Cystic-Solid Papillary Tumour: An Uncommon Neoplasm of the Pancreas
Navarra G1, Bonomi S1, Mitolo CI1, Grassi A1, Al Sahlani U1, Ventrucci M2, Virzì S1
1Department of Surgery and 2Department of Internal Medicine and Gastroenterology, Bentivoglio Hospital. Bologna, Italy
ABSTRACT
Background The cystic-solid papillary tumour of the pancreas is rare. It occurs predominantly in young women and generally shows in most cases a benign behaviour. Since 1959, when the first case was described by Franz, until today, around 500 cases have been documented in literature. Despite the large number of investigations, the pathogenesis of this tumour remains still unclear.
Case report We report a case of cystic-solid papillary tumour of the pancreas in a 16-year-old woman. The patient underwent abdominal CT that showed an apparently capsulated, solid, expansive mass originating in the retroperitoneal region. The tumour was identified by histopathology examination with immunohistochemical staining. The tumour was localized in the hooked process of the pancreas. It was adherent to the inferior cava vein, portal vein, common bile duct, duodenum and coeliac tripod, and it was capsulated. We performed a curative resection. The patient was monitored during a follow-up period of thirty-six months without any evidence of disease recurrence and she is currently in good health.
Discussion The satisfactory outcome of this case supports the use of an aggressive surgical approach in all patients diagnosed with a cystic neoplasm of the pancreas. The tumour is rare and difficult to diagnose prior to surgery. The surgical approach is justified for the following reasons: 1) preoperative differentiation of a benign versus malignant tumour is very difficult; 2) potential adverse consequences on non resectional therapy are significant; 3) prognosis with curative resection is good.
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