J Korean Med Sci.  2017 Dec;32(12):2079-2084. 10.3346/jkms.2017.32.12.2079.

Radiologic Findings in Extrapancreatic Solid Pseudopapillary Tumor with Aggressive Behavior: a Case Report

• Choi HW
• Park HJ
• Hong SA
• Park SB
• Lee ES
• Ahn HS
• Lee JB
• Choi BI

• KMID: 2396390
• DOI: http://doi.org/10.3346/jkms.2017.32.12.2079

Abstract

Solid pseudopapillary tumor (SPT) is a low grade malignant tumor in the pancreas, and extrapancreatic SPT is extremely rare. We report a case of a 61-year-old woman who complained abdominal pain with diffuse tenderness. She was diagnosed with extrapancreatic SPT with extensive peritoneal dissemination and hepatic metastases. Although a few cases have reported imaging findings of extrapancreatic SPT, there have been no reports of extrapancreatic SPT with aggressive tumor behavior and dismal prognosis. Although imaging features closely resembled those of classical pancreatic SPTs, malignant transformation of extrapancreatic SPT should be considered when focal discontinuity of the tumor capsule with ill-defined margin and invasion of adjacent structures were identified.

Keyword

Solid Pseudopapillary Tumor; Extrapancreatic; CT; Ultrasonography

MeSH Terms

Abdominal Pain
Female
Humans
Middle Aged
Neoplasm Metastasis
Pancreas
Prognosis
Ultrasonography

Figure

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  Fig. 1 CT images in mid-abdomen level. (A) Precontrast, (B) portal venous phase, (C) 3-minute delayed phase. The tumor shows heterogeneously persistent enhancement, which replaces entire abdomen. Amorphous calcifications (black arrows) and internal necrotic foci (asterisks) are also identified. Despite of bowel invasion (white arrows), bowel obstruction does not occur. CT = computed tomography.

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  Fig. 2 CT images of SPT on portal venous phase with adjacent organ invasions. (A) Axial image, (B) coronal image. Heterogeneously enhanced seeding masses (asterisks) scallop the liver surface. The masses are separated from pancreatic head. Pancreas (black arrows) is normal. Focally ill-defined margin of the mass reveals direct invasion to right abdominal wall (white arrows). CT = computed tomography, SPT = solid pseudopapillary tumor.

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  Fig. 3 CT images in the pelvic cavity level. (A) Precontrast, (B) portal venous phase. The tumor shows intralesional hemorrhage (black arrows), scattered calcification (white arrow) and internal necrotic foci (asterisks). Both ovaries are not visible. CT = computed tomography.

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  Fig. 4 Transverse ultrasonographic images of the SPT. (A, B) Gray scalses, (C) color Doppler image. The tumor shows well-encapsulated, heterogeneous echogenicity in gray-scale images (A, B). Cystic or necrotic components (asterisks), internal echogenic spots (white arrows), and septations (short black arrows) are identified. The posterior capsule of the mass (black arrows) shows an echogenic rim with good through-transmission of sound. Color Doppler image (C) shows increased vascularity at the solid portion of the tumor. Curved arrow indicates biopsy needle. SPT = solid pseudopapillary tumor.

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  Fig. 5 Histological features of the tumor. (A) H & E stained, × 100, (B) H & E stained, × 400. (C) Immunohistochemical staining for β-catenin nucleus, (D) Immunohistochemical staining for E-cadherin. The tumor (A, B) shows solid and pseudopapillary growth with a monotonous round to oval nucleus, fine chromatin and abundant mitosis. Translocation of β-catenin nucleus (C) and loss of E-cadherin (D) are observed on immunohistochemical staining. H & E = hematoxylin and eosin.

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