title: Solid pseudopapillary tumor of the pancreas: 'experiences' and 'lessons' at a tertiary-care oncology center.
abstract: Solid pseudopapillary tumor of the pancreas (SPT) is a rare and fascinating entity of elusive histogenesis and unpredictable biology. It has a peculiar proclivity to afflict young females and involve the pancreatic body-tail region. Cytology diagnosis of these rare neoplasms remains a challenge. We analyzed the cytology features of all SPT cases diagnosed on fine needle aspiration cytology (FNAC) from 2003 to 2009 along with their histopathology slides. Nineteen consecutive cases were diagnosed as SPT on FNAC. Fifteen out of nineteen cases were confirmed as true SPT on histopathology. Amongst the true SPT, all except one occurred in females. Age ranged from 14 to 50 years. Pseudopapillae bearing stout branches terminating in bulbous tips and enclosing transgressing vessels, separated from a collar of tumor cells by a clear zone of myxohyaline coat were pathognomonic of SPT. Singly dispersed monomorphic tumor cells with bland chromatin formed the second diagnostic component of SPT. Nuclear grooves and hyaline globules were in addition helpful in segregating SPT from its close differentials. In four cases diagnosed as SPT on FNAC, histopathology revealed a different final diagnosis (one case each of paraganglioma, extragastrointestinal stromal tumor, metastatic papillary renal cell carcinoma and inflammatory myofibroblastic tumor). Conversely, one case of SPT had been erroneously diagnosed as neuroendocrine tumor on FNAC. Six cases (40%) developed metastasis; commonest site being liver. In conclusion, cytology in conjunction with clinico-radiologic findings plays a key role in making a correct diagnosis. Awareness of unique cytomorphological features is important in distinguishing this tumor from its diverse mimics.
authors.affiliation: Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India. munita.m@rediffmail.com
authors.forename: Munita Meenu
authors.initials: MM
authors.lastname: Bal
authors.forename: Kedar
authors.initials: K
authors.lastname: Deodhar
authors.forename: Shailesh
authors.initials: S
authors.lastname: Shrikhande
authors.forename: Parul
authors.initials: P
authors.lastname: Shukla
authors.forename: Supreeta
authors.initials: S
authors.lastname: Arya
authors.forename: Mukta
authors.initials: M
authors.lastname: Ramadwar
mesh_terms: D000293:Adolescent; D000328:Adult; D044963:Biopsy, Fine-Needle; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging / Q000556:secondary*; D002292:Carcinoma, Renal Cell / Q000175:diagnosis; D002467:Cell Nucleus / Q000473:pathology; D003951:Diagnostic Errors; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000175:diagnosis; D006104:Granuloma, Plasma Cell / Q000175:diagnosis; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008297:Male; D008875:Middle Aged; D016522:Oncology Service, Hospital; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D010235:Paraganglioma / Q000175:diagnosis; D011859:Radiography; D015203:Reproducibility of Results; D062606:Tertiary Care Centers; D055815:Young Adult