A solid pseudopapillary neoplasm (SPN) is considered a low-grade malignant neoplasm,
more often composed of both solid and cystic components with pseudopapillary areas
but predominantly solid in 15 % of cases [1]. It is estimated to account for 1 % to 3 % of all pancreatic tumors [2]. Immunostaining of SPNs for beta-catenin is specific [3]. The natural history of these lesions is unknown, but the malignant potential is
demonstrated especially in large lesions. The gold standard therapy is surgical resection.
Nonetheless, an alternative such as endoscopic ultrasound-guided radiofrequency ablation
(EUS-RFA), which is less invasive [4], should be discussed, especially for young patients with small lesions [5]. All cases of SPN seen and treated with EUS-RFA between 2018 and 2020 were reviewed
(IRB 00010835).
Herein, we report on three women, ages 26, 27, and 63, who had pancreatic head lesions
(19, 11, and 20 mm, respectively). The case of the 63-year-old woman is described
([Fig. 1]). EUS fine needle biopsy (FNB) diagnosed an SPN ([Fig. 2 a, b]). [Video 1] demonstrates the initial appearance of the lesion in B mode and contrast harmonic
mode. The procedure was successfully performed (four shots) with no remaining vascularization
in contrast harmonic mode after RFA. At the 3-month follow-up, EUS evidenced hyperechoic
nonvascularized necrotic tissue ([Fig. 3]). No remaining lesion was seen on magnetic resonance imaging (MRI), computed tomography
(CT), and EUS at 1 and 2 years.
Fig. 1 Computed tomography scan showing hypodense pancreatic head lesion (red arrow).
Fig. 2 a Biopsy showing monomorphic cells on histology. b Cells are positively stained for beta-cathenin.
Video 1 Endoscopic ultrasound-guided radiofrequency ablation for solid pseudopapillary neoplasm
of the pancreas.
Fig. 3 Biopsy showing inflammatory and necrotic cells not stained for beta-cathenin (red
arrow).
For the two other cases, one and two RFA sessions were respectively required to completely
destroy the lesions. EUS-RFA procedures were uneventful with no post-procedural adverse
events. No recurrence was noted at the 24-month follow-up. This treatment option should
be considered in patients unfit for pancreatic surgery and could be discussed for
small lesions ≤ 2 cm.
Endoscopy_UCTN_Code_TTT_1AS_2AD
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
All papers include a high-quality video and are published with a Creative Commons
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