Solid Pseudopapillary Neoplasms of the Pancreas: Clinicopathologic and Radiologic Features According to Size

OBJECTIVE. The purpose of this study was to retrospectively analyze and correlate clinicopathologic and radiologic features of resected solid pseudopapillary neoplasms of the pancreas according to their size. MATERIALS AND METHODS. Clinicopathologic and radiologic features of 106 resected solid pseudopapillary neoplasms of the pancreas over a 20-year period were retrospectively analyzed. Tumors were divided into three groups according to their size (≤ 30 mm, 31-50 mm, and ≥ 51 mm). Clinicopathologic and radiologic features were compared among groups using Kruskal-Wallis and Fisher exact tests. RESULTS. Forty-one tumors that were 30 mm or smaller, 30 tumors between 31 and 50 mm, and 35 tumors that were 51 mm or larger were included. Preoperative MRI of 76 patients and CT of 40 patients were examined. Patients with tumors that were 30 mm or smaller were significantly older than the other groups of patients (p = 0.038). Large tumors (31-50 and ≥ 51 mm) were more frequently located in the pancreatic body or tail (p = 0.008). Most tumors had well-defined margins (87.7%) and a mixed solid and cystic appearance (54.7%) at imaging; tumors that were 30 mm or smaller were more frequently entirely solid (p = 0.028). At histologic analysis, 13 tumors had at least one feature of malignancy; nodal and liver metastases were found in one patient (0.9%). No significant differences between groups were found regarding the presence of malignant histologic features (p = 0.932). The rate of incorrect preoperative diagnosis was higher in tumors 30 mm or smaller, albeit without significant differences between groups (p = 0.561). CONCLUSION. Malignancy in solid pseudopapillary neoplasms is not correlated with tumor size; tumors that are 30 mm or smaller may present atypical imaging features, which may overlap those of other solid tumors of the pancreas.