title: Solid pseudopapillary tumors of the pancreas: Specific pathological features predict the likelihood of postoperative recurrence.
abstract: BACKGROUND
  Since their introduction in the WHO classification, the incidence of solid pseudopapillary tumors (SPTs) of the pancreas has progressively increased, mainly because of the widespread use of cross-sectional imaging. Few recent studies have analyzed the biological behavior of SPTs, but reliable data on long-term follow-up are needed.
  
  
  METHODS
  Retrospective analysis of two Institutions with high caseload, The Department of General Surgery-Pancreas Institute, University of Verona Hospital Trust and the Department of General Surgery, Massachusetts General Hospital, Harvard Medical School, was carried out. Data from 131 consecutive resections for SPT performed during the last three decades were collected and analyzed.
  
  
  RESULTS
  The majority of patients were female (86.3%) with a median age of 33 (7-68) years. The prevalent location was the pancreatic tail (33.5%). Applying the WHO criteria, 16 (12.2%) SPTs were considered malignant due to the presence of at least pancreatic parenchyma (9.9%), perineural (4.6%), and/or angiovascular invasion (2.3%). After a median of 62 months after surgery, only two patients had a recurrence (1.5%). Both of them fulfilled the WHO criteria for malignant SPT (vs. 10.7% of those who did not recur, P = 0.01), had an infiltrative growth pattern (vs. 10.8%, P = 0.01), pancreatic parenchyma invasion (vs. 9.7%, P = 0.01) and capsular invasion (vs. 4.9%, P = 0.004).
  
  
  CONCLUSIONS
  Overall, SPTs are associated with excellent survival results after surgical resection. Disease recurrence is extremely rare, and might occur if the primary tumor presents with either pancreatic parenchyma or capsule invasion. J. Surg. Oncol. 2016;114:597-601. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of General and Pancreatic Surgery, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Marchegiani
authors.affiliation: Department of General and Pancreatic Surgery, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Andrianello
authors.affiliation: Department of General and Pancreatic Surgery, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Massignani
authors.affiliation: Department of General and Pancreatic Surgery, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Malleo
authors.affiliation: Department of General and Pancreatic Surgery, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Maggino
authors.affiliation: Department of General and Pancreatic Surgery, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Paiella
authors.affiliation: Department of General Surgery, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts.
authors.forename: Cristina R
authors.initials: CR
authors.lastname: Ferrone
authors.affiliation: Department of Diagnostic and Public Health, ARC-Net Research Centre-University of Verona Hospital Trust, Verona, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Luchini
authors.affiliation: Department of Diagnostic and Public Health, ARC-Net Research Centre-University of Verona Hospital Trust, Verona, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Scarpa
authors.affiliation: Department of Diagnostic and Public Health, ARC-Net Research Centre-University of Verona Hospital Trust, Verona, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Capelli
authors.affiliation: Department of Pathology, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts.
authors.forename: Mari
authors.initials: M
authors.lastname: Mino-Kenudson
authors.affiliation: Department of General Surgery, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
authors.affiliation: Department of General and Pancreatic Surgery, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
authors.affiliation: Department of General Surgery, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts.
authors.forename: Carlos Fernàndez-Del
authors.initials: CF
authors.lastname: Castillo
authors.affiliation: Department of General and Pancreatic Surgery, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy. roberto.salvia@univr.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: SPN; SPT; cystic pancreatic neoplasm; pancreas; solid pseudopapillary neoplasms; solid pseudopapillary tumors