Laparoscopic Resection of Pediatric Solid Pseudopapillary Tumors of the Pancreas

Background Solid pseudopapillary tumors (SPTs) of the pancreas arise rarely in children, are often large, and can associate intimately with splenic vessels. Splenic preservation is a fundamental consideration when resecting distal SPT. Occasionally, the main splenic vessels must be divided to resect the SPT with negative margins, but the spleen can be preserved if the short gastric vessels remain intact (ie, Warshaw procedure). The purpose of this study was to evaluate outcomes of distal pancreatectomy (DP) for SPT in children and to highlight 2 cases of splenic preservation using the Warshaw procedure. Methods Patients 19 years and younger who were treated at a single children’s hospital between July 2004 and January 2021 were examined. Patient characteristics were collected from the electronic medical record. A pediatric radiologist calculated SPT and pre- and post-operative (ie, non-infarcted) splenic volumes. Results Eleven patients received DP for SPT. Six DPs were performed open and 5 laparoscopically. The spleen was preserved in 3 open and 4 laparoscopic DPs. A laparoscopic Warshaw procedure was performed in 2 patients. Laparoscopic resection associated with less frequent epidural use ( P = .015), shorter time to full diet ( P = .030), and post-operative length of stay ( P = .009), compared to open resection. Average residual splenic volume after the laparoscopic Warshaw procedure was 70% of preoperative volume. Discussion Laparoscopic DP for pediatric SPT achieved similar oncologic goals to open resection. Splenic preservation was feasible with laparoscopy in most cases and was successfully supplemented with the Warshaw procedure, which has not been previously reported for SPT resection in children.

A case of curative surgical treatment of the rare pancreatic tumor in a child

Pancreatic tumors are very rare problem in children that mostly in literature presented just with case reports. Solid-pseudopapillary tumors of the pancreas are a little part, just about 1–2%, from all nonendocrine tumors of the pancreas. About 90% of all patients with this tumor are female teenagers and young women. Solid-pseudopapillary tumors of the pancreas are innocent, and mostly all of them are incidental findings. However, we can see clinical findings if patient has big size of such tumor, which compress nearest anatomical structures. In this article we present a case of incidental finding of solid- pseudopapillary tumor of body and tale of the pancreas in 11 years old girl, who was treated with distal resection of pancreas.

A laparoscopic access in the surgical treatment of children with solid pseudopapillary tumors of the pancreas

Introduction. Solid-pseudopapillary tumors (SPT) of the pancreas are rare, not exceeding 1-2% of all exocrine pancreatic tumors. Treatment of patients with this pathology consists of the radical removal of the tumor which has to a favorable prognosis of the disease. If the tumor is localized only in the pancreas tail or in the body with invasion into the tail, distal subtotal splenopreserving or distal splenopreserving pancreatic resections are performed. Objective. To demonstrate potentials of laparoscopic access in the surgical treatment of children with SPT. Material and methods. The article discusses 9 patients with diagnosed SPT who had the abovementioned surgical interventions via laparoscopic access . Discussion. The researchers demonstrated that pancreatic resections can be performed laparoscopically. Conclusions. The laparoscopic access is a priority for distal, distal subtotal pancreatic resections. It reduces surgical time, minimizes surgical trauma, accelerates patients’ rehabilitation , improves cosmetic effects as well as makes hospital stay shorter. In addition, it does not worsen immediate and long-term outcomes of the treatment.

Incidence, prediction, and the long-term outcome of solid pseudopapillary tumor of the pancreas with malignant behaviors: a pooled-analysis

Background: Microscopic malignancy or gross metastasis of solid pseudopapillary tumor of the pancreas were considered to be malignant behaviors. The clinical status of solid pseudopapillary tumors of the pancreas with malignant behaviors (SPTM) are unclear. This study was to perform a review and pooled-analysis to determine the incidence and predictors of SPTM, and explore the survival and prognostic factors.Methods: A registered meta-analysis (PROSPERO: CRD42020163788) was performed. Studies reporting on SPTM and follow-up information were identified between 1960 and 2020 by searching PubMed, Scopus, and Embase. The search process followed the PRISMA guidelines.Results: A total of 98 articles were included in this study, including 22 articles reporting the incidence of SPTM, and 159 SPTM cases containing survival information in 77 articles. Pooled estimates showed that the incidence of SPTM in solid pseudopapillary tumors of the pancreas was 22% [95% CI：19~24%], and tumor size ≥5 cm (OR: 2.03，95%CI: 1.28~3.22) was the only risk factor for predicting the occurrence of SPTM. The 5-, and 10-year survival rates of SPTM patients after complete surgical resection were 92% and 77%, respectively. Larger tumors (diameter ≥5cm) (p=0.046), lymphovascular invasion (p=0.005), lymph node metastasis (p=0.02), cellular atypia (0.018), Ki67 index ≥5% (p=0.001), tumor recurrence (p=0.004), recurrent time <5 years (p=0.005) and positive margin (p=0.003) were prognosis unfavorable factors for survival. Additionaly, lymphovascular invasion (OR:8.25, 95% CI:2.26-30.1), lymph node metastasis (OR:25.28, 95% CI:3.01-211.74), extrapancreatic invasion (OR:9.07, 95% CI:2.36-34.84), cellular atypia (OR:16, 95% CI:3-85.3), and Ki67 ≥5% (OR: 7.88, 95%CI: 1.53~40.51) increased the risk of recurrences of resected SPTM. Conclusion: Tumor size is an important factor in predicting the occurrence of SPTM before operation, and complete surgical resection can provide SPTM patients a expected long-term survival. Proved clinicopathological factors by current research will help to determine prognosis and recurrence, and close follow-up of five years or more after operation is essential.

Ovarian Solid Pseudopapillary Tumor Resembling Benign Hemorrhagic Cyst on Rapid Frozen Section

Solid pseudopapillary tumors are rare, with the majority of described cases originating in the pancreas. To date, there are only 10 documented reports of primary ovarian solid pseudopapillary tumors. Here, we describe the case of a 24-year-old woman who presented with worsening pelvic pain and dysmenorrhea. Workup demonstrated a right ovarian solid mass on ultrasound and an elevated serum LDH, which raised concerns for dysgerminoma due to her relatively young age. Therefore, she was taken to the operating room and underwent laparoscopic right salpingo-oophorectomy. On initial rapid frozen section, her ovarian cyst had a grossly hemorrhagic appearance with multiple hemosiderin deposits noted microscopically, which suggested a benign hemorrhagic cyst. However, the final pathology was reported as solid pseudopapillary tumor based on several defining histologic characteristics. Most importantly, immunostaining was positive for β-catenin and negative for E-cadherin. This report presents a brief review of the current literature on primary ovarian solid pseudopapillary tumors, including a discussion of expected prognosis after surgical resection, as well as a discussion of the role of immunohistochemistry (IHC) in differentiating ovarian neoplasms in young premenopausal women.