CASE REPORT

Long-term Follow-up after Pancreatoduodenectomy with
Portal Vein Resection for a Huge Solid Pseudopapillary Neoplasm
in an Adolescent Girl
Toshio Kanai,1 Shinichiro Miyazaki,1 Tomotaka Akatsu,1 Motohito Nakagawa1 and Kaori Kameyama2
1Department of Surgery, Hiratsuka City Hospital, Kanagawa, Japan

2Division of Diagnostic Pathology, School of Medicine, Keio University, Tokyo, Japan(Received for publication on March 10, 2014)(Revised for publication on May 27, 2014)(Accepted for publication on June 23, 2014)(Published online in advance on August 29, 2014)

A 16-year-old Japanese girl with a huge 13-cm-diameter tumor in the pancreas head presented withlife-threatening symptoms and findings including severe anemia, obstructive jaundice, duodenal stenosis, and serious portal vein compression. She underwent a pancreatoduodenectomy with combined
resection of the portal vein. Reconstruction of the portal vein was successfully performed using an
external iliac vein graft and postoperative anticoagulant therapy. Pathological examination revealed asolid pseudopapillary neoplasm of the pancreas. The patient’s postoperative course was uneventful, but
her menstruation ceased for 14 months. She is now alive with no evidence of recurrence 100 months postoperatively and she suffers no impairments in daily activities of life. As a treatment of solid pseudopapillary neoplasms of the pancreas, pancreatoduodenectomy combined with portal vein resection is rarely
performed in adolescent patients, but is reportedly successful, with patients tolerating the operationand surviving without recurrence. An aggressive surgical attitude is recommended when dealing withthis tumor type with curative resection, even in adolescent patients. (doi: 10.2302/kjm.2014-0003-CR;
Keio J Med 63 (3) : 52–59, September 2014)

Keywords: solid pseudopapillary neoplasm, pancreatoduodenectomy, portal vein resection,
adolescent

Introduction

portal vein and major invasive surgery in adolescent patients.

Solid pseudopapillary neoplasms (SPNs) of the pancreas are well known to have a benign character and to arise
most often in young women.1,2 This tumor type is also
described as a solid and cystic disease of the pancreas
because of the variety of features of the macroscopic appearance of the tumor.2 We present herein a successfully
resected case of a huge tumor arising at the head of thepancreas with life-threatening effects that was treatedwith pancreatoduodenectomy (PD) with combined resection of the portal vein and its reconstruction. We also
discuss the technical aspects of the reconstruction of theCase
A 16-year-old Japanese girl presented with vomitingin September 2005 and was admitted to our hospital.
Physical examination revealed a huge mass in her upper
abdomen with mild tenderness and anemic conjunctiva.
Laboratory tests showed severe anemia with a hemoglobin level of 4.3 g/dl, leucocytosis (19300 /mm3), and mild
elevation of aspartate aminotransferase (AST) (86 IU/l)
and alanine aminotransferase (ALT) (108 IU/l). Comput-

Reprint requests to: Toshio Kanai, MD, PhD, Department of Surgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa 2540065, Japan, E-mail: kaitosh57blm@ak.em-net.ne.jp
Copyright © 2014 by The Keio Journal of Medicine
52Keio J Med 2014; 63 (3): 52–59

53

Fig. 1 (A) Enhanced computed tomography before surgery: a huge (13 × 11 cm), round, solid tumor is demonstrated at the pancreas
head. The tumor has a clear boundary and expanding growth, markedly compressing the portal vein and adjacent organs. (B) Portal
phase of superior mesenteric arteriography. The portal vein and superior mesenteric vein are markedly stenotic as a result of compression by the tumor.

