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E1781. SPIN the SPEN: Update on the Clinical and Imaging Features of Solid Pseudo-papillary Epithelial Neoplasms
Authors
  1. Dhakshinamoorthy Ganeshan; University of Texas MD Anderson Cancer Center
  2. Eric Tamm; University of Texas MD Anderson Cancer Center
  3. Vincenzo Wong; University of Texas MD Anderson Cancer Center
  4. Juan Ibarra Rovira; University of Texas MD Anderson Cancer Center
  5. Janio Szklaruk; University of Texas MD Anderson Cancer Center
  6. Priya Bhosale; University of Texas MD Anderson Cancer Center
Background
Solid Pseudo-papillary Epithelial Neoplasms (also known as Solid pseudo-papillary tumors) are rare, accounting for less than 3% of primary pancreatic neoplasms. Vast majority of these tumors occur in women in their 2nd and 3rd decades of life. The exact etiopathogenesis of this tumor is not yet clear, but is thought to develop from either pluripotent pancreatic stem cells or cells of female genital epithelial origin. Small tumors are usually asymptomatic and often detected incidentally but larger lesions can cause clinical symptoms, secondary to mass effect. However, obstructive jaundice is rarely seen. On gross pathology, these tumors are typically well encapsulated and display a variegated and degenerative appearance, presumed secondary to vascular ischemia. On microscopic pathology, pseudo-papillary appearance may be seen secondary to tumor cells surrounding delicate vessels and vascularized stroma. While most of the solid pseudo-papillary tumors are associated with excellent prognosis, about 15% of these tumors may display malignant behavior. The purpose of this exhibit is to review the spectrum of multimodality imaging features of Solid Pseudo-papillary tumor, discuss the differential diagnosis of this disease, describe the unique demographics and how that can be utilized to suggest this diagnosis and to discuss management of this lesion and the role of imaging in that management.

Educational Goals / Teaching Points
Review the spectrum of multimodality imaging features of solid pseudo-papillary tumor and discuss management of these tumors

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
In this educational exhibit, we will review the CT and MR imaging characteristics of solid pseudo-papillary tumor. These are more commonly seen in the tail of pancreas and are usually large at the time of diagnosis. They tend to demonstrate varying amounts of solid and cystic changes, accompanied with hemorrhage. The large tumors tend to be heterogeneous with thick, irregularly enhancing solid peripheral portions and non-enhancing cystic changes and areas of central necrosis. However, small solid pseudo-papillary tumor can be completely solid, and it can be difficult to distinguish them from other solid neoplasms.

Conclusion
Solid pseudo-papillary tumors are rare exocrine tumors of the pancreas. Combination of clinical and radiological features can help in the diagnosis. Surgical resection is the mainstay of treatment, and is associated with excellent oncological outcome in most patients.