Surgical treatment of Solid and Papillary Epithelial Neoplasm of the Pancreas

Yang, Sun Mo; Lee, Sang Mok; Hong, Sung Hwa; Oh, Soo Myung

Abstract

BACKGROUND: Solid and papillary epithelial neoplasm(SPEN) is a rare malignant tumor of the pancreas that typically occurs in young females and has an excellent prognosis. This tumor has a low malignant potential, and is highly curable with surgical treatment.
METHODS
AND MATERIALS: From January 1986 to July 1999, ten patients of solid and papillary epithelial neoplasm of the pancreas pathologically verified at Kyung Hee University Hospital were retrospectively analyzed. Pre-, intra-, and post-operative data were evaluated in all patients to determine optimal management with specific reference to surgical strategy.
RESULTS
Nine patients out of ten were females, with a mean age of 21.8 years (range 12-38). Six patients presented with a palpable abdominal mass and four patients with abdominal pain. Remaining patients presented with fever, low back pain, and no specific symptom. Abdominal ultrasonography and/or CT scan showed an abdominal mass in all patients. The correct preoperative diagnosis of SPEN was made in six patients. Incorrect diagnosis included pseudocysts in two and cystadenoma in two. The tumor size ranged from 5 to 14.5 cm in diameter (average 8.85 cm). Four patients with tumor in the pancreatic head had a pylorus preserving pancreaticoduodenectomy (PPPD). Four patients with tumor in the pancreatc tail underwent distal pancreatectomy and splenectomy(without in one). Two patients were performed mass enucleation only. The histologic diagnosis was confirmed in all patients. There were no nuclear atypia and pleomorphism in microscopic findings. Postoperative complications were intraabdominal abscess in one, lymphatics leakages in one, and wound infection in one. All ten patients are alive without sign of recurrence with a mean follow-up of 5.36 years (range 0.1 to 13 years).
CONCLUSIONS
SPEN is an indolent tumor of the pancreas with low malignant potential and excellent long-term prognosis and should be considered in the differential diagnosis of large pancreatic masses, especially in young females. Resection is the treatment of choice that is resectable.