Solid Pseudopapillary Neoplasms of the Pancreas: Clinicopathologic and Radiologic Features According to Size
Riccardo De Robertis1, Giovanni Marchegiani2, Matteo Catania3, Maria Chiara Ambrosetti3, Paola Capelli4, Roberto Salvia2 and Mirko D'Onofrio3 Show less
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Citation: American Journal of Roentgenology: 1-8. 10.2214/AJR.18.20715
AbstractFull TextReferencesPDFPDF PlusAdd to FavoritesPermissionsDownload Citation
ABSTRACT :
OBJECTIVE. The purpose of this study was to retrospectively analyze and correlate clinicopathologic and radiologic features of resected solid pseudopapillary neoplasms of the pancreas according to their size.
MATERIALS AND METHODS. Clinicopathologic and radiologic features of 106 resected solid pseudopapillary neoplasms of the pancreas over a 20-year period were retrospectively analyzed. Tumors were divided into three groups according to their size (≤ 30 mm, 31–50 mm, and ≥ 51 mm). Clinicopathologic and radiologic features were compared among groups using Kruskal-Wallis and Fisher exact tests.
RESULTS. Forty-one tumors that were 30 mm or smaller, 30 tumors between 31 and 50 mm, and 35 tumors that were 51 mm or larger were included. Preoperative MRI of 76 patients and CT of 40 patients were examined. Patients with tumors that were 30 mm or smaller were significantly older than the other groups of patients (p = 0.038). Large tumors (31–50 and ≥ 51 mm) were more frequently located in the pancreatic body or tail (p = 0.008). Most tumors had well-defined margins (87.7%) and a mixed solid and cystic appearance (54.7%) at imaging; tumors that were 30 mm or smaller were more frequently entirely solid (p = 0.028). At histologic analysis, 13 tumors had at least one feature of malignancy; nodal and liver metastases were found in one patient (0.9%). No significant differences between groups were found regarding the presence of malignant histologic features (p = 0.932). The rate of incorrect preoperative diagnosis was higher in tumors 30 mm or smaller, albeit without significant differences between groups (p = 0.561).
CONCLUSION. Malignancy in solid pseudopapillary neoplasms is not correlated with tumor size; tumors that are 30 mm or smaller may present atypical imaging features, which may overlap those of other solid tumors of the pancreas.
Keywords: CT, MRI, pancreas, pathology, solid pseudopapillary neoplasm
References
Previous section
1. Law JK, Ahmed A, Singh VK, et al. A systematic review of solid-pseudopapillary neoplasms: are these rare lesions? Pancreas 2014; 43:331–337 [Crossref] [Medline] [Google Scholar]
2. Papavramidis T, Papavramidis S. Solid pseudopapillary tumors of the pancreas: review of 718 patients reported in English literature. J Am Coll Surg 2005; 200:965–972 [Crossref] [Medline] [Google Scholar]
3. Martin RC, Klimstra DS, Brennan MF, Conlon KC. Solid-pseudopapillary tumor of the pancreas: a surgical enigma? Ann Surg Oncol 2002; 9:35–40 [Crossref] [Medline] [Google Scholar]
4. Bosman FT, Carneiro F, Hruban RH. WHO classification of tumours of the digestive system, 4th ed., vol. 3. Geneva, Switzerland: World Health Organization, 2010 [Google Scholar]
5. Buetow PC, Buck JL, Pantongrag-Brown L, Beck KG, Ros PR, Adair CF. Solid and papillary epithelial neoplasm of the pancreas: imaging-pathologic correlation on 56 cases. Radiology 1996; 199:707–711 [Crossref] [Medline] [Google Scholar]
6. Baek JH, Lee JM, Kim SH, et al. Small (≤3 cm) solid pseudopapillary tumors of the pancreas at multiphasic multidetector CT. Radiology 2010; 257:97–106 [Crossref] [Medline] [Google Scholar]
7. Marchegiani G, Andrianello S, Massignani M, et al. Solid pseudopapillary tumors of the pancreas: specific pathological features predict the likelihood of postoperative recurrence. J Surg Oncol 2016; 114:597–601 [Crossref] [Medline] [Google Scholar]
