Solid-pseudopapillary Tumour Of The Pancreas Showing A Remarkable Reduction In Size Over The 10-year Follow-up Period.
Nakahara, K., Kobayashi, G., Fujita, N., Noda, Y., Ito, K., Horaguchi, J., Takasawa, O., & Obana, T. (2008). Solid-pseudopapillary tumor of the pancreas showing a remarkable reduction in size over the 10-year follow-up period. Internal medicine (Tokyo, Japan), 47(14), 1335–1339. https://doi.org/10.2169/internalmedicine.47.0767
View Original Source →Abstract
An 18-year-old healthy woman was admitted to our department for further evaluation of a pancreatic mass (45 mm in diameter) by transabdominal ultrasound at a general health check. Solid-pseudopapillary tumor (SPT) was suspected from the findings of diagnostic images. Therefore, surgery was recommended. The patient and her family, however, refused surgery. Ultrasound-guided transcutaneous biopsy revealed proliferation of tumor cells with small nuclei showing a pseudopapillary arrangement. PAS positive granules and alpha-1-antitrypsin positive cells were proven, which led to the diagnosis of SPT. As the grade of atypism of the tumor cells was low, the patient underwent follow-up examination once a year at our outpatient department thereafter. The tumor gradually decreased its maximum diameter in 10 years from 45 mm to 15 mm. Thus far, there have been very few reports on the natural course of SPT, and this is the first report describing marked spontaneous shrinkage of a tumor in a long follow-up period.
Case Details
Disease Location
Pancreas
Personal Characteristics
18-year-old healthy woman, no history of abdominal injury.
Clinical Characteristics
Admitted for further evaluation of a pancreatic mass 45 mm in diameter detected by transabdominal ultrasound at a general health check in 1997. Neither anemia nor jaundice was present in the conjunctiva. Physical examination revealed a soft, flat abdomen with no palpable mass or tenderness, and no enlargement of superficial lymph nodes. Laboratory data on admission showed no abnormalities in serum hormones levels nor in tumour markers. On CT, the mass was 45 mm in diameter showing slight enhancement with administration of contrast at the late phase. No involvement of the bile duct or the portal vein, or lymph node enlargement was detected. Ultrasound-guided transcutaneous biopsy led to the diagnosis of spatient.
Remission Characteristics
The patient underwent follow-up examination once a year. The maximum diameter of the tumour gradually decreased (31 mm in 2001, 26 mm in 2003, 19 mm in 2005, and 15 mm in 2007). Four years after the biopsy, CT demonstrated a tiny cystic area in the periphery of the tumour, which had disappeared at the time of CT performed the next year. In 10 years, the tumour had shrunk from 45 mm to 15 mm in diameter on CT (fig. 4). She is presently doing well and continuing follow-up in our department.
Treatment & Mechanisms
Proposed Remission Mechanisms
Degenerative change, including hemor- rhage and necrosis followed by absorpatiention.
Clinical Treatment
Biopsy