ed tomography identified a huge 13 × 11-cm solid tumor
originating from the head of the pancreas (Fig. 1A). The
tumor was round, well circumscribed, and showed inhomogeneous enhancement. Magnetic resonance imaging
also visualized the huge tumor and identified a mixtureof solid and cystic components. T2-weighted imaging
showed a high-intensity area, suggestive of hemorrhagic
pathology of the tumor. The portal vein and common bile
duct were compressed and deviated ventrally. Hypotonic
duodenography showed a compressed duodenum andpoor passage. Arteriography revealed a huge hypervascular tumor fed by both the superior and inferior pancreaticoduodenal arteries. Portography revealed severe compression, stretching, and narrowing of the portal vein,with the formation of collateral vessels (Fig. 1B). Endoscopic retrograde cholangiopancreatography showed themain pancreatic duct with a normal diameter at the head,but failed to enhance the distal part of the duct. The common bile duct could not be cannulated.
Jaundice developed on day 3 after admission and thelevel of total bilirubin increased to 3.3 mg/dl. The imaging findings strongly suggested a SPN of the pancreas,
presenting with severe clinical problems of anemia andpassage disturbances of the duodenum, common bileduct, portal vein, and pancreatic duct. The resection of
the tumor was necessitated because of these life-threatening conditions. Open laparotomy was carried out in October 2005. A huge soft tumor, 13 cm in diameter, was located at the head of the pancreas (Fig. 2). The tumor was
round and encapsulated with expanding growth characteristics. The duodenum, common bile duct, and portal

vein were riding on the tumor and all were compressedand deviated ventrally, as visualized preoperatively. The
portal and superior mesenteric veins were involved andwere flattened on the tumor for a distance of about 8 cm.
Portal collateral vessels had developed at the liver hilum
and hepatoduodenal ligament. No distant metastasis wasfound. PD with combined resection of the portal vein andChild’s reconstruction were performed. The procedure
took 18 h and involved 2970 mL of blood loss. Portal veinreconstruction was achieved using a right external iliac
vein graft under portal clamping for 36 min. The pancreatic duct was intubated with a 6-French tube and totallydrained, and a pancreatojejunostomy was performed with
the invagination method.
Heparin was continuously infused as postoperative
anticoagulant therapy with a daily dose of 10000 units
starting just after the operation and continuing for 16
days; heparin was followed by warfarin administration
for a further 38 days. Pathological examination revealed
a huge encapsulated tumor, 11 × 10 cm in size; the solid
cut surface demonstrated hemorrhage and necrosis (Fig.
3A). The duodenum, common bile duct, and portal vein
were markedly compressed and were involved, but were
not directly invaded by the tumor. Microscopically, thetumor consisted of eosinophilic polygonal neoplastic
cells arranged in a solid and pseudopapillary pattern(Fig. 3B). Immunohistochemically, the neoplastic cells
were positive for alpha-1-antitrypsin, neuron-specificenolase, vimentin (Fig. 3C), and nuclear accumulation ofbeta-catenin (Fig. 3D). No lymph node metastasis was
detected microscopically. The final pathological diag-Kanai T, et al: PD with Portal Vein Resection for SPN

54

Fig. 2 Operational view. The tumor at the pancreas head is huge and is compressing the surrounding organs. The portal vein (PV) is
stretched, flattened, and severely narrowed for 8 cm of its length. The pancreas has already been cut at the body and the pancreatic ductcannulated. SMV, superior mesenteric vein.