8. Hanada K, Kurihara K, Itoi T, et al. Clinical and pathological features of solid pseudopapillary neoplasms of the pancreas: a nationwide multicenter study in Japan. Pancreas 2018; 47:1019–1026 [Crossref] [Medline] [Google Scholar]
9. Wang P, Wei J, Wu J, et al. Diagnosis and treatment of solid-pseudopapillary tumors of the pancreas: a single institution experience with 97 cases. Pancreatology 2018; 18:415–419 [Crossref] [Medline] [Google Scholar]
10. Anil G, Zhang J, Al Hamar NE, Nga ME. Solid pseudopapillary neoplasm of the pancreas: CT imaging features and radiologic-pathologic correlation. Diagn Interv Radiol 2017; 23:94–99 [Crossref] [Medline] [Google Scholar]
11. Gao H, Gao Y, Yin L, et al. Risk factors of the recurrences of pancreatic solid pseudopapillary tumors: a systematic review and meta-analysis. J Cancer 2018; 9:1905–1914 [Crossref] [Medline] [Google Scholar]
12. Jutric Z, Rozenfeld Y, Grendar J, et al. Analysis of 340 patients with solid pseudopapillary tumors of the pancreas: a closer look at patients with meta-static disease. Ann Surg Oncol 2017; 24:2015–2022 [Crossref] [Medline] [Google Scholar]
13. Wang DB, Wang QB, Chai WM, Chen KM, Deng XX. Imaging features of solid pseudopapillary tumor of the pancreas on multi-detector row computed tomography. World J Gastroenterol 2009; 15:829–835 [Crossref] [Medline] [Google Scholar]
14. Choi JY, Kim MJ, Kim JH, et al. Solid pseudopapillary tumor of the pancreas: typical and atypical manifestations. AJR 2006; 187:[web]W178–W186 [Abstract] [Google Scholar]
15. Chung EM, Travis MD, Conran RM. Pancreatic tumors in children: radiologic-pathologic correlation. RadioGraphics 2006; 26:1211–1238 [Crossref] [Medline] [Google Scholar]
16. Ventriglia A, Manfredi R, Mehrabi S, et al. MRI features of solid pseudopapillary neoplasm of the pancreas. Abdom Imaging 2014; 39:1213–1220 [Crossref] [Medline] [Google Scholar]
17. Guerrache Y, Soyer P, Dohan A, et al. Solid-pseudopapillary tumor of the pancreas: MR imaging findings in 21 patients. Clin Imaging 2014; 38:475–482 [Crossref] [Medline] [Google Scholar]
18. Yu MH, Lee JY, Kim MA, et al. MR imaging features of small solid pseudopapillary tumors: retrospective differentiation from other small solid pancreatic tumors. AJR 2010; 195:1324–1332 [Abstract] [Google Scholar]
19. Chae SH, Lee JM, Baek JH, et al. Magnetic resonance imaging spectrum of solid pseudopapillary neoplasm of the pancreas. J Comput Assist Tomogr 2014; 38:249–257 [Crossref] [Medline] [Google Scholar]
20. Falconi M, Eriksson B, Kaltsas G, et al.; Vienna Consensus Conference participants. ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors. Neuroendocrinology 2016; 103:153–171 [Crossref] [Medline] [Google Scholar]
21. Wang X, Chen YH, Tan CL, et al. Enucleation of pancreatic solid pseudopapillary neoplasm: short-term and long-term outcomes from a 7-year large single-center experience. Eur J Surg Oncol 2018; 44:644–650 [Crossref] [Medline] [Google Scholar]
22. Virgilio E, Mercantini P, Ferri M, et al. Is EUS-FNA of solid-pseudopapillary neoplasms of the pancreas as a preoperative procedure really necessary and free of acceptable risks? Pancreatology 2014; 14:536–538 [Crossref] [Medline] [Google Scholar]
23. Lee JH, Yu JS, Kim H, et al. Solid pseudopapillary carcinoma of the pancreas: differentiation from benign solid pseudopapillary tumour using CT and MRI. Clin Radiol 2008; 63:1006–1014 [Crossref] [Medline] [Google Scholar]
24. Rastogi A, Assing M, Taggart M, et al. Does computed tomography have the ability to differentiate aggressive from nonaggressive solid pseudopapillary neoplasm? J Comput Assist Tomogr 2018; 42:405–411 [Crossref] [Medline] [Google Scholar]
Address correspondence to R. De Robertis (riccardo.derobertislombardi@aovr.veneto.it).
