Rare Presentation Of Solid Pseudopapillary Tumor In A Young Male

Introduction: Solid Pseudopapillary Tumors (SPT) of the pancreas is a rare non-functioning tumor. Almost exclusively found in females in the 2nd or 3rd decade of life. It has a low-grade malignant potential and is curable with complete surgical excision in most instances. Here, we present a case of SPT in a young male patient discovered incidentally on imaging. Case Presentation: 26 year-old Hispanic male presenting to GI clinic for evaluation of incidental 8.3 x 7.8 cm heterogeneous pancreatic mass seen on CT Abdomen and Pelvis. The patient initially presented with complaints of left flank pain and was treated for an obstructive left renal calculus status post lithotripsy and urethral stent. Patient underwent endoscopic ultrasound (EUS) with fine needle aspiration (FNA). EUS revealed a heterogeneous hypo-echoic mass lesion consistent with solid and cystic components abutting the body and tail of the pancreas with FNA cytology revealing branching papillary fronds with monomorphic tumor cells with a palisaded appearance and fibrovascular core. Patient subsequently underwent a laparoscopic distal pancreatectomy and splenectomy. Surgical pathology of the specimen and immunohistochemistry confirmed the diagnosis of SPT and the patient was referred to Oncology for follow-up.Figure 1Figure 2Figure 3Discussion: SPT account for 1%-3% of pancreatic tumors and have a low-grade malignant potential, with metastatic disease occurring in 5%-10% of patients. Complete surgical excision can achieve a favorable prognosis, with a 5-year survival rate of 95%. This case was unique as this patient was a young male. SPT typically occurs in the 2nd and 3rd decade has a female to male ratio of 10:1. There have been controversies regarding whether male patients were shown to have distinct patterns of onset or aggressiveness compared to female patients and consideration for more radical surgical approaches. However, literature review of 116 cases of SPT with 16 of the patients being male revealed radical resection was not necessary in male patients compared to female patients. Surgical strategies should be tailored based on tumor location, size and adjacent organ compromise, not gender.