nosis was SPN. The patient’s postoperative course wasmostly good, but minimal right leg edema occurred for a
few days postoperatively. She was able to return to school
soon after discharge from the hospital on postoperative
day 35.
The patient’s body weight recovered to the preoperative level at 9 months. Amenorrhea developed postoperatively, but her menstruation reappeared first at 14 months.
Follow-up computed tomography showed no finding ofrecurrence and good patency of the portal vein (Fig. 4).
The serum levels of fasting blood glucose (86 mg/dL) andglycosylated hemoglobin A1c (5.6%) were normal. Currently, at 100 months after surgery, she is well and works
in an office.
Discussion
SPN was first described as a papillary tumor of the pancreas by Frantz in 1959.1 It has a definitive pathologicaldescription, namely, “a benign or low-grade malignant
epithelial tumor which occurs predominantly in young
women and is composed of monomorphous cells variably
expressing epithelial, mesenchymal, and endocrine markers.”2 Many pathologists have expressed a great deal ofinterest in this type of tumor, mainly because of its morphologic characteristic features of a mixture of solid andcystic components macroscopically and a solid and papillary pattern microscopically. Because of these characteristics, SPN has many synonyms, such as “solid-cystic
tumor,” “papillary-cystic tumor,” and “solid and papillary epithelial neoplasm.”2 Another point of pathologicalinterest is that the tumors characteristically demonstrate
multiple expressions of acinar cell and neuroendocrine
differentiation, and therefore, it has been suggested thatthe origin of the tumor is a pluripotent stem cell.2–4 Clinically, the disease often affects young adolescence girls
and has a good prognosis in resected cases.5 These clinical characteristics thus encourage surgeons to treat SPN
aggressively.5,6
The SPN in our case was pathologically typical, but had
several specific characteristics: (1) it was accompanied bysevere anemia, (2) huge tumor size, (3) presentation withvomiting, (4) development of jaundice, and (5) severe
portal vein involvement.
First, severe anemia was noted. SPNs tend to exhibit
tumor necrosis and hemorrhage,2 and the pathologicalcauses of anemia associated with SPN may be hemorrhage within the tumor or duodenal bleeding via the pan-Keio J Med 2014; 63 (3): 52–59

55

Fig. 3 (A) Gross appearance of the tumor. The tumor is encapsulated, 11 × 10 cm in size, solid, and inhomogeneous at the cut surface,suggesting the presence of hemorrhage and necrotic regions. The defect in the capsule at the left upper side is an artifact from processing the resected specimen. (B) Microscopic appearance of the tumor (hematoxylin and eosin stain, ×100). In the solid tumor, theepithelial neoplastic cells with low-grade atypia are arranged in a pseudopapillary pattern with a fibrovascular core. This is a typicalfinding for a solid pseudopapillary neoplasm of the pancreas. (C, D) Immunohistochemically, the cells stain positively for vimentin (C,×400) and show nuclear accumulation of beta-catenin (D, ×400).

creatic duct or the papilla of Vater. Duodenal mucosal
bleeding was not likely in our case because of the lackof direct invasion of the duodenum. The severe anemia
was life-threatening and was an important factor in theindication of resection.
Second, the mean sizes of SPNs are reportedly in therange 8–10 cm2 and 6.08 cm.5 Therefore, the size of 13 cm
in our case was large compared with other reported cases
and meant a great deal of tumor pressure against adjacentorgans, which resulted in the subsequently mentioned compressive morbidities. Third and fourth, as a result of compression by the tumor, the patient presented with vomiting
as the primary symptom, resulting from duodenal stenosis,
and preoperatively developed obstructive jaundice due tocholedochal stenosis. These problems would have wors-

ened if an operation had not been carried out; therefore,
they supported the indication of surgical intervention.
Finally, compression of the portal venous system was
the most significant and potentially lethal problem in thepresent patient. The compression was serious because theportal vein and superior mesenteric veins were flattened
and involved within the tumor capsule for a distance of
8 cm, and collateral vessel formation was identified. Thiscondition also resulted from the large size of the tumor.
Portal vein obstruction is well known in pancreatic cancer and is often managed with combined resection andreconstruction.7 However, collateral vessel formation in
the portal system in pancreatic cancer is a sign of poor
prognosis and suggested that our patient was an inappropriate candidate for tumor resection.7 For SPNs, portal

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Kanai T, et al: PD with Portal Vein Resection for SPN

Fig. 4 Follow-up computed tomography at 88 months demonstrating no evidence of recurrence and good patency of the portal vein.

vein resection has been reported in only a few cases. In
1983, Dales et al. reported a case of SPN in the pancreas
body treated with total pancreatectomy and combined resection of the portal vein.8 Jeng et al. reported in 1993
the first SPN patient (a 28-year-old woman with a 10-cm
tumor) who underwent PD and combined resection of
the portal vein; the patient died of unrelated hepatic encephalopathy 66 months after the initial surgery.9 Chenet al. reported the second such case, which involved an
11-year-old girl with liver metastasis who underwent PD
with portal vein resection and resection of metastatic lesions of the liver; the patient survived 3 years without
tumor recurrence.6 Chen et al. recommended aggressive
surgery including portal vein reconstruction and metastasectomy. Thus, ours was the third case of PD with portal
vein resection for SPN.
The excellent prognosis for patients with SPN has been
mainly achieved by tumor resection, even in patients withportal vein involvement. Our patient had an excellent outcome, being alive without recurrence 100 months after
surgery. In SPN, the mechanism of portal vein involvement seems to be mainly compression, whereas pancreatic cancer tends to invade the portal vein wall.7 Thus,
the reason for the favorable prognosis of resected casesof SPN with portal vein involvement is thought to be thatportal vein involvement does not mean extensive spread-ing of tumor cells. We emphasize that because most SPNs
have a relatively benign character of tumor growth, aggressive surgery is recommended, despite the involvement of major vessels.5,6 Even under metastatic conditions of SPN, aggressive hepatic resections have beenreported and recommended with successful results.6,10,11
For portal vein reconstruction, the safety of the operation should be thoroughly established during the perioperative period. We performed external iliac vein grafting during portal vein reconstruction7 because direct
anastomosis of the portal trunk and superior mesentericvein would have been risky because of resulting tension
caused by the 8-cm defect in the length of the vessel.
We selected an autograft to achieve a tension-free anastomosis and to obtain long-term functionality. Because
the vein graft was substantially long and there were twoanastomotic sites, we used anticoagulant therapy postoperatively in the present case. However, it remains controversial whether therapeutic anticoagulant reduces therate of thrombotic complications after venous reconstruction.12,13
Operative indications and postoperative characteristics
concerning PD in adolescent patients with SPN are notwell known. There are few papers analyzing the effect orharm of invasive PD on teenage patients. We have summarized reported cases of PD for SPN in adolescent (i.e.,

13

19

17

16

15

10

15

13

14

19

11

17

13

12

11

10

10

16

Taxy15

Kingsnorth16

Panieri17

Yoon18Rebhandl19

Sakurai20

Shikano21

Casanova22

Potrc23

Huang24

Chen6

Karatag25

Muller26

Muller26

Muller26

Sugito27

Sugito27

Kanai(this case)

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

F

F

F

M

F

M

F

F

M

M

M

F

F

F

F

F

F

F

sex

Japan

Japan

Japan

FranceFranceFranceTurkeyChina

TaiwanSlovenia

Italy

Japan

Japan

Austria

Philippines

S. Africa

China

USA

USA

Country

Patient

13

ND

ND

ND

ND

ND

ND

ND

10

9

3

ND

5

9

12

8

20

6.5

10

Tumor
size
(cm)

