillary-cystic neoplasm of the pancreas with multiple hepatic metastases: a case report. Gastroenterol JPN. 22:379–384. 1987.PubMed/NCBI
22	Kang CM, Kim KS, Choi JS, Kim H, Lee WJ and Kim BR: Solid pseudopapillary tumor of the pancreas suggesting malignant potential. Pancreas. 32:276–280. 2006. View Article : Google Scholar : PubMed/NCBI
23	Fried P, Cooper J, Balthazar E, Fazzini E and Newall L: A role for radiotherapy in the treatment of solid and papillary neoplasms of the pancreas. Cancer. 56:2783–2785. 1985. View Article : Google Scholar : PubMed/NCBI
24	Zauls JA, Dragun AE and Sharma AK: Intensity-modulated radiation therapy for unresectable solid pseudopapillary tumor of the pancreas. Am J Clin Oncol. 29:639–640. 2006. View Article : Google Scholar : PubMed/NCBI
25	Kanter J, Wilson DB and Strasberg S: Downsizing to resectability of a large solid and cystic papillary tumor of the pancreas by single-agent chemotherapy. J Pediatr Surg. 44:E23–E25. 2009. View Article : Google Scholar : PubMed/NCBI
26	Das G, Bhuyan C, Das BK, et al: Spleen-preserving distal pancreatectomy following neoadjuvant chemotherapy for papillary solid and cystic neoplasm of pancreas. Indian J Gastroenterol. 23:188–189. 2004.PubMed/NCBI
27	Levy P, Bougaran J and Gayet B: Diffuse peritoneal carcinomas of pseudo-papillary and solid tumor of the pancreas. role of abdominal injury. Gastroenterol Clin Biol. 21:789–793. 1997.
28	Huang HI, Shih SC, Chang WH, Wang TE, Chen MJ and Chan YJ: Solid-pseudopapillary tumor of the pancreas: clinical experience and literature review. World J Gastroenterol. 11:1403–1409. 2005. View Article : Google Scholar : PubMed/NCBI
29	Li JX, Wu H, Huang JW, Prasoon P and Zeng Y: Synchronous intraoperative radiofrequency ablation for multiple liver metastasis and resection of giant solid pseudopapillary tumors of the pancreas. Chinese Med J. 125:1661–1663. 2012.
30	Tajima H, Ohta T, Okamoto K, et al: Radiofrequency ablation induces dedifferentiation of hepatocellular carcinoma. Oncol Lett. 1:91–94. 2010.PubMed/NCBI
31	Tajima H, Ohta T, Shoji Y, et al: Expression of epithelial-mesenchymal transition markers in locally recurrent hepatocellular carcinoma after radiofrequency ablation. Exp Ther Med. 1:347–350. 2010. View Article : Google Scholar