Korean J Gastroenterol.  2022 Feb;79(2):77-82. 10.4166/kjg.2021.133.

Solid Pseudopapillary Neoplasm of the Pancreas with Lymph Node Metastasis in a Young Male Patient

• Park S
• Park MG
• Roh YH
• Kim DK

• KMID: 2526794
• DOI: http://doi.org/10.4166/kjg.2021.133

Abstract

Solid pseudopapillary pancreatic neoplasms are rare. The male-to-female ratio is 1:9, and metastasis occurs only in a few cases. A 39-year-old male with a solid pseudopapillary neoplasm (SPN) with lymph node metastasis underwent ultrasonography, CT, and MRI, which revealed a mass (8 cm) in the pancreatic head. Fluorodeoxyglucose (FDG)-PET showed a hypermetabolic lymph node in the root area of the superior mesenteric artery (SMA). The patient underwent pylorus-preserving pancreaticoduodenectomy, which confirmed a peripancreatic lymph node metastasis. The lymph node of the SMA root area remained because of the encasing of the superior mesenteric artery. After 14 months of follow-up (with no adjuvant therapy initiated), the residual metastatic lymph nodes showed no change and no recurrence. In conclusion, surgery of the primary tumor for patients with SPN is recommended, even in cases with metastatic lymph nodes remaining.

Keyword

Pancreatic neoplasms; Male; Lymphatic metastasis; Pancreaticoduodenectomy

Figure

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  Fig. 1 Abdomen ultrasound revealed a 6.2 cm sized, peripheral calcified soft tissue mass at the portocaval area.

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  Fig. 2 Arterial phase of pancreas computed tomography revealed a mixed solid and cystic mass, with heterogeneous enhancement surrounding the rim calcification in the pancreatic head area or uncinate process.

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  Fig. 3 Magnetic resonance imaging showed an 8 cm-sized mass with heterogeneous signal intensity. (A) It showed high signal intensity on T2-weighted images, (B) low signal intensity on T1-weighted images, and (C) a solid portion of it was showed relatively homogenous delayed enhancement on the gadolinium-enhanced dynamic scan.

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  Fig. 4 Fluorodeoxyglucose-positron emission tomography/computed tomography scan showed a hypermetabolic mass (5.94 SUVmax) in the pancreas head area with uneven hypermetabolism. A metastatic lymph node in the superior mesenteric artery root area (yellow arrow) was revealed.

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  Fig. 5 Pathology findings. (A) The tumor showed pseudopapillary architecture (hematoxylin and eosin stain [H&E], ×100). (B) Focal solid growth pattern and hyaline globules were observed (H&E, ×100). (C) The tumor has multiple ossification foci surrounded by tumor cells (H&E, ×100). (D) The tumor cells showed nuclear and cytoplasmic positivity for beta-catenin (immunohistochemical stain, ×200).

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