Anemia, jaundice,
duodenal stenosis

Liver metastasis

Rupture

PPPD

Recurrent status
after tumorectomy

PD

PD

PD

PPPD

PPPD

PPPD

PD

PD+Htx

PD

PD

PPPD

PPPD

PD

PD

PPPD

PPPD

PD

PD

Vomiting

Anemia, cholestasis

Jaundice

IVC obstruction

Preoperative condition Procedure

Operation

Yes

No

No

No

No

No

No

Yes

No

No

No

No

No

No

No

No

No

No

No

Resection ofPV

Uneventful

Uneventful

Alive

Alive

Pancreatic exocrine
insufficiency
Transient amenorrhea

Alive

Pancreatic exocrine
insufficiency

Alive

Transient delayed
gastric emptying
Uneventful

Alive

Transient pleural
effusion

Alive

Alive

Alive

Alive

Alive

Alive

Alive

Alive

ND

Alive

Alive

Alive

Alive

Alive

Pancreatic exocrine
insufficiency, IDDM

No malnutrition, good
QOL

Usual teenage activity

Long-term period
status or problems

Uneventful

Uneventful

Uneventful

Uneventful

Uneventful

Uneventful

Uneventful

Uneventful

Uneventful

In-hospital
recovery

Postoperative course

No

No

No

No

No

No

No

No

No

No

No

No

No

No

ND

No

ND

No

No

100

84

192

ND

ND

ND

36

36

12

36

16

60

60

48

87

48

ND

3

16

Recurrence (months)

OutcomeND, not described; IVC, inferior vena cava; PD, pancreatoduodenectomy; PPPD, pylorus-preserving pancreatoduodenectomy; Htx, hepatectomy; PV, portal vein; QOL, quality of life;
IDDM, insulin-dependent diabetes mellitus.

12

Hamoudi14

Age

1

No. Author

Table 1. Cases of pancreatoduodenectomy for solid pseudopapillary neoplasm of the pancreas in adolescent patients reported in the English-language literature

Keio J Med 2014; 63 (3): 52–59
57

58

teenage) patients in Table 1.6,14–28 Almost half of the cases were reported in Asian countries. Some patients hadserious preoperative morbidities other than abdominal
mass, e.g., choledochal stenosis, duodenal stenosis, andhemorrhage, similar to our case, and were thus obligatedto undergo surgery. Only two cases (No.12 and our patient) underwent combined resection of the portal vein.
In-hospital postoperative courses were uneventful in the
majority of cases, a fact that endorses the aggressive approach to the treatment of SPN. All patients survived,
mostly without recurrence. While the median follow-up
period of the reported cases is 48 months, the present casehas the second longest time of observation (100 months).
Less invasive surgery should also be considered, especially in adolescent patients. Akiyama et al. reported a
successful case of duodenum-preserving pancreas headresection for SPN.28 In a Japanese case (No. 8), pancreatic insufficiency and insulin dependent diabetes mellitus
occurred after adjuvant chemotherapy for 2 years.21 Adverse reactions to anticancer drugs were likely involvedin the pathogenesis of these pancreatic disorders. In thepresent report, we described the complication of transientamenorrhea for 14 months after PD. Menstruation disturbance probably resulted from nutritional impairment
after surgery, and the reappearance of regular menstruation may be a sign of full recovery after major surgery
in adolescent girls. Looking at Table 1, we can see thatadolescent patients were often obligated to undergo major
surgery, i.e., PD, but tolerated it well and recovered fromSPN.
The outcome after surgical resection for SPN is excellent, with more than 90% enjoying long-term survival.
Recurrence is reported in approximately 5% of cases, andtypical recurrence sites are the liver, lymph nodes, andperitoneum.5,29 There is general consensus that surgicaldebulking should be recommended for these metastases,in contrast to other pancreatic malignancies.
In conclusion, we reported a very rare case of combined resection of the pancreas head and portal vein for
SPN in an adolescent girl. The operation was necessary
because of life-threatening conditions caused by severe
anemia due to tumor hemorrhage and by the huge mass ofthe tumor resulting in compressive morbidities including
duodenal stenosis, obstructive jaundice, and severe portal
vein stenosis. The present patient is now alive with noevidence of recurrence 100 months postoperatively; she
has no impairments in daily activities of life. Aggressive
major surgery, including PD and portal vein reconstruction, should be performed even in adolescent patients if
it is necessary to relieve life-threatening conditions or tocure neoplastic conditions, especially for tumors having
a better prognosis such as SPNs.

Kanai T, et al: PD with Portal Vein Resection for SPN

References
1. Frantz VK: Tumors of the pancreas. In: Atlas of tumor pathology,
section VII, fascicles 27 and 28. Washington, DC, Armed Forces
Institute of Pathology; 1959; 32–33.
2. Solcia E, Capella C, Klöppel G: Tumors of the pancreas. In: Atlas of tumor pathology, third series, fascicle 20. Washington, DC,
Armed Forces Institute of Pathology, 1997; 120–129.
3. Stömmer P, Kraus J, Stolte M, Giedl J: Solid and cystic pancreatictumors. Clinical, histochemical, and electron microscopic features in ten cases. Cancer 1991; 67: 1635–1641. [Medline] [CrossRef]
4. Notohara K, Hamazaki S, Tsukayama C, Nakamoto S, Kawabata
K, Mizobuchi K, Sakamoto K, Okada S: Solid-pseudopapillarytumor of the pancreas: immunohistochemical localization ofneuroendocrine markers and CD10. Am J Surg Pathol 2000; 24:
1361–1371. [Medline] [CrossRef]
5. Papavramidis T, Papavramidis S: Solid pseudopapillary tumors of
the pancreas: review of 718 patients reported in English literature.
J Am Coll Surg 2005; 200: 965–972. [Medline] [CrossRef]
6. Chen X, Zhou GW, Zhou HJ, Peng CH, Li HW: Diagnosis andtreatment of solid-pseudopapillary tumors of the pancreas. Hepatobiliary Pancreat Dis Int 2005; 4: 456–459. [Medline]
7. Takahashi S, Ogata Y, Aiura K, Kitajima M, Hiramatsu K: Combined resection of the portal vein for pancreatic cancer: preoperative diagnosis of invasion by portography and prognosis. Hepatogastroenterology 2000; 47: 545–549. [Medline]
8. Dales RL, Garcia JC, Davies RS: Papillary-cystic carcinoma of
the pancreas. J Surg Oncol 1983; 22: 115–117. [Medline] [CrossRef]
9. Jeng LB, Chen MF, Tang RP: Solid and papillary neoplasm of thepancreas. Emphasis on surgical treatment. Arch Surg 1993; 128:
433–436. [Medline] [CrossRef]
10. Saiura A, Umekita N, Matsui Y, Maeshiro T, Miyamoto S, Kitamura M, Wakikawa A: Successful surgical resection of solid
cystic tumor of the pancreas with multiple liver metastases and atumor thrombus in the portal vein. Hepatogastroenterology 2000;
47: 887–889. [Medline]
11. Martin RC, Klimstra DS, Brennan MF, Conlon KC: Solid-pseudopapillary tumor of the pancreas: a surgical enigma? Ann Surg
Oncol 2002; 9: 35–40. [Medline] [CrossRef]
12. Smoot RL, Christein JD, Farnell MB: Durability of portal venousreconstruction following resection during pancreaticoduodenectomy. J Gastrointest Surg 2006; 10: 1371–1375. [Medline] [CrossRef]
13. Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell
CW, Ray JG: Prevention of venous thromboembolism: the seventh
ACCP conference on antithrombotic and thrombolytic therapy.
Chest 2004; 126(Suppl): 338S–400S. [Medline] [CrossRef]
14. Hamoudi AB, Misugi K, Grosfeld JL, Reiner CB: Papillary epithelial neoplasm of pancreas in a child. Report of a case with electron microscopy. Cancer 1970; 26: 1126–1134. [Medline] [CrossRef]
15. Taxy JB: Adenocarcinoma of the pancreas in childhood. Reportof a case and a review of the English language literature. Cancer
1976; 37: 1508–1518. [Medline] [CrossRef]
16. Kingsnorth AN, Galloway SW, Lewis-Jones H, Nash JR, Smith
PA: Papillary cystic neoplasm of the pancreas: presentation andnatural history in two cases. Gut 1992; 33: 421–423. [Medline][CrossRef]
17. Panieri E, Krige JE, Bornman PC, Graham SM, Terblanche J,
Cruse JP: Operative management of papillary cystic neoplasmsof the pancreas. J Am Coll Surg 1998; 186: 319–324. [Medline][CrossRef]

