Spontaneous Regression In Solid Pseudopapillary Neoplasm Of Pancreas
Yasuda, H., Kataoka, K., Miyake, H., Sogame, Y., Sakagami, J., Yasukawa, S., Konishi, E., Yanagisawa, A., & Itoh, Y. (2023). Spontaneous regression in solid pseudopapillary neoplasm of pancreas. Clinical journal of gastroenterology, 16(1), 105–109. https://doi.org/10.1007/s12328-022-01715-4
View Original Source →Abstract
A solid pseudopapillary neoplasm (SPN) of the pancreas is a rare neoplasm that mainly occurs in young women. We herein report the case of spontaneous regression in SPN of the pancreas. A 48-years-old female was found to have a mass in the head of the pancreas on examination for her back pain and referred to our hospital in 20XX. Laboratory data showed no abnormalities in serum levels of pancreatic enzymes and tumor markers. A contrast CT scan of upper abdomen showed a slightly enhanced lesion (23 × 19 mm in diameter) without cystic component or fibrous capsule in the head of the pancreas. An MRI scan showed the mass as low-intensity in T1-WI and high-intensity in T2-WI. She admitted to our hospital for further examination of a pancreatic mass by EUS-FNA in 20XX + 4. EUS showed a slightly hypoechoic mass (30 × 19 mm in diameter) compared with the neighboring normal pancreas. Tumor margin was relatively clear and the internal echo image was homogenous. Histological findings revealed a solid and pseudopapillary proliferation of eosinophilic polygonal cells with oval nuclei. The tumor cells were positive for vimentin and CD10 in the cytoplasm and β-catenin in the nuclei, which led to the diagnosis of SPN. We recommended this patient to undergo surgical resection, however, the patient chose follow-up examinations. Follow-up study after 1 year using MRI scan showed spontaneous regression, which was coincided with her menopause. These findings suggest that the natural regression of SPN may occur and female sex hormone changes may regulate the growth of SPN.
Case Details
Disease Location
Pancreas
Personal Characteristics
48-year-old woman
Clinical Characteristics
Referred for a pancreatic head tumor that was detected on examination for back pain. Enhanced CT scan showed a well-circumscribed mass on the pancreatic head, which was 23 × 19 mm in diameter and was hypovascular at an early phase and isovascular at the late phase after administration of contrast medium. Fdg-PET/CT showed fdg accumulation within the mass. After 4 years of follow-up, when the pancreatic head tumor was slightly enlarged, endoscopic ultrasound-guided fine needle aspiration was performed. Histological findings revealed pseudopapillary and solid proliferation of atypical cells with eosinophilic cytoplasm and peripherally polarized oval nuclei
Remission Characteristics
One year later, a follow-up MRI scan revealed that the pancreatic head tumor had spontaneously shrunk, which coincided with her menopause. Three years later, a repeated MRI scan showed the disappearance of the pancreatic head tumor
Treatment & Mechanisms
Proposed Remission Mechanisms
Explained by the declining levels of ovarian steroid hor- money during the period of menopause.
Clinical Treatment
Biopsy