Two cases of solid-pseudopapillary neoplasm of the pancreas with contrasting imaging findings

A solid pseudo-papillary tumor of the pancreas is a rare neoplasm which mainly occurs in young women. Here, we report two cases of solid-pseudopapillary neoplasm of the pancreas (SPN) with contrasting imaging findings. One was a 59-year-old woman having no symptomatic complaint with a pancreatic cystic tumor in the tail. The tumor was 60 mm in diameter with a cyst composed of a calcified wall and low-density content which was poorly perfused on contrast-enhanced computed tomography (CT). We diagnosed SPN based on imaging findings and performed distal pancreatectomy. Histology revealed SPN, and the patient had two years of recurrence -free survival (RFS). The other case was a 34-year-old man with an asymptomatic solid tumor in the pancreatic tail. Contrast-enhanced CT showed low peripheral attenuation of a 25-mm solid tumor, with the main duct dilated distal from tumor. We diagnosed him with pancreatic cancer with atypical image findings. Pathological findings revealed SPN, and the patient had five years of RFS. Small-sized SPN is being increasingly recognized because of the recent advances in CT and MRI. We should consider SPN even if it occurs in a male, and endoscopic ultrasound -guided fine-needle aspiration has recently been reported to be useful in diagnosing SPN

A case of a mesenteric desmoid tumor preoperatively distinguished from imaging findings

　A 73-year-old woman was admitted for closer investigation into an abdominal tumor. Abdominal ultra-sonography, CT, and magnetic resonance imaging showed a discrete abdominal tumor. Especially on MRI, the tumor appeared as a relatively ill-defined whorled soft-tissue thickening within the mesenteric fat, causing angulation or speculation of adjacent bowel mesentery. Surgery was performed under a presumptive diagnosis of a mesojejunum desmoid. The tumor was invading the transverse mesocolon and mesojejunum as well as the third portion of the duodenum and the middle colic artery, and it was close to but apart from the superior mesenteric artery. The tumor was resected, including removal of part of the duodenum and transverse colon. The specimen contained a white solid tumor measuring 14×12×8cm. Pathologic examination showed differentiated fibroblasts and copious collagen fibers. The tumor was negative for CD34, c-kit, S-100, and α-SMA, but positive for β-catenin. On the basis of these findings, we established a diagnosis of mesenteric desmoid tumor of the small intestine. The patient has been followed postoperatively for 2 years, no sign of recurrence, to date