A case of recurrence of a solid pseudopapillary neoplasm of the pancreas effectively treated with proton beam radiothera
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CASE REPORT
A case of recurrence of a solid pseudopapillary neoplasm of the pancreas effectively treated with proton beam radiotherapy Ryo Kodama1 · Youshin Koh1 · Hajime Midorikawa1 · Yukiko Yokota1 · Hisanobu Saegusa1 · Hiroyasu Ushimaru1 Received: 30 July 2020 / Accepted: 5 October 2020 © Japanese Society of Gastroenterology 2020
Abstract We report a case of a male in his 50 s who underwent pancreaticoduodenectomy for solid pseudopapillary neoplasm (SPN) of the pancreas at 30 years. He developed a liver abscess 15 years after the surgery, and CT scan revealed a swollen retroperitoneum lymph node and a tumor in the liver. Symptoms, including abdominal distension, appetite loss, and epigastric pain, appeared due to lymph node metastasis. Endoscopic ultrasonography-guided fine-needle aspiration against the lymph node revealed SPN recurrence. The tumor had invaded the common hepatic artery, and surgery was not indicated. Chemotherapy of Gemcitabine/nab-Paclitaxel biweekly was performed 8 times; however, no reduction in tumor size was observed, and the patient’s symptoms worsened. Proton beam therapy (67.5 GyE in 25 fractions) was subsequently performed for lymph node metastasis, and led to a gradual reduction in lymph node metastasis, and an improvement in symptoms. No re-expansion of lymph node metastasis has been observed 3 years after proton beam therapy. Since SPN is low malignancy and most cases can be expected to be cured by surgery, there is currently no standard treatment of unresectable SPN. This case is the first report of proton beam therapy for SPN, and was considered to be effective. Keywords Solid pseudopapillary neoplasm · Unresectable · Recurrence · Proton beam therapy
Introduction
Case report
Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare neoplasm, which mainly occurs in young women and is considered to have a relatively good prognosis. However, there are SPN cases with multiple organ metastases and local recurrence, and appropriate surgical treatment and postoperative careful observation is still important [1]. However, there are few reports on treatment strategies for unresectable SPN. Herein, we report a case of pancreatic SPN with recurrent lymph node and liver metastases 15 years after surgery, in whom proton beam therapy was applied to lymph node metastasis.
The case was a male in the 50 s who had a large tumor in the pancreatic head at the age of 30 years. The preoperative abdominal CT scan of 15 years ago (Fig. 1) showed a cystic lesion 7 cm in diameter, with an intracystic solid component that had a contrasting effect in the pancreas head. No evidence of metastasis was found, and pancreaticoduodenectomy was performed. Lymph node dissection was performed up to group 1, and the 12b lymph node was swollen with a diameter of 1 cm, and revealed no metastasis by intraoperative rapid pathological diagnosis. The tumor was a solid lesion of 95 × 55 × 35 mm, and both bleeding and necrosis were present. Mild capsule infiltration, pancreatic parenchymal invasion, venous infiltr
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