Pancreatic Solid and Pseudopapillary Neoplasm

Brooke R. Jeffrey, MD

Michael P. Federle, MD, FACR

Key Facts

Imaging

Encapsulated solid mass with cystic or hemorrhagic foci but no septation; in young women
Well-defined, heterogeneous, large mass
± calcification ( 5-10%)
Low-density areas of variable size within lesion; hemorrhage and necrosis
Thick, enhancing “capsule” (solid component)
± vascular invasion, metastases to liver, lymph nodes

Top Differential Diagnoses

Mucinous cystic pancreatic tumor
- Spherical mass in body or tail of pancreas with several cystic spaces separated by thin septa
- Most common in middle-aged to elderly women
Exophytic gastrointestinal stomal tumor
Pancreatic ductal carcinoma
- Rarely necrotic or hemorrhagic
- Obstructs pancreatic ± bile ducts
- Older adults
Pancreatic serous cystadenoma
- Typically has sponge appearance with innumerable small cysts
- No large solid component

Pathology

Rare: < 3% of all pancreatic tumors
Low malignant potential (< 10% metastasize or recur)

Clinical Issues

< 35 years (rarely reported in older adults)
90% are women; often African-American

(Left) Graphic shows a large encapsulated mass arising from the pancreatic tail with prominent solid and cystic or hemorrhagic components. (Right) Axial CT shows a large encapsulated mass

with foci of necrosis and calcification

. The portal vein is compressed or invaded by the tumor

. This pancreatic tumor also displaces the stomach and liver.

(Left) Axial CT in a 21-year-old woman shows a complex cystic-solid mass

with peripheral rim calcification

in the tail of the pancreas. Endoscopic ultrasound (not shown) confirmed a complex cystic mass. Needle aspiration of the mass at ultrasound yielded fluid that had few cells and no elevated “tumor markers.” The fluid was not mucoid. (Right) The resected mass shows areas of hemorrhage and necrosis, surrounded by tissues with solid and pseudopapillary projections

TERMINOLOGY

Synonyms

Solid and papillary epithelial neoplasm, papillary epithelial neoplasm, papillary cystic carcinoma, solid and cystic tumor of pancreas

IMAGING

General Features

Best diagnostic clue
- Encapsulated solid mass with cystic or hemorrhagic foci but no septation; in young women
Size
- Average: 10 cm, range: 2.5-20 cm

CT Findings

CECT
- Well-defined, heterogeneous, large mass
- ± calcification (5-10%)
- Low-density areas of variable size within lesion; depends on degree of hemorrhage and necrosis
- Thick, enhancing “capsule” (solid component)
- ± vascular invasion, metastases to liver, nodes