Nakaguchi Yuta, Kishi Shinji, Shirakami Naoto, Ito Takashi, Ohnishi Takamasa
Department of Surgery, Nishiwaki Municipal Hospital, Nishiwaki, Hyogo, Japan.
Diagnostic Pathology, Nishiwaki Municipal Hospital, Nishiwaki, Hyogo, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0079. Epub 2025 Jun 14.
Pancreatic solid pseudopapillary neoplasms (SPNs) are rare tumors, accounting for 1%-3% of all pancreatic tumors, with a predilection for young women. Owing to their often asymptomatic nature, SPNs are typically discovered incidentally. Spontaneous rupture of SPNs is extremely rare, with few reported cases. Herein, we report a case of spontaneous SPN rupture and review the literature on similar cases.
A 17-year-old girl presented with sudden, severe left upper abdominal pain and hemorrhagic shock. Contrast-enhanced computed tomography revealed a 13-cm heterogeneous pancreatic tail tumor with internal extravasation and massive ascites, indicative of intraperitoneal hemorrhage. The patient underwent distal pancreatectomy and splenectomy. Histopathological examination confirmed SPN with no vascular invasion. Immunohistochemistry was positive for β-catenin, CD10, CD56, and synaptophysin, with a low Ki-67 index (1%-2%). The patient had an uneventful recovery and was discharged on postoperative day 13.
Spontaneous SPN rupture is an exceedingly rare occurrence, and its underlying mechanisms remain unclear. Ruptured SPNs may pose a higher risk of recurrence and peritoneal dissemination, necessitating long-term follow-up. Further studies are needed to elucidate the factors influencing SPN rupture and its long-term implications.
胰腺实性假乳头状瘤（SPN）是罕见肿瘤，占所有胰腺肿瘤的1%-3%，好发于年轻女性。由于其通常无症状，SPN通常是偶然发现的。SPN自发性破裂极为罕见，报道的病例很少。在此，我们报告一例SPN自发性破裂病例并回顾类似病例的文献。
一名17岁女孩因突发严重左上腹疼痛和失血性休克就诊。增强计算机断层扫描显示胰尾有一个13厘米的异质性肿瘤，内部有造影剂外渗和大量腹水，提示腹腔内出血。患者接受了胰体尾切除术和脾切除术。组织病理学检查确诊为SPN，无血管侵犯。免疫组织化学检测β-连环蛋白、CD10、CD56和突触素呈阳性，Ki-67指数较低（1%-2%）。患者恢复顺利，术后第13天出院。
SPN自发性破裂极为罕见，其潜在机制尚不清楚。破裂的SPN可能具有更高的复发和腹膜播散风险，需要长期随访。需要进一步研究以阐明影响SPN破裂的因素及其长期影响。
