Diagnostic imaging of a solid pseudopapillary tumour of the pancreas in a 20-year-old woman – a case study

Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumour of uncertain histopathological origin derived from the exocrine pancreas and most often first detected on radiological imaging. It predominantly affects young women in their second and third decades of life. Solid pseudopapillary neoplasm has a low-grade malignant potential with excellent post-surgical curative rates. The lesions can be detected and differentiated from other pancreatic lesions by ultrasound imaging (US), computed tomography (CT), and magnetic resonance imaging (MRI). We report a case of solid pseudopapillary neoplasm of the pancreas that was diagnosed on CT imagining and confirmed on postoperative histological examination.
A 20-year-old woman with no prior medical history was admitted to the Emergency Department with a 2-day history of nausea, vomiting, and diarrhoea. She described a one-year history of abdominal ‘fullness’ but no other symptoms of note. Her vital observations were stable. On physical examination there was a palpable mass in the right hypochondriac region. Haematological and biochemical tests, including tumour markers (CEA, CA-125, CA19-9, hCD, -fetoprotein), were within normal limits. Transabdominal ultrasound scan revealed a well-circumscribed, heterogeneous lesion with anechoic areas. It measured 80 × 70 mm and was situated between the right kidney and the right lobe of the liver. A multiphase contrast-enhanced computer tomography scan was ordered. It showed a round, retroperitoneal lesion with cystic and solid components measuring 70 × 61 × 96 mm located in the head of pancreas. The mass was separated from its surroundings by a wall of variable thickness (Figures 1 A, B). There were some linear areas of calcification on the rim and in the internal content as well as cystic areas filled with fluid of 30 Hounsfield unit (HU) mean density (Figure 2). Its upper margin contained multiple areas of soft-tissue density that enhanced with contrast (Figure 3). The lesion exerted a mass effect on the visceral surface of the right liver lobe, the head of the pancreas, and the duodenum, resulting in displacement of these structures. The remaining intra-abdominal organs were of normal radiological appearance with no lymphadenopathy. The above findings were suggestive of a Frantz tumour of the pancreas. Gastroscopy revealed inflammation of the gastric antrum but no other changes. A chest radiograph was unremarkable.
The patient was transferred to the...


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