Combined pancreatic solid-pseudo-papillary tumor and spleen lesions: diagnosis complexities in determining treatment tactics

Solid pseudopapillary tumors (SPTs) are rare neoplasms, which account for less than 2% of exocrine pancreatic tumors. These are low-grade epithelial malignancies. Currently, there are no data on SPT metastasis to the spleen in the literature. However, due to the rare SPT incidence and the ongoing accumulation and data analysis on these type of tumors globally, the presence of a combined cystic-solid structure lesion in the spleen does not allow us to exclude such a situation. Two clinical cases of SPT combined with focal spleen lesions are presented. The first one is with a cystic lesion verified as cavernous spleen lymphangioma according to the morphology of the removed lesion. Despite the fact that the splenic lesions included in the differential series during examination were benign, the size of the lesion and the risk of its rupture demonstrated the advisability of spleen resection performing. The second one is combined with multiple spleen hemangiomas verified by preoperative MSCT, which allowed performing a sparing operation - median resection (tumor enucleation) of the pancreatic head. Thus, а thorough examination of patients with combined focal lesions, one of which being SPT, a tumor with malignant potential, allows us to clearly determine the entire volume of the lesion and determine the correct surgical tactics.