Solid pseudopapillary neoplasm of the pancreas in a 54-year-old woman: A case report and the literature analysis.

INTRODUCTION: Solid pseudopapillary neoplasm (SPN) is a rare pancreatic tumor typically occurring in young females. This case presents an instance of SPN in a 54-year-old Caucasian female, highlighting atypical age of onset and providing new insights into the tumor's clinical and histopathological diversity.

CASE REPORT: A 54-year-old female with no significant past medical history presented with upper abdominal discomfort and weakness. Initial diagnostic imaging suggested a pancreatic tumor. The patient underwent laparotomic resection with pancreatic-gastric anastomosis. Histopathological analysis revealed a 2 cm tumor with mixed growth patterns - solid, trabecular, microcystic, and pseudopapillary - with varying cell types including vacuolated, eosinophilic, and clear cells. Despite showing malignant features such as local invasion in the adjacent pancreatic parenchyma, lymphovascular and perineural invasion, areas of haemorrhage, and focal nuclear atypia, no metastasis was observed. Immunohistochemistry confirmed the diagnosis of SPN with aberrant β-catenin expression. The tumor was resected successfully, and the patient had an uneventful recovery with no additional therapy required. A 60-month follow-up showed no recurrence.

CONCLUSION: This case underscores the rarity of SPN in older patients and the variability in its histopathological presentation. Different growth patterns and microscopic malignant features of SPNs should be taken into account during histological evaluation and pathological reporting, as they may be important for determination of tumor prognostic potential and treatment strategies. Further research is needed to standardize pathologic evaluations and improve understanding of SPN recurrence and management.