Solid Pseudopapillary Neoplasm of the Pancreatic Tail With Splenic Hilar Involvement: A Case Report

Solid pseudopapillary epithelial neoplasm (SPEN) is a rare pancreatic epithelial tumour that predominantly affects young women and is characterised by low malignant potential and favourable prognosis following complete surgical resection. A 28-year-old woman presented with intermittent left upper abdominal pain and loss of appetite for one month. Physical examination and laboratory investigations, including tumour markers, were unremarkable. Contrast-enhanced computed tomography revealed a 7.4 × 7.0 × 6.4 cm well-defined cystic lesion with solid components arising from the pancreatic tail, suggestive of SPEN. The patient underwent distal pancreatectomy with splenectomy due to splenic hilar involvement. Histopathological examination and immunohistochemistry confirmed SPEN, demonstrating β-catenin and progesterone receptor positivity with a Ki-67 index <1%. SPEN is an uncommon pancreatic tumour that typically presents with non-specific symptoms, often leading to delayed diagnosis. Characteristic imaging findings combined with histopathological and immunohistochemical evaluation are essential for accurate diagnosis. Complete surgical resection remains the treatment of choice and is associated with favourable outcomes. SPEN should be considered in young women presenting with pancreatic cystic lesions and vague abdominal symptoms. Complete surgical excision by distal pancreatectomy with splenectomy can achieve excellent oncological outcomes, even in cases with splenic hilar involvement.