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Category: Volume 05 Issue 08 August 2017
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Title: Solid pseudopapillary epithelial neoplasm of pancreas in pregnancy: Case Report of a Rare Co-Occurrence

Authors: Dr Muskaan Chhabra, Dr Rekha G. Daver

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i8.164

Abstract

Background: Solid pseudopapillary epithelial neoplasm of pancreas (SPEN) also known as papillary epithelial neoplasm and cystic-solid papillary carcinoma of the pancreas is an uncommon neoplasm of exocrine pancreas. It predominantly occurs in young women in their twenties and thirties and accounts for 1-2% of all pancreatic tumors. It is a peculiar tumor for having low grade malignant potential and an excellent prognosis. Most patients are asymptomatic at diagnosis and may present with gradually enlarging abdominal mass or vague abdominal pain. The diagnosis is usually done by imaging (CECT, MRI) and histopathology. Here we report a case of 22 years old pregnant woman who was referred to our hospital with a history of gradually increasing abdominal lump and vague abdominal pain since 1 year. She was diagnosed with SPN by imaging and histopathology.

Case Report: A 22 years old female with full term gestation was referred to us in view of gradually increasing abdominal mass and history of vague abdominal pain since 1 year. At 12 weeks of gestation she was investigated at her native place and was diagnosed with a mass in left renal fossa. In our hospital she delivered male child at full term by normal vaginal delivery. In postnatal period CECT was done which showed a lobulated lesion with internal calcification in left anterior para-renal space. A USG guided trucut biopsy confirmed the diagnosis of pseudopapillary epithelial neoplasm of pancreas. Distal pancreaticosplenectomy with left radical nephrectomy and left hemicolectomy was done. At the time of discharge patient was advised regular follow up. We are reporting this case because SPN are uncommon tumors and their co-occurrence with pregnancy is even rarer.

Conclusion: SPENs are rare but curable neoplasm of exocrine pancreas affecting young females in their 2nd or 3rd decade. The diagnosis is sometimes difficult because of a wide differential diagnosis however once diagnosed it has an excellent prognosis because of its low malignant potential. Presence of gradually increasing, well defined, cystic pancreatic mass in young females should raise the suspicion of SPN.

Keywords: Pseudopapillary epithelial neoplasm of pancreas, Pregnancy, Imaging, Surgical resection.

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Corresponding Author

Dr Muskaan Chhabra

Department of Obstetrics and Gynaecology,

Grant Govt. Medical College & Sir JJ Group of Hospitals Mumbai