title: [Recurrent duodenal ulcer bleeding as the first manifestation of a solid pseudopapillary neoplasm of the pancreas with hepatic metastases].
abstract: METHODS
  In a 17-year-old girl recurrent duodenal ulcer bleeding had led to severe anemia.
  
  
  METHODS
  Sonography and computed tomography revealed a partially cystic tumour of the pancreatic head and suspicious hepatic lesions. TREATMENT AND PATHOLOGICAL DIAGNOSIS: A partial duodenopancreatectomy was performed and two liver metastases were resected. Histological examination of the resected pancreatic specimen revealed a solid pseudopapillary neoplasm of the pancreas (SPN) with hepatic metastases. CLINICAL COURSE AND PROGNOSIS: The seven remaining liver metastases were removed in a second procedure (right hepatectomy). One year later two new liver metastases were treated by radiofrequency ablation. Two years after the initial operation, the patient is well and tumor-free.
  
  
  CONCLUSIONS
  SPN is a rare cystic tumor that is mainly found in young women. Direct tumor infiltration of stomach or duodenum can cause gastrointestinal bleedings in rare cases. Resection of the primary tumor and surgical or interventional removal of metastases are the treatment of choice.
authors.affiliation: Institut für Allgemeine Pathologie und Pathologische Anatomie, Technische Universität München.
authors.forename: A M
authors.initials: AM
authors.lastname: Schlitter
authors.forename: B
authors.initials: B
authors.lastname: Konukiewitz
authors.forename: J
authors.initials: J
authors.lastname: Kleeff
authors.forename: G
authors.initials: G
authors.lastname: Klöppel
authors.forename: I
authors.initials: I
authors.lastname: Esposito
mesh_terms: D000231:Adenocarcinoma, Papillary / Q000175:diagnosis / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D000293:Adolescent; D017115:Catheter Ablation; D003299:Cooperative Behavior; D003937:Diagnosis, Differential; D004381:Duodenal Ulcer / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D005260:Female; D006498:Hepatectomy; D006801:Humans; D033183:Interdisciplinary Communication; D008099:Liver / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D010179:Pancreas / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation