title: Solid pseudopapillary neoplasm of the pancreas: Management and long-term outcome.
abstract: BACKGROUND
  Solid pseudopapillary neoplasm (SPN) of pancreas is a rare pancreatic neoplasm with a low metastatic potential. Our aim was to study the clinical-pathological characteristics, and long-term outcome of this tumor.
  
  
  METHODS
  Rretrospective single center study of patients operated for SPN of pancreas. Clinical and pathological data were collected.
  
  
  RESULTS
  From 1995 to 2016, 1320 patients underwent pancreatic resection. SPN was confirmed in 32 cases (2.46%), including 29 (90.6%) female and three (9.4%) male, with a mean age of 28.4 ± 12.2 years. SPN was the most common pathology among female patients under age of 40 (72.4%). Abdominal pain was the most frequent presenting symptom (48%), whereas none of the patients presented with jaundice. Mean tumor diameter was 5.9 cm (range, 0.9-14 cm). All patients underwent margin-negative surgical resection. Two patients demonstrated gross malignant features, including liver metastases at presentation (n = 1), and adjacent organ and vascular invasion (n = 1). Microscopic malignant features were present in thirteen patients (40.6%). Recurrence occurred in the retroperitoneal lymph nodes (n = 1, 7 years post resection) and in the liver (n = 2, 1 and 5 years post resection). Mean follow-up was 49.2 months (range, 1-228 months). Five and 10-year disease-free survival was 96.5% and 89.6% respectively.
  
  
  CONCLUSIONS
  SPNs are low-grade tumors with a good prognosis. Margin-negative surgical resection is curative in most patients. However, almost 15% of patients demonstrate malignant features including invasion of adjacent organs or metastatic disease. Patients with malignant disease are still expected to have long survival, and aggressive surgical approach is advocated.
authors.affiliation: The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel. Electronic address: nirl@tlvmc.gov.il.
authors.forename: N
authors.initials: N
authors.lastname: Lubezky
authors.affiliation: The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Papoulas
authors.affiliation: The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Lessing
authors.affiliation: Institute of Pathology, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Gitstein
authors.affiliation: Institute of Pathology, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Brazowski
authors.affiliation: The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Nachmany
authors.affiliation: The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Lahat
authors.affiliation: The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Goykhman
authors.affiliation: The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Ben-Yehuda
authors.affiliation: The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Nakache
authors.affiliation: The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel.
authors.forename: J M
authors.initials: JM
authors.lastname: Klausner
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D002291:Carcinoma, Papillary / Q000150:complications / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D000072662:Margins of Excision; D009364:Neoplasm Recurrence, Local; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D010534:Peritoneal Neoplasms / Q000556:secondary; D011379:Prognosis; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D047368:Tumor Burden; D055815:Young Adult
keywords: Solid pseudopapillary neoplasm pancreas