Recurrent solid pseudopapillary neoplasm of the pancreas with hepatic and lymphatic metastasis in a teenager: A case report

Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare neoplasm with low malignant potential, predominantly affecting young women. Despite its generally favorable prognosis following complete resection, recurrence or metastasis may occur years later. A 15-year-old female who had undergone enucleation of a large pancreatic head SPN at the age of 6 years was admitted to the hospital due to persistent abdominal pain. She had been followed at a local hospital but the follow up was interrupted due to COVID-19 restrictions. She underwent a magnetic resonance that showed a recurrence of the SPN, with a hepatic. The diagnosis was confirmed with a core needle biopsy. We took her to the operating room and did a pancreaticoduodenectomy (Whipple procedure) with portal vein reconstruction, hepatic wedge resection, and extensive lymphadenectomy. Pathological analysis confirmed recurrent SPN with hepatic metastasis and found SPN infiltration in 3 out of 29 peripancreatic lymph nodes. The patient tolerated the procedure well. She developed a low-flow pancreatic fistula that was managed conservatively and resolved spontaneously. Oral feedings were started after the resolution of pancreatic fistula on postoperative day 7. She was discharged 13 days after the operation. At 4 years of follow up she remains asymptomatic and free of recurrence. Simple enucleation may not be an acceptable approach for the management of large SPN of the pancreatic head, since as seen in our patient, it may be associated with recurrences.