Keio J Med 2014; 63 (3): 52–59
18. Yoon DY, Hines OJ, Bilchik AJ, Lewin K, Cortina G, Reber HA:
Solid and papillary epithelial neoplasms of the pancreas: aggressive resection for cure. Am Surg 2001; 67: 1195–1199. [Medline]
19. Rebhandl W, Felberbauer FX, Puig S, Paya K, Hochschorner S,
Barlan M, Horcher E: Solid-pseudopapillary tumor of the pancreas (Frantz tumor) in children: report of four cases and review ofthe literature. J Surg Oncol 2001; 76: 289–296. [Medline] [CrossRef]
20. Sakurai K, Koshinaga T, Fukuzawa M: A case of solid and cystic
tumor of the pancreas in a 10-year-old female treated by pylorus
preserving pancreatoduodenectomy. Nihon Univ J Med 2002; 44:
13–20.
21. Shikano T, Tabata Y, Takahashi Y, Anakura M: A case of 15-yearold boy with relapsed solid and cystic tumor of the pancreas: pancreatic insufficiency followed by postoperative chemotherapy(in Japanese with English abstract). J Jpn Pediatr Soc 2002; 106:496–499.
22. Casanova M, Collini P, Ferrari A, Cecchetto G, Dall’Igna P, Mazzaferro V: Solid-pseudopapillary tumor of the pancreas (Frantz
tumor) in children. Med Pediatr Oncol 2003; 41: 74–76. [Medline][CrossRef]
23. Potrc S, Kavalar R, Ivanecz A, Gadžijev EM: Acute presentation of a solid pseudopapillary tumor of the pancreas. Wien Klin
Wochenschr 2004; 116(Suppl 2): 100–103. [Medline]

59
24. Huang HL, Shih SC, Chang WH, Wang TE, Chen MJ, Chan YJ:
Solid-pseudopapillary tumor of the pancreas: clinical experienceand literature review. World J Gastroenterol 2005; 11: 1403–1409.
[Medline]
25. Karatag O, Yenice G, Ozkurt H, Basak M, Basaran C, Yilmaz B:
A case of solid pseudopapillary tumor of the pancreas. World J
Gastroenterol 2006; 12: 6239–6243. [Medline]
26. Muller CO, Guérin F, Goldzmidt D, Fouquet V, Franchi-Abella S,
Fabre M, Branchereau S, Martelli H, Gauthier F: Pancreatic resections for solid or cystic pancreatic masses in children. J Pediatr
Gastroenterol Nutr 2012; 54: 369–373. [Medline] [CrossRef]
27. Sugito K, Furuya T, Kaneda H, Masuko T, Ohashi K, Inoue
M, Ikeda T, Koshinaga T, Tomita R, Maebayashi T: Long-term
follow-up of nutritional status, pancreatic function, and morphological changes of the pancreatic remnant after pancreatic tumor
resection in children. Pancreas 2012; 41: 554–559. [Medline][CrossRef]
28. Akiyama H, Ono K, Takano M, Sumida K, Ikuta K, Miyamoto
O: Solid-pseudopapillary tumor of the pancreatic head causing
marked distal atrophy: a tumor originated posterior to the main
pancreatic duct. Int J Gastrointest Cancer 2002; 32: 47–52. [Medline] [CrossRef]
29. Kim CW, Han DJ, Kim J, Kim YH, Park JB, Kim SC: Solid pseudopapillary tumor of the pancreas: can malignancy be predicted?
Surgery 2011; 149: 625–634. [Medline] [CrossRef]