Title : Diagnosis and management of solid pseudopapillary neoplasms of the pancreas: A comprehensive review and single-center experience
Abstract:
Title: Solid Pseudopapillary Neoplasms of the Pancreas: A Decade-Single Institution Experience in Diagnosis, Surgical Management and Long-Term Outcomes.
Background & Objectives: Solid pseudopapillary neoplasm (SPN) is an uncommon pancreatic epithelial neoplasm that preferentially affects young women and carries low-grade malignant potential. Because its imaging and cytologic features overlap with other cystic or solid pancreatic lesions, accurate pre-operative characterization remains challenging. We reviewed our institutional cohort to define contemporary diagnostic pathways, surgical strategies and prognostic determinants that optimise care for SPN patients.
Methods: All patients undergoing pancreatic resection for histologically confirmed SPN at the First Affiliated Hospital of Harbin Medical University between January 2022 and December 2024 were retrospectively analysed. Pre-operative work-up included contrast-enhanced CT/MRI, endoscopic ultrasound (EUS) when indicated, and serum tumour markers. Immunohistochemistry for β-catenin, vimentin, SOX-11 and TFE3 was performed on resected specimens. Clinicopathological variables, operative details, post-operative morbidity (ISGPS and Clavien-Dindo classifications), recurrence patterns and survival were evaluated. Continuous variables are presented as median (IQR) and survival was estimated by Kaplan-Meier analysis.
Results: Of 82 identified patients, 75 (91%) were female; median age was 27 years (18–49). Tumours were located in the pancreatic head (n=28), body (n=22) and tail (n=32); median size 5.5 cm (2.1–12 cm). Pre-operative diagnostic accuracy was 78% for MRI, 71% for CT and 93% when both modalities were combined. Characteristic features—well-defined capsule, haemorrhagic degeneration and progressive peripheral enhancement—were present in 88% of cases. Immunohistochemistry showed diffuse nuclear β-catenin in 98%, SOX-11 in 97% and vimentin in 95%. Surgical procedures included pancreatoduodenectomy (n=26), distal pancreatectomy ± splenectomy (n=44) and parenchyma-sparing enucleation (n=12). R0 resection was achieved in 96%. Post-operative pancreatic fistula rate was 18% (mostly ISGPS grade B); 90-day mortality was zero. After median follow-up of 68 months (12–132), five patients (6%) developed recurrence: three hepatic, two loco-regional. All recurrences were treated surgically; four patients remain disease-free, one alive with disease. Overall 5-year disease-specific survival was 97%; recurrence-free survival 94%. Microscopic infiltration of peripancreatic fat (HR 3.7, p=0.04) were independent predictors of recurrence.
Conclusions: SPN can be confidently diagnosed pre-operatively by recognising specific MRI/CT traits supplemented by characteristic immunohistochemical markers. Complete surgical resection—achievable in virtually all patients—offers excellent long-term cure with acceptable morbidity. Parenchyma-sparing or spleen-preserving operations are justified when oncologically safe. Lifelong surveillance is warranted for individuals with male gender or extrapancreatic invasion, whereas routine imaging may be de-escalated in low-risk, R0-resected female patients.
