Ann Hepatobiliary Pancreat Surg.  2025 Feb;29(1):83-87. 10.14701/ahbps.24-147.

A rare case of a large solid pseudopapillary neoplasm with extensive liver metastasis

• Kim JH
• Kim HS
• Lee JM
• Nahm JH
• Park JS

• KMID: 2565411
• DOI: http://doi.org/10.14701/ahbps.24-147

Abstract

Solid pseudopapillary neoplasms (SPNs) are uncommon pancreatic tumors that primarily affect young females. We report a case of a 24-year-old female diagnosed with SPN and liver metastasis during a routine examination. Imaging revealed an 8-cm pancreatic mass with multiple liver metastases. Histopathology confirmed SPN. Subsequent next-generation sequencing revealed a CTNNB1 mutation. The patient underwent a total pancreatectomy with splenectomy, right hemihepatectomy, and intraoperative radiofrequency ablation. Two years after the surgery, she remained complication-free. She is under regular surveillance. This case underscores the importance of early detection and comprehensive management of SPN.

Keyword

Pancreatic neoplasms; Neoplasm metastasis; Case reports; Solid pseudopapillary neoplasm; Liver metastasis

Figure

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  Fig. 1 Computed tomography findings of pancreatic tumor and liver metastases. (A, B) A 9.2-cm mass is observed in the head/neck of the pancreas, suggestive of a solid pseudopapillary neoplasm (indicated by a white asterisk). (C, D) This mass shows a direct invasion into superior mesenteric and proximal main portal veins (highlighted by a yellow arrow). A 6.5-cm lesion is seen in segment 5 (S5), a 2-cm lesion in S4, and at least 15 other smaller lesions scattered throughout the liver. Additionally, multiple lymph nodes up to 1.3 cm in the left para-aortic region are noted as possibly metastatic.

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  Fig. 2 Magnetic resonance imaging findings of pancreatic tumor and liver metastases. (A) Multiple metastases are observed, with sizes up to 7 cm, scattered in segment 4 (S4) and the right hepatic lobe. These metastases present with or without internal hemorrhaging. (B) A 9 cm lobulated, soft tissue-enhancing mass with significant internal hemorrhagic necrosis is seen in the head/neck portion of the pancreas.

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  Fig. 3 Specimen and pathology of pancreatic mass and liver metastases. Macroscopic and microscopic features of pancreatic and liver masses. (A) Total pancreatectomy specimen shows a 10.0 × 7.5 × 5.5 cm-sized, encapsulated, multilobulated, brownish friable mass with extensive hemorrhage and necrosis. (B) Viable tumor cells are located at the periphery of the tumor, with an infiltrative growth margin in the pancreatic parenchyma (H&E, 10×). (C, D) The tumor shows pseudopapillary structures or solid patterns composed of relatively uniform round cells with eosinophilic cytoplasm (H&E, 200× and 400×). (E) Serially cut surface of the right hepatectomy specimen shows seven red-brownish friable masses with hemorrhage and necrosis or without. (F) In low-power fields, multiple small metastatic masses are noted (indicated by a black arrow) (H&E, 7×). (G) In high-power fields, metastatic tumors comprise similar tumor cells as pancreatic solid pseudopapillary tumors (H&E, 200×). (H) Immunohistochemical staining for β-catenin shows aberrant nuclear expression in the pancreas and liver tumors (β-catenin, 400×).

Reference

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