Comprehensive Insights into Solid Pseudopapillary Neoplasms of the Pancreas: A Single Center Experience of 64 Surgical Cases

Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor with low-grade malignant potential, predominantly affecting young females. Despite its indolent course, there is limited data from the Indian subcontinent. A retrospective study was conducted on 64 patients who underwent surgical resection for SPN between 2010 and 2022 at a tertiary center in Hyderabad, India. Data on demographics, clinical presentation, imaging, surgical details, histopathology, and outcomes were analyzed. The mean age of patients was 23.5 years, with a female predominance (female to male ratio, 10:1). Abdominal pain (63.6%) was the most common presenting symptom. Most tumors (62.8%) were located in the body and tail of the pancreas. The diagnosis was primarily made via characteristic imaging on cross-sectional imaging, with endoscopic ultrasound-guided biopsy aiding in up to 57% of cases. Surgical procedures included distal pancreaticosplenectomy (51.56%) and pancreaticoduodenectomy (35.94%). Postoperative complications included clinically relevant pancreatic fistula (14.06%) and major complications (13.6%). Long-term outcomes showed a disease-free survival of 72 months, with local recurrence in one patient and distant metastasis in another. Immunohistochemistry commonly showed positive staining for beta-catenin (74.24%) and negative for chromogranin (65.15%). A case highlighted the role of PET scan in detecting additional metastatic lesions missed on CT. This study presents the largest case series of SPN from India, highlighting evolving diagnostic and management strategies. Despite challenges, surgical resection remains the cornerstone, offering excellent survival outcomes.