Solid pseudopapillary neoplasm of the pancreas–proposed algorithms for diagnosis and surgical treatment

Romics, Jr., László; Oláh, Attila; Belágyi, Tibor; Hajdú, Nóra; Gyűrűs, Péter; Ruszinkó, Viktória
August 2010
Langenbeck's Archives of Surgery;Aug2010, Vol. 395 Issue 6, p747
Academic Journal
The incidence of solid pseudopapillary neoplasm (SPN) of the pancreas is rising. Although the evidence for proper management is accumulating, we still lack diagnostic and therapeutic guidelines. In this paper, therefore, we propose an algorithm for diagnosis and treatment of this rare type of tumor. A literature search was carried out on “Medline” and “Pubmed” databases to identify studies investigating the clinicopathologic features, pathogenesis, diagnostic, and differential diagnostic pathways, and surgical and adjuvant treatment options. Evidence from relevant published literature was completed with data of six patients treated with SPN in our institution. This study included case series and retrospective reviews only, since no higher level of evidence exists in the relevant literature. The articles emphasized that preoperative diagnosis is desirable to set up a precise plan for surgical treatment. Further, an R0 organ-sparing resection for primary SPN and an en bloc resection of locally advanced SPN are advised, while resection of synchronous as well as metachronous distant metastases is strongly advocated for this rare type of pancreatic cancer. The role of adjuvant chemo- or radiotherapy still needs to be defined. Finally, a diagnostic and therapeutic algorithm is devised in this paper to aid proper management of SPN. Current recommendations for treatment of SPN of the pancreas rely mainly on case series as single institutional experiences and retrospective reviews. Although the level of evidence is relatively low, the way of management discussed above is likely to provide an excellent prognosis in typically young patients with SPN.


Related Articles

  • CURRENT MANAGEMENT OF CYSTIC NEOPLASMS OF THE PANCREAS. Carpizo, D. R.; Allen, P. J.; Brennan, M. F. // Surgeon (Edinburgh University Press);Oct2008, Vol. 6 Issue 5, p298 

    Over the last decade there has been a dramatic increase in the number of patients identified with pancreatic cysts. This increase has been largely attributed to advances in imaging. The majority of these cysts represent benign neoplasms; however, a significant fraction of these are pre-malignant...

  • 18-Fluorodeoxyglucose positron emission tomography in predicting survival of patients with pancreatic carcinoma Sperti, Cosimo; Pasquali, Claudio; Chierichetti, Franca; Ferronato, Andrea; Decet, Giandomenico; Pedrazzoli, Sergio // Journal of Gastrointestinal Surgery;Dec2003, Vol. 7 Issue 8, p953 

    The prediction of survival of patients with pancreatic cancer is usually based on tumor staging and grading and on the level of tumor markers. However, accurate tumor staging can be obtained only after resection, and still there is a great difference in survival rates among patients with the...

  • PANCREATIC CANCER: STILL GRIM REAPER. Shah, Monica // Drug Topics;2/21/2005, Vol. 149 Issue 4, DRUG TOPICS p11 

    Pancreatic cancer is the 10th most common oncological diagnosis, but the third leading cause of cancer mortality in the U.S. Despite tremendous endeavors in the past few decades, conventional therapeutic modalities have had minimal effect on the course of the aggressive disease. This article...

  • Time from Diagnosis to Surgical Treatment of Breast Cancer: Factors Influencing Delays in Initiating Treatment. WRIGHT, G. PAUL; WONG, JAN H.; MORGAN, JOHN W.; ROY-CHOWDHURY, SHARMILA; KAZANJIAN, KEVORK; LUM, SHARON S. // American Surgeon;Oct2010, Vol. 76 Issue 10, p1119 

    No clear guidelines exist defining the appropriate time frame from diagnosis to definitive surgical treatment of breast cancer. Studies have suggested that treatment delays greater than 90 days may be associated with stage migration. We sought to evaluate demographic factors that influence...

  • Parathyroid Cancer, a Continued Diagnostic and Therapeutic Dilemma: Report of Four Cases and Review of the Literature. Snell, Sarah B.; Gaar, Earl E.; Stevens, Scott P.; Flynn, Michael B. // American Surgeon;Aug2003, Vol. 69 Issue 8, p711 

    Parathyroid cancer presents a diagnostic challenge as a rare endocrine malignancy usually not recognized preoperatively and often not conclusively identified intraoperatively. We examined a cluster of parathyroid cancers treated at University of Louisville-affiliated hospitals during a 5-year...

  • Back. McClanahan, Rebecca // Gettysburg Review;Autumn2005, Vol. 18 Issue 3, p363 

    In this essay the authoress narrates her experiences of cancer diagnosis and surgery. The walls of the examination room were pale blue, the gowns were blue, and the nurse's eyes above the paper mask were blue. The doctor told the authoress that he had found something, and he, then, went on to...

  • Esophageal cancer: ESMO Clinical Recommendations for diagnosis, treatment and follow-up. Stahl, M.; Oliveira, J. // Annals of Oncology;May2008 Supplement 2, Vol. 19 Issue 0, pii21 

    The article presents the clinical recommendations of the European Society for Medical Oncology (ESMO) for the diagnosis, treatment and follow-up of patients with esophageal carcinoma. Statistics that show the crude incidence and mortality rate of esophageal cancer in the European Union are...

  • Current Management of Medullary Thyroid Cancer. Sippel, Rebecca S.; Kunnimalaiyaan, Muthusamy; Chen, Herbert // Oncologist;May2008, Vol. 13 Issue 5, p539 

    Medullary thyroid cancer accounts for 5%-10% of all thyroid cancers. The majority of medullary thyroid cancers are sporadic, but 20% of cases are a result of a germline mutation in the ret proto-oncogene. Hereditary medullary thyroid cancer can be seen as part of the multiple endocrine neoplasia...

  • To Tell the Truth. NAHUM, LOUIS H. // Connecticut Medicine;Aug2013, Vol. 77 Issue 7, p437 

    The article discusses the benefits of informing the patient that he or she has a cancer. One is the opportunity for early diagnosis and adequate treatment which has led to many cures. Another is that if the surgery is not successful in removing the basic focus, several months or even years of...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics