Rathi Jalaj, Anuragi Gajendra, J R Livin Jose, R Prabhakaran, C Sugumar, O L Naganath Babu
Surgical Gastroenterology, Madras Medical College, Chennai, IND.
Cureus. 2021 Aug 29;13(8):e17541. doi: 10.7759/cureus.17541. eCollection 2021 Aug.
Solid pseudopapillary neoplasm (SPN) of the pancreas is a low-grade malignant neoplasm with unpredictable behavior. Factors associated with recurrence were not conclusively identified. The aim of this study is to define the clinicopathological criteria for recurrence risk prediction in SPNs based on the most recent scientific evidence and to present our experience with SPNs.
A retrospective review of patients with SPNs operated on in our institution from June 2012 to June 2018 was completed. Patient characteristics and clinical outcomes were analyzed. A detailed literature review was performed to evaluate the factors associated with the recurrence of SPNs.
The cohort consisted of 13 female patients with a median age of 24 years and a mean tumor size of 7.7 cm. Body and tail (53.8%) were the most common location, and distal pancreatectomy with splenectomy was the prevalent surgical procedure. One patient of SPN operated on for local recurrence after 11 years which had high-grade malignant histological features on the previously resected tumor. At a median follow-up of 42 months (range 36 to 108), all patients were disease free and alive. The proposed criteria for predicting recurrence in SPNs include tumor size >8 cm, synchronous metastasis, malignant SPN (according to 2000 or 2010 World Health Organization [WHO] criteria), lymphovascular invasion, pancreatic parenchymal invasion, and high Ki-67 index (>4%). All these are worse prognostic factors and should be considered as high-risk factors for postoperative relapse.
The above-mentioned criteria can better predict SPN recurrence. Patients with high-risk features should undergo an extended follow-up.
胰腺实性假乳头状瘤（SPN）是一种行为不可预测的低级别恶性肿瘤。与复发相关的因素尚未得到最终确定。本研究的目的是根据最新科学证据确定SPN复发风险预测的临床病理标准，并介绍我们对SPN的经验。
对2012年6月至2018年6月在我院接受手术的SPN患者进行回顾性研究。分析患者特征和临床结局。进行详细的文献综述以评估与SPN复发相关的因素。
该队列包括13名女性患者，中位年龄24岁，平均肿瘤大小7.7 cm。胰体和胰尾（53.8%）是最常见的部位，胰体尾切除加脾切除术是主要的手术方式。1例SPN患者在11年后因局部复发接受手术，其先前切除的肿瘤具有高级别恶性组织学特征。中位随访42个月（范围36至108个月）时，所有患者均无病存活。提出的SPN复发预测标准包括肿瘤大小>8 cm、同步转移、恶性SPN（根据2000年或2010年世界卫生组织[WHO]标准）、脉管侵犯、胰腺实质侵犯和高Ki-67指数（>4%）。所有这些都是较差的预后因素，应被视为术后复发的高危因素。
上述标准可更好地预测SPN复发。具有高危特征的患者应接受延长随访。