Read More: https://www.ajronline.org/doi/abs/10.2214/AJR.18.20715
Riccardo De Robertis1, Giovanni Marchegiani2, Matteo Catania3, Maria Chiara Ambrosetti3, Paola Capelli4, Roberto Salvia2 and Mirko D'Onofrio3 Show less
Share Share
+ Affiliations:
Citation: American Journal of Roentgenology: 1-8. 10.2214/AJR.18.20715
AbstractFull TextReferencesPDFPDF PlusAdd to FavoritesPermissionsDownload Citation
ABSTRACT :
OBJECTIVE. The purpose of this study was to retrospectively analyze and correlate clinicopathologic and radiologic features of resected solid pseudopapillary neoplasms of the pancreas according to their size.
MATERIALS AND METHODS. Clinicopathologic and radiologic features of 106 resected solid pseudopapillary neoplasms of the pancreas over a 20-year period were retrospectively analyzed. Tumors were divided into three groups according to their size (≤ 30 mm, 31–50 mm, and ≥ 51 mm). Clinicopathologic and radiologic features were compared among groups using Kruskal-Wallis and Fisher exact tests.
RESULTS. Forty-one tumors that were 30 mm or smaller, 30 tumors between 31 and 50 mm, and 35 tumors that were 51 mm or larger were included. Preoperative MRI of 76 patients and CT of 40 patients were examined. Patients with tumors that were 30 mm or smaller were significantly older than the other groups of patients (p = 0.038). Large tumors (31–50 and ≥ 51 mm) were more frequently located in the pancreatic body or tail (p = 0.008). Most tumors had well-defined margins (87.7%) and a mixed solid and cystic appearance (54.7%) at imaging; tumors that were 30 mm or smaller were more frequently entirely solid (p = 0.028). At histologic analysis, 13 tumors had at least one feature of malignancy; nodal and liver metastases were found in one patient (0.9%). No significant differences between groups were found regarding the presence of malignant histologic features (p = 0.932). The rate of incorrect preoperative diagnosis was higher in tumors 30 mm or smaller, albeit without significant differences between groups (p = 0.561).
CONCLUSION. Malignancy in solid pseudopapillary neoplasms is not correlated with tumor size; tumors that are 30 mm or smaller may present atypical imaging features, which may overlap those of other solid tumors of the pancreas.
Keywords: CT, MRI, pancreas, pathology, solid pseudopapillary neoplasm
References
Previous section
1. Law JK, Ahmed A, Singh VK, et al. A systematic review of solid-pseudopapillary neoplasms: are these rare lesions? Pancreas 2014; 43:331–337 [Crossref] [Medline] [Google Scholar]
2. Papavramidis T, Papavramidis S. Solid pseudopapillary tumors of the pancreas: review of 718 patients reported in English literature. J Am Coll Surg 2005; 200:965–972 [Crossref] [Medline] [Google Scholar]
3. Martin RC, Klimstra DS, Brennan MF, Conlon KC. Solid-pseudopapillary tumor of the pancreas: a surgical enigma? Ann Surg Oncol 2002; 9:35–40 [Crossref] [Medline] [Google Scholar]
4. Bosman FT, Carneiro F, Hruban RH. WHO classification of tumours of the digestive system, 4th ed., vol. 3. Geneva, Switzerland: World Health Organization, 2010 [Google Scholar]
5. Buetow PC, Buck JL, Pantongrag-Brown L, Beck KG, Ros PR, Adair CF. Solid and papillary epithelial neoplasm of the pancreas: imaging-pathologic correlation on 56 cases. Radiology 1996; 199:707–711 [Crossref] [Medline] [Google Scholar]
6. Baek JH, Lee JM, Kim SH, et al. Small (≤3 cm) solid pseudopapillary tumors of the pancreas at multiphasic multidetector CT. Radiology 2010; 257:97–106 [Crossref] [Medline] [Google Scholar]
7. Marchegiani G, Andrianello S, Massignani M, et al. Solid pseudopapillary tumors of the pancreas: specific pathological features predict the likelihood of postoperative recurrence. J Surg Oncol 2016; 114:597–601 [Crossref] [Medline] [Google Scholar]
8. Hanada K, Kurihara K, Itoi T, et al. Clinical and pathological features of solid pseudopapillary neoplasms of the pancreas: a nationwide multicenter study in Japan. Pancreas 2018; 47:1019–1026 [Crossref] [Medline] [Google Scholar]
9. Wang P, Wei J, Wu J, et al. Diagnosis and treatment of solid-pseudopapillary tumors of the pancreas: a single institution experience with 97 cases. Pancreatology 2018; 18:415–419 [Crossref] [Medline] [Google Scholar]
10. Anil G, Zhang J, Al Hamar NE, Nga ME. Solid pseudopapillary neoplasm of the pancreas: CT imaging features and radiologic-pathologic correlation. Diagn Interv Radiol 2017; 23:94–99 [Crossref] [Medline] [Google Scholar]
11. Gao H, Gao Y, Yin L, et al. Risk factors of the recurrences of pancreatic solid pseudopapillary tumors: a systematic review and meta-analysis. J Cancer 2018; 9:1905–1914 [Crossref] [Medline] [Google Scholar]
12. Jutric Z, Rozenfeld Y, Grendar J, et al. Analysis of 340 patients with solid pseudopapillary tumors of the pancreas: a closer look at patients with meta-static disease. Ann Surg Oncol 2017; 24:2015–2022 [Crossref] [Medline] [Google Scholar]
13. Wang DB, Wang QB, Chai WM, Chen KM, Deng XX. Imaging features of solid pseudopapillary tumor of the pancreas on multi-detector row computed tomography. World J Gastroenterol 2009; 15:829–835 [Crossref] [Medline] [Google Scholar]
14. Choi JY, Kim MJ, Kim JH, et al. Solid pseudopapillary tumor of the pancreas: typical and atypical manifestations. AJR 2006; 187:[web]W178–W186 [Abstract] [Google Scholar]
15. Chung EM, Travis MD, Conran RM. Pancreatic tumors in children: radiologic-pathologic correlation. RadioGraphics 2006; 26:1211–1238 [Crossref] [Medline] [Google Scholar]
16. Ventriglia A, Manfredi R, Mehrabi S, et al. MRI features of solid pseudopapillary neoplasm of the pancreas. Abdom Imaging 2014; 39:1213–1220 [Crossref] [Medline] [Google Scholar]
17. Guerrache Y, Soyer P, Dohan A, et al. Solid-pseudopapillary tumor of the pancreas: MR imaging findings in 21 patients. Clin Imaging 2014; 38:475–482 [Crossref] [Medline] [Google Scholar]
18. Yu MH, Lee JY, Kim MA, et al. MR imaging features of small solid pseudopapillary tumors: retrospective differentiation from other small solid pancreatic tumors. AJR 2010; 195:1324–1332 [Abstract] [Google Scholar]
19. Chae SH, Lee JM, Baek JH, et al. Magnetic resonance imaging spectrum of solid pseudopapillary neoplasm of the pancreas. J Comput Assist Tomogr 2014; 38:249–257 [Crossref] [Medline] [Google Scholar]
20. Falconi M, Eriksson B, Kaltsas G, et al.; Vienna Consensus Conference participants. ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors. Neuroendocrinology 2016; 103:153–171 [Crossref] [Medline] [Google Scholar]
21. Wang X, Chen YH, Tan CL, et al. Enucleation of pancreatic solid pseudopapillary neoplasm: short-term and long-term outcomes from a 7-year large single-center experience. Eur J Surg Oncol 2018; 44:644–650 [Crossref] [Medline] [Google Scholar]
22. Virgilio E, Mercantini P, Ferri M, et al. Is EUS-FNA of solid-pseudopapillary neoplasms of the pancreas as a preoperative procedure really necessary and free of acceptable risks? Pancreatology 2014; 14:536–538 [Crossref] [Medline] [Google Scholar]
23. Lee JH, Yu JS, Kim H, et al. Solid pseudopapillary carcinoma of the pancreas: differentiation from benign solid pseudopapillary tumour using CT and MRI. Clin Radiol 2008; 63:1006–1014 [Crossref] [Medline] [Google Scholar]
24. Rastogi A, Assing M, Taggart M, et al. Does computed tomography have the ability to differentiate aggressive from nonaggressive solid pseudopapillary neoplasm? J Comput Assist Tomogr 2018; 42:405–411 [Crossref] [Medline] [Google Scholar]
Address correspondence to R. De Robertis (riccardo.derobertislombardi@aovr.veneto.it).
Read More: https://www.ajronline.org/doi/abs/10.2214/AJR.18.20715
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