An Operative Case of Metastatic Solid-Pseudopapillary Tumor in the Liver after Curative Resection

Hidenobu Okino, Motomasa Hiroyoshi, Yoshiki Kitaura, Koji Onitsuka, Masaki Shono, Yuji Shinagawa, Kazuo Shimada, Soichi Yoshitomi, Jiro Watanabe* and Shigeaki Takeda

Department of Surgery and Clinical Research and Department of Pathology*, National Hospital Organization, Kokura Hospital

A 45-year-old woman who underwent distal pancreatectomy and splenectomy for a solid-pseudopapillary tumor of the pancreas (PSPT) 2 years and 5 months earlier was found to have multiple liver metastases in follow-up CT, necessitating curative anterior segmentectomy and radiofrequency ablation. PSPT is a rare neoplasm with distinctive pathological features and low-grade malignant potential that preferentially affects young women, although cases developing into metastatic disease mostly involving the liver and peritoneum are increasingly reported. Based on maximal data, we analyzed and summarized clinical features of 50 cases with liver metastasis reported. in Japan as follows: average age was approximately 15 years older than that of the cases without hepatic metastasis; location of the primary tumor in the pancreas head is rare; tumors are about 15 mm bigger than those of the cases without hepatic metastasis; metastasis took an average of 6.8 years to develop; 56% of cases showed multiple hepatic metastases; the prognosis for patients undergoing surgical treatment was good; and chemotherapy was not effective. These results indicated the need for long-term postoperative follow-up and aggressive surgical treatment in liver metastasis. Molecular biology recently revealed that pancreatic ductal carcinoma and PSPT progress genetically through two pathways, distinctly reflecting both prognosis and gender preference, but PSPT remains a surgical enigma.

Key words
solid-pseudopapillary tumor, liver metastasis

Reprint requests
Hidenobu Okino Department of Surgery and Clinical Research, National Hospital Organization, Kokura Hospital
10-1 Harugaoka, Kokuraminami-ku, Kitakyushu, 802-8533 JAPAN

Accepted
September 28, 2005

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