Skip to main content
SpringerLink
Log in

Potential Role for Observation in Small Solid Pseudopapillary Neoplasm (SPN)

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Solid pseudopapillary neoplasms (SPN) are rare tumors of the pancreas, typically affecting young women. Resection is the mainstay of treatment but is associated with significant morbidity and potential mortality. We explore the idea that small, localized SPN could be safely observed.

Methods

This retrospective review of the Pancreas National Cancer Database from 2004 to 2018 identified SPN via histology code 8452.

Results

A total of 994 SPNs were identified. Mean age was 36.8 ± 0.5 years, 84.9% (n = 844) were female, and most had a Charlson–Deyo Comorbidity Coefficient (CDCC) of 0–1 (96.6%, n = 960). Patients were most often staged clinically as cT2 (69.5%, n = 457) followed by cT3 (17.6%, n = 116), cT1 (11.2%, n = 74), and cT4 (1.7%, n = 11). Clinical lymph node and distant metastasis rates were 3.0 and 4.0%, respectively. Surgical resection was performed in 96.6% of patients (n = 960), most commonly partial pancreatectomy (44.3%) followed by pancreatoduodenectomy (31.3%) and total pancreatectomy (8.1%). In patients clinically staged as node (N0) and distant metastasis (M0) negative, occult pathologic lymph node involvement was found in 0% (n = 28) of patients with stage cT1 and 0.5% (n = 185) of patients with cT2 disease. The risk of occult nodal metastasis significantly increased to 8.9% (n = 61) for patients with cT3 disease. The risk further increased to 50% (n = 2) in patients with cT4 disease.

Conclusions

Herein, the specificity of excluding nodal involvement clinically is 99.5% in tumors ≤ 4 cm and 100% in tumors ≤ 2 cm. Therefore, there may be a role for close observation in patients with cT1N0 lesions to mitigate morbidity from major pancreatic resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Torres OJM, Rezende MB, Waechter FL, et al. Pancreatoduodenectomy for solid pseudopapillary tumor of the pancreas: a multi-institution study. Arq Bras Cir Dig. 2019;32(2):e1442.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hamilton S, Aaltonen L, World Health Organization classificaiton of tumors. Pathology and genetics of tumours of the digestive system. USA: IARC Press; 2000.

    Google Scholar 

  3. Vollmer CM Jr, Dixon E, Grant DR. Management of a solid pseudopapillary tumor of the pancreas with liver metastases. HPB. 2003;5(4):264–7.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Yagci A, Yakan S, Coskun A, et al. Diagnosis and treatment of solid pseudopapillary tumor of the pancreas: experience of one single institution from Turkey. World J Surg Oncol. 2013;11:308.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lanke G, Ali FS, Lee JH. Clinical update on the management of pseudopapillary tumor of pancreas. World J Gastrointest Endosc. 2018;10(9):145–55.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Law JK, Ahmed A, Singh VK, et al. A systematic review of solid-pseudopapillary neoplasms: are these rare lesions? Pancreas. 2014;43(3):331–7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Romics L Jr, Olah A, Belagyi T, Hajdu N, Gyurus P, Ruszinko V. Solid pseudopapillary neoplasm of the pancreas–proposed algorithms for diagnosis and surgical treatment. Langenbecks Arch Surg. 2010;395(6):747–55.

    Article  PubMed  Google Scholar 

  8. Shuja A, Alkimawi KA. Solid pseudopapillary tumor: a rare neoplasm of the pancreas. Gastroenterol Rep. 2014;2(2):145–9.

    Article  Google Scholar 

  9. Abudalou M, Vega EA, Dhingra R, et al. Solid pseudopapillary neoplasm-diagnostic approach and post-surgical follow up: three case reports and review of literature. World J Clin Cases. 2021;9(7):1682–95.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Jena SS, Ray S, Das SAP, Mehta NN, Yadav A, Nundy S. Rare Pseudopapillary neoplasm of the pancreas: a 10-year experience. Surg Res Pract. 2021;2021:7377991.

    PubMed  PubMed Central  Google Scholar 

  11. Lubezky N, Papoulas M, Lessing Y, et al. Solid pseudopapillary neoplasm of the pancreas: management and long-term outcome. Eur J Surg Oncol. 2017;43(6):1056–60.

    Article  CAS  PubMed  Google Scholar 

  12. Martin RC, Klimstra DS, Brennan MF, Conlon KC. Solid-pseudopapillary tumor of the pancreas: a surgical enigma? Ann Surg Oncol. 2002;9(1):35–40.

    Article  PubMed  Google Scholar 

  13. Sharma I, Cho WC, Thaker S, et al. Solid pseudopapillary neoplasm of the pancreas. J Pediatr Surg Case Rep. 2018;37:63–9.

    Article  Google Scholar 

  14. Stensbol AB, Krogh J, Holmager P, et al. Incidence, Clinical presentation and trends in indication for diagnostic work-up of small intestinal and pancreatic neuroendocrine tumors. Diagnostics. 2021;11(11):2030.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Santo E, Bar-Yishay I. Pancreatic solid incidentalomas. Endosc Ultrasound. 2017;6(Suppl 3):S99–103.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Yu PF, Hu ZH, Wang XB, et al. Solid pseudopapillary tumor of the pancreas: a review of 553 cases in Chinese literature. World J Gastroenterol. 2010;16(10):1209–14.

    Article  PubMed  PubMed Central  Google Scholar 

  17. De Robertis R, Marchegiani G, Catania M, et al. Solid pseudopapillary neoplasms of the pancreas: clinicopathologic and radiologic features according to size. AJR Am J Roentgenol. 2019;213(5):1073–80.

    Article  PubMed  Google Scholar 

  18. Albuquerque GPX, Ramos A, Anaissi AKM, et al. Hepatic metastasis in Frantz’s tumor: a case report. Int J Surg Case Rep. 2020;71:66–9.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Distler M, Ruckert F, Hunger M, et al. Evaluation of survival in patients after pancreatic head resection for ductal adenocarcinoma. BMC Surg. 2013;13:12.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Cusworth BM, Krasnick BA, Nywening TM, et al. Whipple-specific complications result in prolonged length of stay not accounted for in ACS-NSQIP Surgical Risk Calculator. HPB. 2017;19(2):147–53.

    Article  PubMed  Google Scholar 

  21. Pugalenthi A, Protic M, Gonen M, et al. Postoperative complications and overall survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. J Surg Oncol. 2016;113(2):188–93.

    Article  PubMed  Google Scholar 

  22. Zhang C, Liu F, Chang H, et al. Less aggressive surgical procedure for treatment of solid pseudopapillary tumor: limited experience from a single institute. PLoS ONE. 2015;10(11):e0143452.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Wu L, Nahm CB, Jamieson NB, et al. Risk factors for development of diabetes mellitus (Type 3c) after partial pancreatectomy: a systematic review. Clin Endocrinol. 2020;92(5):396–406.

    Article  Google Scholar 

  24. Burkhart RA, Gerber SM, Tholey RM, et al. Incidence and severity of pancreatogenic diabetes after pancreatic resection. J Gastrointest Surg. 2015;19(2):217–25.

    Article  PubMed  Google Scholar 

  25. Lee LC, Grant CS, Salomao DR, et al. Small, nonfunctioning, asymptomatic pancreatic neuroendocrine tumors (PNETs): role for nonoperative management. Surgery. 2012;152(6):965–74.

    Article  PubMed  Google Scholar 

  26. Gaujoux S, Partelli S, Maire F, et al. Observational study of natural history of small sporadic nonfunctioning pancreatic neuroendocrine tumors. J Clin Endocrinol Metab. 2013;98(12):4784–9.

    Article  CAS  PubMed  Google Scholar 

  27. Bettini R, Partelli S, Boninsegna L, et al. Tumor size correlates with malignancy in nonfunctioning pancreatic endocrine tumor. Surgery. 2011;150(1):75–82.

