case_images: PMC11830896_01
case_images: Computed tomography findings of pancreatic tumor and liver metastases. (A, B) A 9.2-cm mass is observed in the head/neck of the pancreas, suggestive of a solid pseudopapillary neoplasm (indicated by a white asterisk). (C, D) This mass shows a direct invasion into superior mesenteric and proximal main portal veins (highlighted by a yellow arrow). A 6.5-cm lesion is seen in segment 5 (S5), a 2-cm lesion in S4, and at least 15 other smaller lesions scattered throughout the liver. Additionally, multiple lymph nodes up to 1.3 cm in the left para-aortic region are noted as possibly metastatic.
case_images: ahbps-29-1-83-f1.jpg
case_images: PMC11830896_01_ahbps-29-1-83-f1.jpg
case_images: F1
case_images: Abdominal CT revealed a mass in the head and neck region of the pancreas, suggesting a direct invasion of the SPN into the superior mesenteric and proximal main portal veins (Fig. 1).
case_images: Magnetic resonance imaging findings of pancreatic tumor and liver metastases. (A) Multiple metastases are observed, with sizes up to 7 cm, scattered in segment 4 (S4) and the right hepatic lobe. These metastases present with or without internal hemorrhaging. (B) A 9 cm lobulated, soft tissue-enhancing mass with significant internal hemorrhagic necrosis is seen in the head/neck portion of the pancreas.
case_images: ahbps-29-1-83-f2.jpg
case_images: PMC11830896_01_ahbps-29-1-83-f2.jpg
case_images: F2
case_images: Abdominal magnetic resonance imaging revealed a 9 cm lobulated, enhanced, soft tissue mass with significant internal hemorrhagic necrosis in the head and neck of the pancreas along with multiple liver metastatic lesions, the largest being 7 cm, dispersed in segment 4 and the right hepatic lobe (Fig. 2).
case_images: Specimen and pathology of pancreatic mass and liver metastases. Macroscopic and microscopic features of pancreatic and liver masses. (A) Total pancreatectomy specimen shows a 10.0 x 7.5 x 5.5 cm-sized, encapsulated, multilobulated, brownish friable mass with extensive hemorrhage and necrosis. (B) Viable tumor cells are located at the periphery of the tumor, with an infiltrative growth margin in the pancreatic parenchyma (H&E, 10x). (C, D) The tumor shows pseudopapillary structures or solid patterns composed of relatively uniform round cells with eosinophilic cytoplasm (H&E, 200x and 400x). (E) Serially cut surface of the right hepatectomy specimen shows seven red-brownish friable masses with hemorrhage and necrosis or without. (F) In low-power fields, multiple small metastatic masses are noted (indicated by a black arrow) (H&E, 7x). (G) In high-power fields, metastatic tumors comprise similar tumor cells as pancreatic solid pseudopapillary tumors (H&E, 200x). (H) Immunohistochemical staining for beta-catenin shows aberrant nuclear expression in the pancreas and liver tumors (beta-catenin, 400x).
case_images: ahbps-29-1-83-f3.jpg
case_images: PMC11830896_01_ahbps-29-1-83-f3.jpg
case_images: F3
case_images: Postoperative histopathological evaluation confirmed the diagnosis of SPN (Fig. 3).