Naik R K Hanumantha, Amudhan Anbalagan, Ashokkumar ArunKumar, Inbasekaran Anbarasu, Thangasamy Selvaraj, Sathyanesan Jeswanth
Institute of Surgical Gastroenterology & Liver Transplant, Centre for GI Bleed, Division HPB Diseases, Stanley Medical College, Chennai, India.
Ann Hepatobiliary Pancreat Surg. 2024 Feb 29;28(1):92-98. doi: 10.14701/ahbps.23-083. Epub 2023 Dec 29.
The solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas is an uncommon tumor that accounts for approximately 1%-2% of exocrine pancreatic neoplasms. It predominantly affects female in their second and third decades of life. In this case report, we present a clinical scenario of a 21-year-old pregnant woman who incidentally discovered a solid cystic lesion in her pancreas, exhibiting features suggestive of SPEN. The patient underwent surgery during the second trimester. Management of pregnant females with SPEN poses challenges due to the absence of definitive treatment guidelines, particularly in determining the ideal timing for surgical intervention. Notably, during pregnancy, the presence of a small SPEN does not necessarily require immediate resection. However, if the tumor is of significant size, it can give rise to complications such as tumor rupture, multivisceral resection, recurrence, spontaneous abortion, intrauterine growth restriction, or premature delivery if not addressed. In the existing literature, a common finding is that approximately two-thirds of pregnant females with SPEN underwent surgery in the second trimester, often without complications for the mother or fetus. All these tumors were larger than 8 cm. The decision to operate before or after birth can be individualized based on team discussion. However, delay in surgery may lead to larger tumors and higher risks like bleeding, rupture, multivisceral resection, and recurrence. Therefore, second-trimester surgery seems safer, and lessens dangers, emergency surgery, and tumor recurrence.
胰腺实性假乳头状上皮性肿瘤（SPEN）是一种罕见肿瘤，约占胰腺外分泌肿瘤的1%-2%。它主要影响二三十岁的女性。在本病例报告中，我们呈现了一名21岁孕妇的临床情况，她偶然发现胰腺有一个实性囊性病变，表现出提示SPEN的特征。患者在孕中期接受了手术。由于缺乏明确的治疗指南，尤其是在确定手术干预的理想时机方面，对患有SPEN的孕妇进行管理具有挑战性。值得注意的是，在怀孕期间，小的SPEN不一定需要立即切除。然而，如果肿瘤体积较大，若不处理，可能会引发诸如肿瘤破裂、多脏器切除、复发、自然流产、胎儿生长受限或早产等并发症。在现有文献中，一个常见的发现是，大约三分之二患有SPEN的孕妇在孕中期接受了手术，且母亲或胎儿通常没有并发症。所有这些肿瘤都大于8厘米。在出生前或出生后进行手术的决定可以根据团队讨论个体化。然而，手术延迟可能导致肿瘤更大，以及出血、破裂、多脏器切除和复发等更高风险。因此，孕中期手术似乎更安全，能降低危险、急诊手术和肿瘤复发的风险。
