Solid and Papillary Neoplasm of the Pancreas: A Potentially Curable Surgical Lesion

Abstract

Two patients with a recently recognized pancreatic neoplasm are reported. In both cases the tumors occurred in young women (21 and 24 years) who presented with an abdominal mass. Both tumors were large (approximately 12 x 12 cm), one requiring a distal 85% pancreatectomy and the other a total pancreatectomy. Gross pathologic examination revealed apparent encapsulation, cystic degeneration, and hemorrhagic necrosis. Microscopically, the tumors were characterized by distinctive solid and papillary patterns. Such lesions have been reported recently in the pathology literature as "solid and papillary" or "papillary-cystic" neoplasms of the pancreas. Approximately 60 such cases have been reported to date. The histogenesis of these lesions is debatable. They may be diagnosed incorrectly as adenocarcinomas, islet cell tumors, cystadenomas, or cystadenocarcinomas. Assessing the degree of malignancy can be difficult since this tumor is capable of local invasion but usually does not metastasize. There is only one report of a patient dying from distant metastases. Both patients presented here are alive and well seven and 24 months post-surgery. It would appear that despite their large size these pancreatic tumors are potentially curable by surgical resection.