PARENCHYMA-SPARING, LIMITED RESECTION OF PANCREATIC HEAD FOR TREATMENT OF LOW RISK PERIAMPULLARY NEOPLASIA

In the intraoperative period, a large retroperitoneal mass was seen, apparently without correlation with the condition. Subsequent investigation performed a magnetic resonance imaging that identified a well-defined heterogeneous mass near aorta and vena cava with compression of adjacent structures. Endoscopic ultrasound was performed to confirm the finding of a solid-cystic retroperitoneal lesion. An ultrasound guide puncture was performed and the anatomopathological report revealed a micropapillary lesion suspect of carcinoma. An elective surgical approach was performed, and an oval lesion of approximately 10 cm was found in the uncinate process of the pancreas, in close contact with the duodenum and bile duct. Choledoccus was observed in anomalous position, whose pathway passed externally to the uncinate process, displaced by the large mass, and whose implantation occurred in the posterior part of the second portion of the duodenum. Opted to perform limited resection of the neoplasia (preservative of pancreatic parenchyma, duodenum and choledoccus), with excision of the uncinate process and pericoledocian lymph node resection. During the mass removal, incomplete section of the bile duct occurred, performed primary fix and Kehr drain positioning. The patient had a good postoperative evolution and was discharged four days later. Returned to the institution on the eighteenth postoperative day with abdominal pain, vomiting and elevation of pancreatic enzymes, was diagnosed with pancreatitis, with good response to clinical treatment. Pathology revealed solid pseudopapillary pancreatic neoplasia (Frantz's tumor) with free surgical margins. Frantz's tumor is a rare tumor with low malignancy, as long as it can be completely resected. Found in 90% of cases in young female patients. Despite the large local growth, it rarely invades organs or adjacent vascular structures. The clinical presentation is often of abdominal pain associated with the tumor, but the condition may be asymptomatic. Tumor excision usually does not require extensive resections. In this case it was possible to remove the tumor with preservation of noble structures (duodenum, bile duct and head of the pancreas), despite its large size and location (uncinate process). The respective procedure contributed to the reduction of morbidity / mortality frequently associated with conventional pancreatectomies.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019