Clinical features and outcome of solid pseudopapillary neoplasm: differences between adults and children

Abstract

OBJECTIVES: To delineate the clinical and pathological characteristics of solid pseudopapillary neoplasm (SPN), compare them between adults and children, and determine the predictive features suggesting malignant potential. DESIGN: Retrospective analysis of patients who underwent surgery for a pathologically confirmed SPN. SETTING: Tertiary care referral center. PATIENTS: Sixty-two consecutive patients who underwent surgery for a pathologically confirmed SPN between 1985 and 2006. MAIN OUTCOME MEASURES: Demographic information and clinical presentation, radiological details, surgical data, pathological characteristics, postoperative course, and long-term survival. RESULTS: Among 62 patients, 47 patients were adults (mean age, 36 years; range, 18-63 years) and 15 patients were children (mean age, 12 years; range, 8-13 years). A palpable mass was the most common presenting symptom in children (9 of 15; 60%) and an incidentally detected pancreatic mass, in adults (18 of 47; 38.3%) (P = .001). The mean tumor size in children was significantly larger than in adults (8.0 vs 6.0 cm; P < .03). In children, the tumor was located in the head of the pancreas (10 of 15; 66.7%) and in adults, in the body or tail (38 of 47; 80.9%) (P = .001). Nine patients (14.5%) had malignant SPN. There was no significant clinical factor suggesting malignant potential. Two patients had a tumor recurrence. They were still alive after debulking surgery. There were no tumor-related deaths. CONCLUSION: Solid pseudopapillary neoplasm had different clinical features in adults and children. Because long-term survival can be achieved, even with the synchronous or metachronous metastatic lesions, SPN should be treated aggressively, with complete resection, even if this requires metastatectomy.