title: Multiple liver metastases of pancreatic solid pseudopapillary tumor treated with resection following chemotherapy and transcatheter arterial embolization: A case report.
abstract: A 33-year-old female was diagnosed with a solid pseudopapillary tumor (SPT) of the pancreas and multiple liver metastases at the Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital (Kanazawa, Japan). Distal pancreatectomy and postoperative systemic chemotherapy with gemcitabine (GEM) and S-1, an oral fluoropyrimidine derivative, was administered, however, liver metastases became enlarged and local recurrence occurred. Therefore, the patient was referred to the Department of Gastroenterologic Surgery at the Graduate School of Medicine (Kanazawa, Japan) for hepatic arterial infusion (HAI) chemotherapy. Oral S-1 (80 mg/m2) was administered as well as HAI chemotherapy with GEM (1,000 mg/standard liver volume). Following 18 cycles, tumor sizes were reduced and 18-fluorodeoxyglucose positron emission tomography (18FDG-PET) examination revealed obvious reduction of tumor FDG uptake. Transarterial tumor embolization (TAE) was performed for the previously unresectable right subphrenic liver tumor, and the other tumors were surgically resected. The resected tumors were diagnosed as liver metastases and a local recurrence of SPT in the postoperative pathological examination, which revealed that the resected tumors were composed of sheets of bland cells, which were positive for CD10, CD56, vimentin, neuron-specific enolase and α-antitrypsin. The postoperative course was uneventful, and the patient is currently under observation at an outpatient clinic; postoperative adjuvant chemotherapy with oral S-1 has continued, and additional TAE is planned. In the future, if the middle segment of the liver becomes enlarged, surgery for the residual right lobe tumor may be possible. This case demonstrates one method of SPT treatment: Preoperative HAI chemotherapy with GEM, plus oral S-1 and TAE. If complete resection can be achieved, the majority of patients with SPT have a favorable prognosis. In patients with unresectable metastases from SPT, it is crucial to conduct systematic multimodal treatment to maximize treatment success.
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Hidehiro
authors: H
authors: Tajima
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Hiroyuki
authors: H
authors: Takamura
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Hirohisa
authors: H
authors: Kitagawa
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Akira
authors: A
authors: Nakayama
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Masatoshi
authors: M
authors: Shoji
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Toshifumi
authors: T
authors: Watanabe
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Tomoya
authors: T
authors: Tsukada
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Shinichi
authors: S
authors: Nakanuma
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Koichi
authors: K
authors: Okamoto
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Seisho
authors: S
authors: Sakai
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Jun
authors: J
authors: Kinoshita
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Isamu
authors: I
authors: Makino
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Keishi
authors: K
authors: Nakamura
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Hironori
authors: H
authors: Hayashi
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Katsunobu
authors: K
authors: Oyama
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Masafumi
authors: M
authors: Inokuchi
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Hisatoshi
authors: H
authors: Nakagawara
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Tomoharu
authors: T
authors: Miyashita
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Itasu
authors: I
authors: Ninomiya
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Sachio
authors: S
authors: Fushida
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Takashi
authors: T
authors: Fujimura
authors: Department of Histology and Embryology, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Tomohiko
authors: T
authors: Wakayama
authors: Department of Histology and Embryology, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Shoichi
authors: S
authors: Iseki
authors: Division of Pathology, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Hiroko
authors: H
authors: Ikeda
authors: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.
authors: Tetsuo
authors: T
authors: Ohta
keywords: chemotherapy; hepatic arterial infusion; liver metastasis; resection; solid pseudopapillary tumor; transarterial tumor embolization