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Solid pseudopapillary tumor of the pancreas: A retrospective analysis of 36 cases from a single institution in India.

BACKGROUND
Solid pseudopapillary tumor (SPT) of the pancreas is uncommon, occurring predominantly in young women. We analyzed the clinicopathological features of SPT diagnosed in our institution.


MATERIALS AND METHODS
A retrospective analysis of all cases of SPT diagnosed in the Department of Pathology from January 2001 to September 2012, utilizing an electronic database search, was carried out. In all, 36 cases (35 resections and 1 fine needle aspiration cytology with cell block material) were found. All these cases were then analyzed for clinical presentation, duration and histopathological features, including immunohistochemistry and correlated with the clinical outcome.


RESULTS
The mean age of patients (31 females) was 24.1 years. The SPT was suspected preoperatively in 25% of cases. Tumor location was equally common in head (15), body (9), tail (8), distal body and tail (3), and neck (1). Thirty five patients underwent resection. The mean tumor size was 7.16 cm. Grossly, the tumors were solid and cystic (22), predominantly solid (11) or entirely cystic (2). Histologically, pseudopapillary structures, cholesterol clefts, hemorrhage, necrosis, and foam cells were commonly seen. Infiltration into the adjacent pancreas or capsule and perineural invasion were seen in some cases. Immunostaining for CD 10, CD56, and vimentin were positive. Chromogranin and cytokeratin were negative. Follow up in 20 patients from 2-82 months did not show evidence of recurrence or metastasis, even in those with limited surgery or minimal parenchymal or focal perineural infiltration.


CONCLUSION
This study suggests that a management approach with only limited complete tumor resection would be adequate in these tumors.