Pathological differential diagnosis of solid-pseudopapillary neoplasm and endocrine tumors of the pancreas.
OBJECTIVE
To investigate differential points of solid-pseudopapillary neoplasm (SPN) of the pancreas and pancreatic endocrine tumor (PET).


METHODS
Ten cases of SPN and fourteen cases of PET were studied in this retrospective study. Clinical and pathologic features, immunostaining reactions and beta-catenin gene mutations were analyzed.


RESULTS
The mean age of SPN patients was 25.6 years and these patients had no specific symptoms. The mean diameter of the tumors was 11.0 cm, 9/10 cases were cystic or a mixture of solid and cystic structures, and there was hemorrhage and necrosis on the cut surface in 8/10 (80%) cases. Characteristic pseudopapillary structure and discohesive appearance of the neoplastic cells were observed in all 10 (100%) cases. The results of immunostaining showed that nuclear expression of beta-catenin and loss of E-cadherin in all the cases, was only seen in SPN. Molecular studies discovered that 9/10 (90%) cases harbored a point mutation of exon 3 in beta-catenin gene. On the other hand, the mean age of PET patients was 43.1 years. Eight of 14 cases presented with symptoms caused by hypoglycemia, and the other 6 cases presented with symptoms similar to those of SPN. The mean size of the tumors was 2.9 cm, most of the tumors were solid, only 3/14 (21%) were a mixture of solid and cystic structures, and macroscopic hemorrhage and necrosis were much less common (3/14, 21%). Histologically, tumor cells were arranged in trabecular, acinar or solid patterns and demonstrated no pseudopapillary structure and discohesive appearance in all 14 (100%) cases. The results of immunostaining and mutation detection were completely different with SPN that membrane and cytoplastic expression of beta-catenin without loss of E-cadherin, as well as no mutation in beta-catenin gene in all the cases.


CONCLUSIONS
Both macroscopic and microscopic features of SPN are quite characteristic. It is not difficult to distinguish it from PET. If necessary, immunostaining of beta-catenin and E-cadherin is quite helpful to make the differential diagnosis.
Liu
Bao-An
BA
Department of Pathology, Xiangya Basic Medical School, Central-south University, 110# Tongzipo Road, Changsha 410013, Hunan Province, China. lba118@yahoo.com.cn
Li
Zhuo-Ming
ZM
Su
Zhan-San
ZS
She
Xiao-Ling
XL
D000293:Adolescent; D000328:Adult; D001483:Base Sequence; D015820:Cadherins / Q000235:genetics / Q000378:metabolism; D004252:DNA Mutational Analysis; D004701:Endocrine Gland Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009154:Mutation; D010179:Pancreas / Q000033:anatomy & histology / Q000378:metabolism / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology*; D012189:Retrospective Studies; D055815:Young Adult; D051176:beta Catenin / Q000235:genetics / Q000378:metabolism
D015820:Cadherins; D051176:beta Catenin