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Incidental detection of a small solid pseudopapillary neoplasm of the pancreas after a traffic accident in a 12-year-old girl: a case report.

Kim Y, Moon SB - Int Med Case Rep J (2015)

Bottom Line: The tumor was 3.5 cm in maximal diameter and was found to have hemorrhagic necrosis without a solid component.Although the initial presentation in this case was that of the traffic accident, the subsequent detection of a small, totally cystic SPN, and then the complete eradication of the lesion, led to a favorable outcome for the patient.Long-term monitoring should prevent any chance of recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, South Korea.

ABSTRACT
Solid pseudopapillary neoplasm (SPN) is a rare tumor of the pancreas that tends to grow silently in patients at a young age, to a large size and mass. We report here a case of a small-sized SPN detected incidentally in a 12-year-old girl following a traffic accident. The tumor was 3.5 cm in maximal diameter and was found to have hemorrhagic necrosis without a solid component. Laparoscopic spleen-preserving distal pancreatectomy was performed which cured the patient. SPN is generally accepted to be a low grade malignant tumor, but its clinical behavior is sometimes unpredictable. Tumor size and the proportion of solid portion of the tumor have both recently been identified as predictors of malignancy. Although the initial presentation in this case was that of the traffic accident, the subsequent detection of a small, totally cystic SPN, and then the complete eradication of the lesion, led to a favorable outcome for the patient. Long-term monitoring should prevent any chance of recurrence.

No MeSH data available.


Related in: MedlinePlus

CT scan of mass in the pancreatic tail region with a homogeneously cystic component with enhancing thin wall (arrows).Abbreviation: CT, computed tomography.
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f1-imcrj-8-259: CT scan of mass in the pancreatic tail region with a homogeneously cystic component with enhancing thin wall (arrows).Abbreviation: CT, computed tomography.

Mentions: The case review was conducted according to all guidelines outlined in the Declaration of Helsinki. As this study involved no interventional experimentation whatsoever and is a retrospective review of a case, written consent from the patient was not required. A 12-year-old girl presented to the emergency department shortly after a traffic accident with upper abdominal pain. She had been in the passenger seat of the car, wearing a seat belt. She had no associated symptoms such as nausea or vomiting. Her past medical history was unremarkable. On physical examination, the patient had an acutely-ill-looking appearance but her vital signs were within normal ranges. Her abdomen was flat and slightly tender in the upper abdominal region but without signs of peritonitis. There were no identifiable external wounds on her abdomen. On laboratory examination, the white blood cell count was 12,100 cells/uL (normal, 4,000–10,000 cells/uL) with 88% segmented neutrophils, and hemoglobin was 11.6 g/dL (normal, 13.3–16.5 g/dL). Liver function tests were normal. Serum amylase and lipase were 86 U/L (normal, 30–118 U/L) and 33 U/L (normal, 12–53 U/L), respectively. Abdominal computed tomography (CT) scan revealed neither free gas nor blood in her abdomen, but a 4 cm mass was detected in the tail of the pancreas, and the patient was hospitalized for further evaluation of the pancreatic mass. The mass had an enhancing thin wall, and the internal texture was homogeneously cystic without enhancing solid components (Figure 1). CEA and CA-125 checked after admission were 1.2 ng/mL (normal, 0–5 ng/mL) and 10.9 U/mL (normal, 0–35 U/mL), respectively. On day 2 of hospital admission, the patient underwent a laparoscopic spleen-preserving distal pancreatectomy to rule out malignancy. The tumor was found to be grossly 3.5 cm in maximal diameter, with a fibrous capsule with extensive hemorrhagic necrosis internally (Figure 2A). Pathological examination confirmed the diagnosis of SPN by demonstrating the characteristic pseudopapillae in which residual tumor cells appear to rosette around the vascular cores (Figure 2B). The resection margin was free of tumor cells. The postoperative course was uneventful and the patient was discharged 7 days after the operation. Currently, 6 months postoperative, the patient is well without radiological evidences of disease recurrence.


