Annals of medicine and surgery (2012) · 2026
Pancreatic solid papillary neoplasm with high-grade malignant transformation and multiple hepatic metastases in an elderly male: a case report.
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Liu Kuang-Ting, Chang Yueh-Ching, Lin Yu-Chieh, Chang Junn-Liang
Аннотация
INTRODUCTION AND CLINICAL IMPORTANCE: Solid pseudopapillary neoplasms (SPNs) are rare pancreatic tumors that predominantly affect young women and generally exhibit low malignant potential. High-grade malignant transformation with distant metastasis is uncommon, particularly in elderly males.
CASE PRESENTATION: A 66-year-old male with hepatitis B virus-related cirrhosis presented with obstructive jaundice, abdominal pain, and significant weight loss. Contrast-enhanced computed tomography revealed a large pancreatic head mass with multiple hepatic lesions. Histopathological examination demonstrated mixed solid and pseudopapillary architecture with marked nuclear atypia, high mitotic activity, and extensive necrosis. Immunohistochemical analysis showed nuclear β-catenin positivity and expression of CD56 and CD99, with negative neuroendocrine markers, and a proliferative Ki-67 labeling index of approximately 60% in the hot spot together, these findings confirmed SPN with high-grade malignant transformation and hepatic metastases.
CLINICAL DISCUSSION: This case represents an aggressive and atypical presentation of an SPN. Advanced disease, extensive metastases, and underlying liver cirrhosis significantly limited therapeutic options; only palliative management was feasible.
CONCLUSION: High-grade metastatic SPNs may exhibit aggressive clinical behavior and a poor prognosis. Elderly male sex may represent a potential adverse prognostic factor for aggressive SPN variants. Early recognition and accurate diagnosis are essential, particularly in atypical populations with significant comorbidities.
CASE PRESENTATION: A 66-year-old male with hepatitis B virus-related cirrhosis presented with obstructive jaundice, abdominal pain, and significant weight loss. Contrast-enhanced computed tomography revealed a large pancreatic head mass with multiple hepatic lesions. Histopathological examination demonstrated mixed solid and pseudopapillary architecture with marked nuclear atypia, high mitotic activity, and extensive necrosis. Immunohistochemical analysis showed nuclear β-catenin positivity and expression of CD56 and CD99, with negative neuroendocrine markers, and a proliferative Ki-67 labeling index of approximately 60% in the hot spot together, these findings confirmed SPN with high-grade malignant transformation and hepatic metastases.
CLINICAL DISCUSSION: This case represents an aggressive and atypical presentation of an SPN. Advanced disease, extensive metastases, and underlying liver cirrhosis significantly limited therapeutic options; only palliative management was feasible.
CONCLUSION: High-grade metastatic SPNs may exhibit aggressive clinical behavior and a poor prognosis. Elderly male sex may represent a potential adverse prognostic factor for aggressive SPN variants. Early recognition and accurate diagnosis are essential, particularly in atypical populations with significant comorbidities.