Solid Pseudopapillary Neoplasms of the Pancreas with Delayed Ovarian Metastasis During Pregnancy: A Case Report and Literature Review

Background: Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare, low-grade malignant epithelial tumor that may originate from embryonic multipotent stem cells. The prevalence of metastatic SPN is approximately 9% to 15%, most commonly in the liver and peritoneum. Delayed ovarian metastasis during pregnancy is exceedingly rare, pregnancy may promote the progression and pose a life-threatening risk. Case Presentation: A 38-year-old female with an early intrauterine pregnancy was found to have a large mass in the right ovary. Following pregnancy termination and surgical resection, initial pathological assessment indicated a sex cord-stromal tumor, specifically a luteinized Sertoli-Leydig cell tumor. Upon reviewing her medical history, it was noted that a pancreatic tumor resection performed ten years prior. Further immunohistochemical analysis demonstrated diffuse nuclear and cytoplasmic expression of β-catenin, along with positivity for LEF-1, CD10, and TFE-3. Based on these findings, the final diagnosis was revised to pancreatic SPN with delayed ovarian metastasis. The patient showed no evidence of disease recurrence during the 2-year follow-up after treatment. Conclusion: This is a rare case of ovarian metastatic pancreatic SPN that occurred during pregnancy ten years after the initial diagnosis. Our findings underscore the diagnostic challenge in distinguishing metastatic lesions from primary ovarian tumors and highlight the clinical importance of excluding high-grade transformation during pathological assessment.