title: Surgical treatment of solid pseudopapillary neoplasms of the pancreas and risk factors for malignancy.
abstract: BACKGROUND
  The aim of this study was to identify clinical predictors of malignancy and surgical strategies for pancreatic solid pseudopapillary neoplasm (SPN) by analysis of surgical outcomes at a single institution.
  
  
  METHODS
  All patients who underwent surgery for SPN between 1995 and 2010 were identified. Histopathology slides of all patients were reviewed by a specialized pathologist and the neoplasms were classified according to the criteria of the World Health Organization 2010.
  
  
  RESULTS
  Of the 106 patients identified, 85 (80·2 per cent) were female, and the median age was 36 (range 10-65) years. Median tumour size was 4·5 (range 1·0-15·0) cm. Some 17 patients (16·0 per cent) were classified as having a high-grade malignant SPN. Tumour size of at least 5 cm was associated with high-grade malignant potential (P = 0·022). Although lymph nodes were removed from 40 patients (37·7 per cent), there were no nodal metastases. A total of five patients underwent en bloc resection of adjacent structures, including two with portal vein involvement. After a median follow-up of 56·9 months, two patients with high-grade malignant SPN had evidence of tumour recurrence in the lymph nodes and liver.
  
  
  CONCLUSIONS
  SPN with a diameter of 5 cm or more is associated with a high-grade malignant phenotype. Complete surgical removal is associated with low recurrence rates.
authors: Department of Surgery, Jeju National University School of Medicine, Jeju, Korea.
authors: M J
authors: MJ
authors: Kim
authors: D W
authors: DW
authors: Choi
authors: S H
authors: SH
authors: Choi
authors: J S
authors: JS
authors: Heo
authors: J-Y
authors: JY
authors: Sung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000517:prevention & control; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult