A Case of Successful Resection for Peritoneal Recurrence of Solid-pseudopapillary Tumor of the Pancreas Occurred in 6.5 Years after Rupture of the Tumor

Takanori Kyokane, Shinsuke Iyomasa, Naoki Sawasaki, Yuichiro Tojima, Hidenari Goto, Masao Matsuda and Sakae Murakami*

Department of Surgery and Department of Pathology*, Chukyo Hospital

We report an extremely rare case of successful resection of a recurrent solid-pseudopapillary tumor (SPT) of the pancreas after tumor rupture. A 58-year-old woman who underwent distal pancreatectomy for a ruptured SPT of the pancreas 6.5 years earlier and admitted for sudden upper abdominal pain onset was found in computed tomography (CT) to have intraabdominal masses, including a large cystic mass, suggesting recurrent SPT of the pancreas with intratumor bleeding. Upper gastrointestinal radiography and barium enema showed stenosis of the jejunum and transverse colon, suggesting direct tumor invation. After pathological comfirmation of SPT by open biopsy, we conductecd surgery, finding 11 intraperitoneal masses 3 to 95 mm in diameter, some adhering strongly to adjacent organs. We completely resected these masses with combined resection of part of the transverse colon, jejumun, liver, and stomach. Histological examination showed recurrent SPT of the pancreas with invasion to the transverse colon, jejunum, and liver. Immunohistochemically, tumor cells were positive for mutant-type p53 staining and the rate of positive cells was 10-20%. Her postoperative course was good, and the woman is doing well without recurrence 16 months after surgery. To the best of our knowledge, this is the first reported case of intraperitoneal recurrence after SPT rupture of the pancreas. Some correlation may be suggested between p53 gene mutation and local tumor invation.

Key words
solid-pseudopapillary tumor, rupture, p53

Reprint requests
Takanori Kyokane Department of Surgery, Chukyo Hospital
1-1-10 Sanjo, Minami-ku, Nagoya, 457-8510 JAPAN

Accepted
April 23, 2008

To read the PDF file you will need Abobe Reader installed on your computer.