Hypoglycemia, a rare presentation of a solid pseudopapillary neoplasm of the pancreas: a case report

A solid pseudopapillary neoplasm of the pancreas is an uncommon and 'enigmatic' pancreatic neoplasm of low malignant potential generally occurring in young women. The pathologic features of this tumor are characteristic, and adequate surgical intervention is associated with an excellent prognosis. We report the first case of combined solid pseudopapillary neoplasm and islet cell hyperplasia of the pancreas in the pediatric age group. A 16-year-old Saudi female presented to the Emergency Room with a history of frequent attacks of hypoglycemia. Radiologically, a mass in the tail of the pancreas was identified. The pre-operative diagnosis of insulinoma was suggested, and en bloc distal pancreatectomy with splenectomy was performed. A solid pseudopapillary neoplasm and islet cell hyperplasia of the tail of the pancreas was diagnosed by routine histology and by immunohistochemistry. The patient was treated successfully and is now in good health with regular follow-up for the last 13 months. In the pediatric age group, these tumors are very rare and can present as repeated episodes of hypoglycemia. This association sheds light on the histogenesis of solid pseudopapillary neoplasm of the pancreas and also allows appropriate and prompt management to be undertaken by the clinicians.