Solid-pseudopapillary tumor of the pancreatic head causing marked distal atrophy: a tumor originated posterior to the main pancreatic duct.
We report the case of a solid-pseudopapillary tumor (SPT) of the head of the pancreas causing occlusion of the main pancreatic duct (MPD) and marked pancreatic atrophy distal to the tumor disproportionate to the tumor size. A 15-yr-old girl was diagnosed with 5-cm solid-pseudopapillary tumor of the pancreatic head with marked distal pancreatic atrophy. Endoscopic retrograde cholangiopancreatography demonstrated obstruction of the MPD in the pancreatic head. We performed a duodenum-preserving pancreatic head resection to avoid postoperative exocrine and endocrine insufficiency. The surgical specimen showed the typical gross appearance of a SPT, with only a thin rim of pancreas anterior to the tumor. We believe that this presentation results when a tumor originates posterior to the MPD. Thus, whether or not pancreatic atrophy occurs depends strongly on the anterior/posterior relationship between the enlarging tumor and the MPD. The risk of SPT causing severe pancreatic atrophy should be kept in mind to avoid irreversible pancreatic insufficiency in young females.
Akiyama
Hiroto
H
Department of Surgery, Inazawa City Hospital, Inazawa City, Japan. h-akiyama@city.inazawa.aichi.jp
Ono
Kaname
K
Takano
Manabu
M
Sumida
Kei
K
Ikuta
Koji
K
Miyamoto
Osamu
O
D000293:Adolescent; D001284:Atrophy; D002114:Calcinosis / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D018292:Cystadenoma, Papillary / Q000737:chemistry / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D009363:Neoplasm Proteins / Q000032:analysis; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010183:Pancreatic Ducts / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000737:chemistry / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D010751:Phosphopyruvate Hydratase / Q000032:analysis; D014057:Tomography, X-Ray Computed; D000515:alpha 1-Antitrypsin / Q000032:analysis
D009363:Neoplasm Proteins; D000515:alpha 1-Antitrypsin; D010751:Phosphopyruvate Hydratase