Jagannathan Aparna M, Rymbai Manbha L, Anand Abhilasha, Paul Anoop, Das Borna, Kodiatte Thomas Alex, Vyas Frederick L, Raju Ravish Sanghi, Joseph Philip
Department of Hepato Pancreato Biliary Surgery, Christian Medical College, Vellore, Tamil Nadu 632002 India.
Department of Pathology, Christian Medical College, Vellore, India.
Indian J Surg Oncol. 2024 May;15(Suppl 2):232-237. doi: 10.1007/s13193-022-01690-9. Epub 2023 Jan 20.
Solid pseudopapillary neoplasm (SPN) is an unusual tumor of the pancreas. Unlike ductal adenocarcinoma, SPN is commoner in young women and is indolent with better prognosis. Fifteen percent of patients, however, develop metastases, often synchronous and involving the liver or peritoneum. Owing to the paucity of cases, management of the metastatic disease is not clearly defined. Retrospective review of case notes of patients treated between 2006 and 2019. There were 53 patients with SPN of which 4 had hepatic metastases-3 synchronous and 1 metachronous. Two patients underwent simultaneous distal pancreatectomy and splenectomy with liver resection (right posterior sectionectomy and metastasectomy). One required right hepatectomy with metastasectomy for metachronous liver metastases. The other underwent a staged operation-remnant tumor excision with metastasectomy followed by right hepatectomy after portal vein embolization. All four patients are recurrence free on median follow-up of 38.5 months. In view of the excellent prognosis, we recommend radical resection of both the primary lesion and metastases for SPN.
实性假乳头状瘤（SPN）是一种不常见的胰腺肿瘤。与导管腺癌不同，SPN在年轻女性中更为常见，生长缓慢，预后较好。然而，15%的患者会发生转移，通常为同时性转移，累及肝脏或腹膜。由于病例较少，转移性疾病的治疗方法尚无明确定义。回顾性分析2006年至2019年期间接受治疗的患者病历。共有53例SPN患者，其中4例发生肝转移，3例为同时性转移，1例为异时性转移。2例患者同时接受了远端胰腺切除术、脾切除术和肝切除术（右后段切除术和转移灶切除术）。1例因异时性肝转移需要行右肝切除术和转移灶切除术。另1例患者接受了分期手术，先切除残余肿瘤并进行转移灶切除术，然后在门静脉栓塞后行右肝切除术。所有4例患者在中位随访38.5个月时均无复发。鉴于其良好的预后，我们建议对SPN的原发灶和转移灶均进行根治性切除。
