ArticleCase reports in oncology
Solid Pseudopapillary Neoplasm of the Pancreatic Head in an 18-Year-Old Presenting with Chronic Intermittent Abdominal Pain: A Case Report.
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Abstract
Introduction: Solid pseudopapillary neoplasm (SPN) is an uncommon pancreatic epithelial tumor of low malignant potential, seen predominantly in adolescent and young adult females. Imaging typically shows a well-circumscribed heterogeneous mass; complete resection is usually curative. Case Presentation: An 18-year-old woman presented with ∼1 year of intermittent colicky epigastric pain, vomiting, and poor oral intake, without jaundice, fever, or weight loss. Examination and routine laboratories, including liver enzymes and bilirubin, were unremarkable. Ultrasonography revealed a 4.3 × 4.2 × 6.0 cm heterogeneous lesion inferior to the pancreatic head, abutting the third part of the duodenum and contacting the superior mesenteric vein. Contrast-enhanced CT demonstrated a 4.3 × 5.1 × 4.9 cm low-attenuation, heterogeneously enhancing mass impressing the pancreatic head, compressing the third part of the duodenum, and closely related to the superior mesenteric vein; small para-aortic nodes (≤6 mm) were present. Ultrasound-guided biopsy suggested SPN. She underwent standard pancreatoduodenectomy. Gross pathology showed an encapsulated 5.5-cm tumor within the pancreatic head. Histology confirmed SPN with negative margins, no vascular or perineural invasion, and no nodal metastasis (0/1). Discussion: The patient's age, sex, and imaging features were characteristic of SPN. Head-site disease may produce duodenal compression without cholestasis. R0 resection is definitive; adverse features were absent, supporting an excellent prognosis, though structured surveillance is advisable. Conclusion: SPN should be considered in young females with a heterogeneous pancreatic mass and nonspecific upper abdominal symptoms. Multimodal imaging, selective biopsy, and complete resection optimize outcomes.
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