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Bone Scintigraphy Reveals a Solid and Papillary Epithelial Neoplasm of the Pancreas

Osaka City University Graduate School of Medicine Osaka 545-8585, Japan

Solid and papillary epithelial neoplasm of the pancreas is a rare low-grade malignant tumor. Preoperative diagnosis is important because resection of the tumor results in an excellent prognosis. This tumor is usually a large, sharply marginated mass with an internal architecture that varies from a solid to a mixture of solid and cystic material to a thick-walled cyst, depending on the degree of cystic changes [1, 2]. Calcification is a characteristic of this tumor [1,2,3,4], and CT sometimes shows calcification in the capsule or in the inner portion of the tumor. Freidman et al. [3] have reported that this tumor shows calcification on an abdominal radiograph.

A 36-year-old woman visited the orthopedics department at our hospital because of pain in the left side of her back. Results of laboratory tests, including tumor markers, were within reference ranges. An abdominal X-ray examination revealed an oval calcification beside the spine in the left upper abdomen (Fig. 2A). Bone scintigraphy performed using ^99mTc-hydroxymethylene diphosphonate revealed a round accumulation at the same site (Fig. 2B). CT scans revealed a mass with ring-shaped calcification of the tail of the pancreas (Fig. 2C). We diagnosed a solid and papillary epithelial tumor of the pancreas, and a distal pancreatectomy and splenectomy were performed. The tumor was 5 x 4 x 4 cm and had a hard, thick wall (3-5 mm) with septa (Fig. 2D). The tumor was diagnosed as a solid and papillary epithelial tumor of the pancreas on the basis of pathologic and electron microscopic examinations.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A. —36-year-old woman with solid and papillary epithelial neoplasm of pancreas. Abdominal radiograph shows oval calcification (arrow) in left upper abdomen.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B. —36-year-old woman with solid and papillary epithelial neoplasm of pancreas. Bone scintigram obtained posteriorly shows round accumulation (arrow) at same site as calcification in A.

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C. —36-year-old woman with solid and papillary epithelial neoplasm of pancreas. CT scan shows mass (arrow) with ring-shaped calcification of tail of pancreas.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D. —36-year-old woman with solid and papillary epithelial neoplasm of pancreas. Photograph of surgical specimen shows tumor 5 x 4 x 4 cm with hard, thick wall (3-5 mm) and septa.

Solid and papillary epithelial tumors of the pancreas are sometimes associated with dysfunction of the metabolism of calcium and phosphate. To the best of our knowledge, ours is the first reported patient in whom a solid and papillary epithelial tumor of the pancreas was first suspected because of the findings on bone scintigraphy.

References

1. Choi BI, Kim KW, Han MC, Kim YI, Kim CW. Solid and papillary epithelial neoplasms of the pancreas: CT findings. Radiology 1988;166:413 -416[Abstract/Free Full Text]
2. Buetow PC, Buck JL, Pantongrag-Brown L, Beck KG, Ros PR, Adair CF. Solid and papillary epithelial neoplasm of the pancreas: imaging-pathologic correlation in 56 cases. Radiology 1996;199:707 -711[Abstract/Free Full Text]
3. Friedman AC, Lichtenstein JE, Fishman EK, Oertel JE, Dachman AH, Siegelman SS. Solid and papillary epithelial neoplasm of the pancreas. Radiology 1985;154:333 -337[Abstract/Free Full Text]
4. Hertzana Y, Bar-Ziv J, Freund U. Computed tomography of unusual calcified pancreatic tumors. J Comput Assist Tomogr 1989;13:75 -76[Medline]

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This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Nishiguchi, S. Articles by Shiomi, S. Search for Related Content PubMed PubMed Citation Articles by Nishiguchi, S. Articles by Shiomi, S. Social Bookmarking                      What's this?