title: Solid-pseudopapillary tumor of the pancreatic head causing marked distal atrophy: a tumor originated posterior to the main pancreatic duct.
abstract: 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.
authors.affiliation: Department of Surgery, Inazawa City Hospital, Inazawa City, Japan. h-akiyama@city.inazawa.aichi.jp
authors.forename: Hiroto
authors.initials: H
authors.lastname: Akiyama
authors.forename: Kaname
authors.initials: K
authors.lastname: Ono
authors.forename: Manabu
authors.initials: M
authors.lastname: Takano
authors.forename: Kei
authors.initials: K
authors.lastname: Sumida
authors.forename: Koji
authors.initials: K
authors.lastname: Ikuta
authors.forename: Osamu
authors.initials: O
authors.lastname: Miyamoto
mesh_terms: 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
chemical_list: D009363:Neoplasm Proteins; D000515:alpha 1-Antitrypsin; D010751:Phosphopyruvate Hydratase