Incidental detection of a small solid pseudopapillary neoplasm of the pancreas after a traffic accident in a 12-year-old girl: a case report.

Kim Y, Moon SB - Int Med Case Rep J (2015)

CT scan of mass in the pancreatic tail region with a homogeneously cystic component with enhancing thin wall (arrows).Abbreviation: CT, computed tomography.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4621174&req=5

f1-imcrj-8-259: CT scan of mass in the pancreatic tail region with a homogeneously cystic component with enhancing thin wall (arrows).Abbreviation: CT, computed tomography.
Mentions: The case review was conducted according to all guidelines outlined in the Declaration of Helsinki. As this study involved no interventional experimentation whatsoever and is a retrospective review of a case, written consent from the patient was not required. A 12-year-old girl presented to the emergency department shortly after a traffic accident with upper abdominal pain. She had been in the passenger seat of the car, wearing a seat belt. She had no associated symptoms such as nausea or vomiting. Her past medical history was unremarkable. On physical examination, the patient had an acutely-ill-looking appearance but her vital signs were within normal ranges. Her abdomen was flat and slightly tender in the upper abdominal region but without signs of peritonitis. There were no identifiable external wounds on her abdomen. On laboratory examination, the white blood cell count was 12,100 cells/uL (normal, 4,000–10,000 cells/uL) with 88% segmented neutrophils, and hemoglobin was 11.6 g/dL (normal, 13.3–16.5 g/dL). Liver function tests were normal. Serum amylase and lipase were 86 U/L (normal, 30–118 U/L) and 33 U/L (normal, 12–53 U/L), respectively. Abdominal computed tomography (CT) scan revealed neither free gas nor blood in her abdomen, but a 4 cm mass was detected in the tail of the pancreas, and the patient was hospitalized for further evaluation of the pancreatic mass. The mass had an enhancing thin wall, and the internal texture was homogeneously cystic without enhancing solid components (Figure 1). CEA and CA-125 checked after admission were 1.2 ng/mL (normal, 0–5 ng/mL) and 10.9 U/mL (normal, 0–35 U/mL), respectively. On day 2 of hospital admission, the patient underwent a laparoscopic spleen-preserving distal pancreatectomy to rule out malignancy. The tumor was found to be grossly 3.5 cm in maximal diameter, with a fibrous capsule with extensive hemorrhagic necrosis internally (Figure 2A). Pathological examination confirmed the diagnosis of SPN by demonstrating the characteristic pseudopapillae in which residual tumor cells appear to rosette around the vascular cores (Figure 2B). The resection margin was free of tumor cells. The postoperative course was uneventful and the patient was discharged 7 days after the operation. Currently, 6 months postoperative, the patient is well without radiological evidences of disease recurrence.

Bottom Line: The tumor was 3.5 cm in maximal diameter and was found to have hemorrhagic necrosis without a solid component.Although the initial presentation in this case was that of the traffic accident, the subsequent detection of a small, totally cystic SPN, and then the complete eradication of the lesion, led to a favorable outcome for the patient.Long-term monitoring should prevent any chance of recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, South Korea.

ABSTRACT
Solid pseudopapillary neoplasm (SPN) is a rare tumor of the pancreas that tends to grow silently in patients at a young age, to a large size and mass. We report here a case of a small-sized SPN detected incidentally in a 12-year-old girl following a traffic accident. The tumor was 3.5 cm in maximal diameter and was found to have hemorrhagic necrosis without a solid component. Laparoscopic spleen-preserving distal pancreatectomy was performed which cured the patient. SPN is generally accepted to be a low grade malignant tumor, but its clinical behavior is sometimes unpredictable. Tumor size and the proportion of solid portion of the tumor have both recently been identified as predictors of malignancy. Although the initial presentation in this case was that of the traffic accident, the subsequent detection of a small, totally cystic SPN, and then the complete eradication of the lesion, led to a favorable outcome for the patient. Long-term monitoring should prevent any chance of recurrence.

No MeSH data available.


Related in: MedlinePlus