PMC6319678_01
CT scan of a patient with an SPT. Abdominal contrast-enhanced CT scan shows an enlarged pancreatic head containing a well-defined, encapsulated solid cystic mass about 4 cm in diameter (arrow). CT, computed tomography; SPT, solid pseudopapillary tumor.
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Abdominal ultrasonography (USG) and CT scan showed an enlarged pancreatic head containing an uneven mixed solid and cystic composition about 3.7 x 4.0 cm (Fig. 1).
Gross examination of an SPT. Photograph of the (a) gross specimen shows the (b) smoothly encapsulated tumor with areas of necrosis and hemorrhage. The ruler shows distance in centimeters.
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On gross examination of the surgical specimen, a soft, round, well-circumscribed mass with pseudocapsule about 3.6 cm in diameter was identified (Fig. 2).
Staining with hematoxylin and eosin shows histopathological appearance of an SPT. The tumor was histologically composed of uniform polygonal cells arranged in the form of solid sheets, microcysts, and pseudopapillary areas filled with hemorrhage and necrotic debris (hematoxylin and eosin stain, magnification in a: x20; magnification in b: x40).
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On histological analysis, the tumor was composed of monotonous uniform polygonal cells with moderate to abundant amphophilic cytoplasm and arranged in solid nests with areas of cystic degeneration, characterized by separation of the cells into pseudopapillary aggregates with intervening accumulation of mucopolysaccharide-rich ground substance (Fig. 3). The tumor cell nuclei were oval or coffee bean shaped (Fig. 3).
The immunohistochemical features of an SPT. The tumor cells showed positive for (a) vimentin, (b) CD10, (c) alpha-antichymotrypsin, (d) alpha-antitrypsin, (e) beta-catenin, (f) neuron-specific enolase, (g) synaptophysin, and (h) progesterone receptor.
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No mitotic figures were identified in 20 HPF (4.75 mm2) from various areas of the tumor. On immunohistochemical analysis, the tumor cells were positive for vimentin, CD10, alpha-1-antichymotrypsin (AACT), alpha-1-antitrypsin (AAT), beta-catenin, neuron-specific enolase (NSE), progesterone receptor (PR), and synaptophysin (Syn) in approximately 30% of the cells, whereas cells were positive for Ki-67 antigen (a proliferation marker) less than 1% of the neoplastic cells (Fig. 4).