    Article  PubMed  Google Scholar 

  28. Gallotti A, Johnston RP, Bonaffini PA, et al. Incidental neuroendocrine tumors of the pancreas: MDCT findings and features of malignancy. AJR Am J Roentgenol. 2013;200(2):355–62.

    Article  PubMed  Google Scholar 

  29. Yoon HJ, Lim JH. Solid pseudopapillary tumor of the pancreas with hepatic metastasis: spontaneous regression over 10-year follow-up period. Korean J Radiol. 2012;13(5):648–51.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hachiya M, Hachiya Y, Mitsui K, Tsukimoto I, Watanabe K, Fujisawa T. Solid, cystic and vanishing tumors of the pancreas. Clin Imaging. 2003;27(2):106–8.

    Article  PubMed  Google Scholar 

  31. Suzuki M, Shimizu T, Minowa K, Ikuse T, Baba Y, Ohtsuka Y. Spontaneous shrinkage of a solid pseudopapillary tumor of the pancreas: CT findings. Pediatr Int. 2010;52(2):335–6.

    Article  PubMed  Google Scholar 

  32. Tanaka M, Fernandez-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12(3):183–97.

    Article  PubMed  Google Scholar 

  33. Vege SS, Ziring B, Jain R, Moayyedi P, Clinical Guidelines C, American Gastroenterology A. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015;148(4):819–22.

    Article  PubMed  Google Scholar 

  34. (NCCN) NCCN. NCCN Clinical Practice Guidelines in Oncology. Neuroendocrine Adrenal Tumor (Version 1.2022). 2022.

  35. Partelli S, Ramage JK, Massironi S, et al. Management of asymptomatic sporadic nonfunctioning pancreatic neuroendocrine neoplasms (ASPEN) ≤ 2 cm: study protocol for a prospective observational study. Front Med. 2020;7:598438.

    Article  Google Scholar 

Download references

Funding

There was no outside funding or influence in this manuscript.

Author information

Authors and Affiliations

  1. Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA

    Oliver Standring MD, Susana Benitez Sanchez MD, Lyudmyla Demyan MS, MD, Neha Lad MD, Samantha M. Ruff MD, Sandeep Anantha MD, William Nealon MD, Gene Coppa MD, Gary Deutsch MD, MPH, Matthew Weiss MD & Danielle K. DePeralta MD

  2. Northwell Health Cancer Institute, Lake Success, NY, USA

    Shamsher Pasha MD, Neha Lad MD, Sandeep Anantha MD, Martin Karpeh MD, Elliot Newman MD, William Nealon MD, Mark Talamini MD, MBA, Gene Coppa MD, Gary Deutsch MD, MPH, Matthew Weiss MD & Danielle K. DePeralta MD

  3. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA

    Sandeep Anantha MD, Martin Karpeh MD, Elliot Newman MD, William Nealon MD, Mark Talamini MD, MBA, Gene Coppa MD, Gary Deutsch MD, MPH, Matthew Weiss MD & Danielle K. DePeralta MD

  4. Department of Surgical Oncology, Northwell Health, Huntington Hospital, Huntington, NY, USA

    Martin Karpeh MD

  5. Department of Surgical Oncology, Northwell Health, Lenox Hill Hospital, New York, NY, USA

    Elliot Newman MD

Authors
  1. Oliver Standring MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susana Benitez Sanchez MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shamsher Pasha MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lyudmyla Demyan MS, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Neha Lad MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Samantha M. Ruff MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sandeep Anantha MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Martin Karpeh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Elliot Newman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. William Nealon MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mark Talamini MD, MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Gene Coppa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Gary Deutsch MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Matthew Weiss MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Danielle K. DePeralta MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Danielle K. DePeralta MD.

Ethics declarations

Disclosure

There are no conflicts of interest for any of the authors listed.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Standring, O., Benitez Sanchez, S., Pasha, S. et al. Potential Role for Observation in Small Solid Pseudopapillary Neoplasm (SPN). Ann Surg Oncol 30, 5105–5112 (2023). https://doi.org/10.1245/s10434-023-13496-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-023-13496-2

Search

Navigation