S3279 Caught in the Spindle: Lessons From a Benign Pancreatic Neuroma Treated With Radical Surgery

Introduction: Pancreatic spindle cell neoplasms are a rare, heterogeneous group of tumors, spanning benign to malignant subtypes, and pose major diagnostic and management challenges. Because imaging and biopsy often cannot reliably distinguish benign from malignant lesions, many patients undergo unnecessarily aggressive surgeries. We present a case that underscores the urgent need for improved diagnostic frameworks—integrating histopathology, molecular profiling, and multidisciplinary collaboration—to avoid overtreatment of benign pancreatic spindle cell tumors. Case Description/Methods: A 68-year-old woman with diabetes, gastric polyps, and breast cancer presented with 3 years of intermittent abdominal pain, diarrhea, early satiety, and weight loss. Computed tomography showed a 1.2 × 1.2 cm hypodense, enhancing lesion in the distal pancreatic body. Endoscopic ultrasound revealed a vague hypoechoic mass with a small cystic component. Fine needle biopsy showed monotonous spindle cells with myxoid background, suggesting smooth muscle differentiation. Given uncertain malignant potential, the tumor board recommended distal pancreatectomy with splenectomy and lymphadenectomy. Final pathology revealed a benign perineuroma, confirming that extensive surgery was performed for a nonmalignant lesion. Discussion: Pancreatic spindle cell tumors represent <0.5% of pancreatic neoplasms and are notoriously difficult to risk-stratify preoperatively. As shown in this case, diagnostic uncertainty often pushes clinicians toward radical surgical approaches, increasing patient morbidity. Conventional imaging and endoscopic ultrasound may be insufficient, emphasizing the need for genetic and molecular diagnostic adjuncts. We advocate for the development of evidence-based guidelines and multidisciplinary decision-making frameworks that integrate histology, molecular markers, and advanced imaging to prevent overtreatment and tailor management for rare pancreatic tumors. Future research must focus on refining risk stratification to reduce unnecessary surgeries and improve patient outcomes.