Large Solid Pseudopapillary Neoplasm of the Pancreas in the Oldest Known Male Patient

Context Solid pseudopapillary neoplasm is an unusual low-grade pancreatic tumour of unknown origin affecting mainly young females. Its development in atypical age and gender groups requires increased awareness to ensure correct diagnosis. Case report An eighty-six-yearold male complained about dull epigastric pain lasting 6 weeks. The medical history was unremarkable. Objectively, a tender epigastric mass was palpable but otherwise the abdomen was soft and painless. Computed tomography revealed a large retroperitoneal mass. En bloc extirpation of it along with resection of the transverse colon, pancreatic corpus and portal vein was performed. End-to-end colonic anastomosis, end-to-side pancreatojejunal anastomosis and side-to-side enteroenteroanastomosis were created. The portal vein was reconstituted by end-to-end anastomosis. The resected tumour measured 20x17x10 cm. It showed solid pseudopapillary architecture with low-grade nuclei and invaded transverse colon and pancreas. Negative PAS stain and positive immunohistochemical expression of vimentin, CD56, progesterone receptors, CD99, cyclin D1 and CD10 confirmed the diagnosis of solid pseudopapillary neoplasm. The proliferation index was low (2.0%). Neoplastic cells lacked epithelial, mesothelial, neuroendocrine, vascular and myogenic markers. Resection lines and five lymph nodes were free of tumour. The patient developed postoperative pancreatitis and succumbed on the 27th postoperative day due to repeated bleeding from necrotic pancreatic tissue. Conclusions To the best of our knowledge, the reported patient is the oldest person and the oldest male patient diagnosed with solid pseudopapillary neoplasm. Awareness of this entity and its occurrence in unusual sex and age groups would be helpful to plan age-adjusted treatment for this low-grade malignancy.

Author(s): Andrejs Vanags, Zane Simtniece, Ervins Vasko, Ilze Strumfa, Peteris Prieditis, Ivanda Franckevica

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