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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 118-119

Solid pseudopapillary tumor of pancreas: A rare case of recurrent pain abdomen


1 Department of Pediatrics, Jagannath Gupta Institute of Medical Sciences, Kolkata, West Bengal, India
2 Department of Pathology, Jagannath Gupta Institute of Medical Sciences, Kolkata, West Bengal, India

Date of Submission15-Mar-2021
Date of Decision29-May-2021
Date of Acceptance31-May-2021
Date of Web Publication30-Jun-2021

Correspondence Address:
Dr. Joydeep Das
Flat 1F, Natural Top, 77 A Christopher Road, Kolkata - 700 046, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpai.jpai_3_21

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  Abstract 


Recurrent abdominal pain (RAP) is a frequent complain in general pediatric practice, and it is really challenging to a treating physician. Many pediatricians often label such case as functional abdominal pain. Sometimes, the symptoms are vague and investigations fail to catch appropriate pathology. We report a slow-growing pancreatic tumor as RAP.

Keywords: Abdominal pain, pancreas, tumor


How to cite this article:
Das J, Pal D, Barua S, Bhanja S, Krishna V, Naik J. Solid pseudopapillary tumor of pancreas: A rare case of recurrent pain abdomen. J Pediatr Assoc India 2020;9:118-9

How to cite this URL:
Das J, Pal D, Barua S, Bhanja S, Krishna V, Naik J. Solid pseudopapillary tumor of pancreas: A rare case of recurrent pain abdomen. J Pediatr Assoc India [serial online] 2020 [cited 2022 Sep 25];9:118-9. Available from: http://www.jpai.in//text.asp?2020/9/3/118/320121




  Introduction Top


Three or more episodes of pain that occur over at least 3 months, severe enough to interfere with normal activities[2] are defined as recurrent abdominal pain (RAP). Despite the decades of experience and knowledge, an experience pediatrician fails to detect a cause in RAP. To clinch a diagnosis, a physician has to depend on various blood tests and imaging when the pain is vague and no localizing value. Sometimes, slow-growing tumor in the retroperitoneal space is the cause of RAP.


  The Case Report Top


A 15 year old girl child female presented with abdominal pain off and on for the last 1 year. The location of pain was vague and varies from the upper abdomen, periumbilicus, and back. Each time it responded with oral drotavarin with or without tramadol for short duration. Liver function test, amylase, lipase, and ultrasound of the whole abdomen were normal on three occasions in the past 6 months. The parents were very worried after the final diagnosis of functional abdominal pain and referred to a clinical psychologist for counseling. While on treatment under counselor, she came to emergency with continuous pain abdomen for 7 days and a contrast computed tomography (CT) abdomen [Figure 1] was done, which showed a mass on the tail of the pancreas. Histopathology sample obtained from CT-guided trucut biopsy as shown in [Figure 2] showed poorly cohesive cells forming pseudopapillary arrangements with eosinophilic cytoplasm and perinuclear vacuoles suggestive of solid pseudopapillary tumor of the pancreas. Common metastatic site inside the abdomen was looked carefully, but tumor is well localized to the site of origin…the tail. The patient was referred to the surgery for complete resection. Surgery was done in our hospital, and she is doing fine.
Figure 1: Contrast-enhanced computed tomography of the abdomen tail of the pancreas mass

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Figure 2: Histopathology Ca pancreas

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  Discussion Top


Solid pseudopapillary carcinoma of the pancreas is very slow-growing tumor comprising only 1%–2% of pancreatic carcinoma. Symptoms and signs depend on mass affect and compression of surrounding tissue. [1,2] For a slow-growing space-occupying lesion within a glandular tissue having duct system, sometimes pain may be intermittent with normal pancreatic enzyme.[3] The origin of tumor is not clear, it may be from ductular epithelium or stroma or extrapancreatic tissue of genital ridge angle-related cells.[4] In this case, anatomical location and cells of origin are not possible due to very small tissue yield on trucut biopsy.

Solid pseudopapillary carcinoma of the pancreas is commonly seen in female 3 and can be a rare cause of pain abdomen in a female child. The diagnosis is only possible with a high index of suspicion and often missed by a busy sonologist due to very slow growth. Timely diagnosis is very important as any delay will produce mass effect and difficult resection.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sathiyasekaran M. Management of recurrent abdominal pain: Have we reached the end of the tunnel? Indian Pediatr 2015;52:841-2.  Back to cited text no. 1
    
2.
Apley J, Naish N. Recurrent abdominal pains: A field survey of 1,000 school children. Arch Dis Child 1958;33:165-70.  Back to cited text no. 2
    
3.
Papavramidis T, Papavramidis S. Solid pseudopapillary tumors of the pancreas: Review of 718 patients reported in English literature. J Am Coll Surg 2005;200:965-72.  Back to cited text no. 3
    
4.
Santini D, Poli F, Lega S. Solid-papillary tumors of the pancreas: Histopathology, JOP. J Pancreas 2006;7:131-6.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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Abstract
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The Case Report
Discussion
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