Solid pseudopapillary tumour of the pancreas
Solid pseudopapillary tumours (SPT) of the pancreas are rare (usually benign) pancreatic tumours.
The tumour has been referred to with multiple different names, including:
- solid pseudopapillary tumour (SPT) of the pancreas
- solid pseudopapillary neoplasm (SPN)
- solid pseudopapillary epithelial neoplasm (SPEN)
- papillary cystic neoplasm of the pancreas
- Hamoudi tumour
- Gruber-Frantz tumour (or just Frantz tumour)
They are extremely rare and thought to account for 1-2% of exocrine pancreatic tumours. They tend to present in young non-Caucasian females around the 2nd and 3rd decades of life.
Most patients are asymptomatic at diagnosis. They may occasionally present with a gradually enlarging abdominal mass or vague abdominal pain.
The tumours frequently contain varying amounts of necrosis, haemorrhage, and cystic change. Lesions can be large at time of diagnosis (median size ~8 cm) 2.
There is a greater predilection to occur at pancreatic tail.
- pancreatic dorsal agenesis: possible association 5
Large well-defined mass with heterogeneous apperances, due to its solid and cystic composition.
Usually seen as a well-encapsulated lesion with varying solid and cystic components owing to haemorrhagic degeneration. Following IV contrast administration, enhancing solid areas are typically noted peripherally, whereas cystic spaces are usually more centrally located. Calcifications and enhancing solid areas may be present at the periphery of the mass.
Typically demonstrates a well-defined lesion. May show a pure solid consistency in ~80% of cases 6.
Reported signal characteristics include:
- T1: low to heterogeneous signal intensity 1,6
- T2: heterogeneous to high signal intensity 1,6
- C+ (Gd): can show heterogeneous and slowly progressive enhancement
Treatment and prognosis
While most lesions are benign, ~15% can be malignant. Complete resection is associated with long-term survival even in the presence of metastatic disease.
History and etymology
It was first described by Frantz et al in 1959 4-5.
- cystic neoplasm (cystic pancreatic mass differential diagnosis)
- solid neoplasm
- nonepithelial pancreatic neoplasms
pancreatitis (mnemonic for the causes)
- gallstone pancreatitis
- interstitial oedematous pancreatitis
- necrotising pancreatitis
- haemorrhagic pancreatitis
- revised Atlanta classification of acute pancreatitis
- chronic pancreatitis
- Ascaris-induced pancreatitis
- tropical pancreatitis
- autoimmune pancreatitis
- emphysematous pancreatitis
- hereditary pancreatitis
- pancreatitis associated with cystic fibrosis
- segmental pancreatitis
- acute pancreatitis
- pancreatic atrophy
- pancreatic lipomatosis
- pancreatic trauma
- 1. Coleman KM, Doherty MC, Bigler SA. Solid-pseudopapillary tumor of the pancreas. Radiographics. 23 (6): 1644-8. doi:10.1148/rg.236035006 - Pubmed citation
- 2. Martin RC, Klimstra DS, Brennan MF et-al. Solid-pseudopapillary tumor of the pancreas: a surgical enigma? Ann. Surg. Oncol. 9 (1): 35-40. - Pubmed citation
- 3. Choi JY, Kim MJ, Kim JH et-al. Solid pseudopapillary tumor of the pancreas: typical and atypical manifestations. AJR Am J Roentgenol. 2006;187 (2): W178-86. doi:10.2214/AJR.05.0569 - Pubmed citation
- 4. Frantz VK. Tumors of the pancreas. Atlas of tumor pathology: fasc 27–28, ser 7. Washington, DC: Armed Forces Institute of Pathology, 1959; 32-33
- 5. Ulusan S, Bal N, Kizilkilic O et-al. Case report: solid-pseudopapillary tumour of the pancreas associated with dorsal agenesis. Br J Radiol. 2005;78 (929): 441-3. doi:10.1259/bjr/91312352 - Pubmed citation
- 6. 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 Am J Roentgenol. 2010;195 (6): 1324-32. doi:10.2214/AJR.10.4452 - Pubmed citation
- 7. Baek JH, Lee JM, Kim SH et-al. Small (less than 3 cm) solid pseudopapillary tumors of the pancreas at multiphasic multidetector CT. Radiology. 2010;257 (1): 97-106. doi:10.1148/radiol.10092089 - Pubmed citation
- 8. Liu W, Liang W, Xu S. Prevalence of small solid pseudopapillary tumors. AJR Am J Roentgenol. 2011;197 (5): W964. doi:10.2214/AJR.10.6309 - Pubmed citation