Laparoscopic distal pancreatectomy for multiple pancreatic solid pseudopapillary neoplasms with marked calcification...

Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare, low-grade malignant tumor that primarily affects young females. Multiple SPNs, particularly in older females, are extremely rare. While these tumors generally have a good prognosis, some may progress to malignancy. A 66-year-old female presented with back pain, and CT revealed two calcified masses in the pancreas. The tumor marker levels were normal, and contrast-enhanced CT, ultrasound, and MRI findings suggested multiple SPNs. Owing to significant calcification, preoperative biopsy was not feasible, so laparoscopic distal pancreatectomy (LDP) was performed for diagnosis and treatment. Histopathological examination revealed tumor cells with a round morphology, which were arranged in nested formations, along with areas of calcification on H&E staining. Immunohistochemical analysis revealed positive staining for CD56, vimentin, and β-catenin, whereas bcl-10 was negative, supporting the definitive diagnosis of multiple SPNs. Although SPNs generally have a good prognosis, recurrence is possible, emphasizing the need for complete resection and long-term follow-ups. Even when preoperative biopsy is difficult due to calcification, aggressive surgical resection is crucial for long-term successful prognoses. Furthermore, LDP offers advantages over traditional open surgery, such as reduced blood loss and faster recovery, and may be considered for diagnosis and treatment in such cases.