Solid pseudopapillary tumour of the pancreas

Case contributed by Dr Yair Glick

Presentation

Acute right lower abdominal pain

Patient Data

Age: 20
Gender: Female

This patient presented to the emergency department with constant abdominal pain that began abruptly the previous night and had wandered from the central abdomen to the right lower quadrant.

In the emergency department:
Subfebrile fever; diffuse abdominal tenderness, more pronounced in the right upper and lower quadrants; slight leukocytosis with neutrophilia; CRP within normal limits.

Abdominal ultrasound was performed to rule out acute appendicitis.

Appendix appears normal and is compressible.

Large mass adjacent to left kidney, appears to originate from pancreatic tail. Possible intralesional flow on colour Doppler.

The patient was admitted to a surgical department for further investigation of the abdominal mass.
Abdominal CT was performed.

Large, solid, heterogeneous, well-circumscribed mass originating in pancreatic tail. No perilesional fat stranding.

Case Discussion

Interestingly, given the patient's history, symptoms, and acuity of presentation, the emergency department was most suspicious for appendicitis. The large mass in the left abdomen was truly an incidental finding.

The patient underwent distal pancreatectomy (a misnomer) 2 and splenectomy. The pathology report confirmed solid pseudopapillary tumour with reactive changes in several regional lymph nodes.

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Case information

rID: 51396
Case created: 14th Feb 2017
Last edited: 15th Feb 2017
Inclusion in quiz mode: Included

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