Distal Pancreatectomy for a Solid-Pseudopapillary Neoplasm of the Pancreaswith the Preoperative Suspicion of Major Arterial Involvement: A Case Report

Background: Solid-pseudopapillary neoplasms (SPNs) of the pancreas are a relatively rare type of tumor low-grade malignant potential. Although surgical resection provides a cure in most of cases, the safety efficacyof surgical treatment for tumors with major arterial involvement remains unknown.Case presentation: A 30-year-old man with a preoperative diagnosis of SPN referred to our department. Abdominal computed tomography (CT) revealed a lobulated mass located at the pancreatic body, with a maximum diameter of 11 cm. The celiac artery (CA) splenic artery (SA) were surrounded (by approximately 270° and 360°, respectively) by an expansively growing tumor, while the common hepatic artery (CHA), superior artery (SMA) superior mesenteric vein (SMV) were contacted by the tumor for a distance of 26.6, 42.8, and 43.5 mm, respectively on CT. The arterial walls of the CHA SMA were smooth without any irregularity; however, narrowing irregularity of the SA present. The imaging findings strongly suggested an SPN of the pancreas; the involvement of the SA, SV SMV by the tumor suspected. Distal pancreatectomy with celiac axis resection planned. After laparotomy, the CHA, SMA, SMV were safely preserved, the tumor was resected by distal pancreatectomy alone. A pathological examination confirmed that the tumor an SPN a malignant component. Although the tumor pathologically invaded the retropancreatic tissue, splenic artery andsplenic vein, the resected margin negative.Conclusion: Although the preoperative examination delineated the gross expansion of an SPN around the CA, CHA, PV, these vessels were safely preserved during pancreatectomy. This case suggests that the surgicalresection of the SPN may occasionally be attempted; even in cases with compressed deviated by the tumor.