Solid pseudopapillary tumor (SPT) of the pancreas is a pathological entity rarely encountered in children. Despite its malignant characteristics, SPT has a favorable clinical prognosis. This tumor is more frequently observed in females and is commonly localized in the tail and body of the pancreas. This is the case report of a 9-year-old female patient who presented with severe abdominal pain of sudden onset and vomiting following blunt abdominal trauma. Upon physical examination, abdominal distension, tenderness and abdominal guarding were detected. Abdominal magnetic resonance imaging revealed a mass sized 8×9×12 cm in the pancreas, with hemorrhagic-necrotic areas, and abundant intra-abdominal fluid. Intra-abdominal exploration confirmed the presence of an abundant amount of intraperitoneal hemorrhagic fluid. A mass was identified, originating from the body and the tail of the pancreas, adherent to the mesentery of the colon and the hilum of the spleen, which had ruptured in its inferolateral side. The tumor was extirpated together with the spleen and the involved parts of the pancreas. Histopathological examination demonstrated a solid pseudopapillary tumor of pancreatic origin. The patient's postoperative course was uneventful, clinically as well as metabolically.
Solid pseudopapillary tumors (SPTs) of the pancreas are a rare occurrence, accounting for 1–2% of all solid pancreatic tumors (
A 9-year-old female patient presented to the emergency service with severe abdominal pain of sudden onset and vomiting following blunt abdominal trauma (impact of a swing on her abdomen). Upon physical examination, the patient was found to have abdominal distension, tenderness, abdominal guarding and elevated body temperature (>37.9°C); she was also tachycardic and mildly hypotensive (blood pressure 80/55 mmHg). The laboratory tests results revealed anemia (Hb 7.9 mg/dl) and leukocytosis (white blood cell count 22.800/mm3). An abdominal X-ray revealed dilated bowel loops and air-fluid levels. On abdominal ultrasound, a mass measuring 120×90 mm was identified on the pancreas, together with a generalized intra-abdominal fluid collection. Abdominal magnetic resonance imaging revealed a mass sized 8×9×12 cm located in the pancreas, with hemorrhagic-necrotic areas and abundant intra-abdominal fluid. The mass appeared to originate from the inferolateral aspect of the pancreas (
Although SPT is usually located in the tail and body of the pancreas (
According to the World Health Organization classification, SPT is considered to be a low-grade exocrine pancreatic malignancy (
The treatment of SPT consists of total surgical excision of the tumor mass and the adjacent pancreatic tissue. Enucleation is not recommended, as it carries the risk of incomplete resection. A statistically significant difference between laparoscopic and open surgery was not detected with regard to postoperative complications and prognosis (
Among pediatric patients, SPT rarely presents with traumatic rupture. Tajima
Park
Our patient presented with similar manifestations. A one-stage operation was performed, during which the patient received subtotal pancreactomy, splenectomy and hemostatic control. No additional treatment was applied. The 1-year follow-up visit revealed no medical problems. This patient remains under close surveillance.
In conclusion, pancreatic SPT is a rare tumor with a low malignant potential. The optimal treatment for the tumor is total surgical excision. Patients with metastatic disease or a ruptured SPT should be closely followed up for tumor recurrence. Tumor markers have not been found to be helpful for postoperative monitorıng (
An abdominal magnetic resonance imaging demonstrated a mass sized 8×9×12 cm in the pancreas (arrow), with hemorrhagic-necrotic areas and abundant intra-abdominal fluid. The mass appeared to originate from the inferolateral aspect of the pancreas.
Macroscopic appearance of the resected tumor.
Histopathological findings of the tumor. Pseudopapillary projections covered with one or more layers of cells were observed, with extensive hemorrhagic areas.