Pancreatic solid papillary neoplasm with high-grade malignant transformation and multiple hepatic metastases in an elderly male: a case report.

Abstract

Introduction and clinical importance: Solid pseudopapillary neoplasms (SPNs) are rare pancreatic tumors that predominantly affect young women and generally exhibit low malignant potential. High-grade malignant transformation with distant metastasis is uncommon, particularly in elderly males.

Case presentation: A 66-year-old male with hepatitis B virus-related cirrhosis presented with obstructive jaundice, abdominal pain, and significant weight loss. Contrast-enhanced computed tomography revealed a large pancreatic head mass with multiple hepatic lesions. Histopathological examination demonstrated mixed solid and pseudopapillary architecture with marked nuclear atypia, high mitotic activity, and extensive necrosis. Immunohistochemical analysis showed nuclear β-catenin positivity and expression of CD56 and CD99, with negative neuroendocrine markers, and a proliferative Ki-67 labeling index of approximately 60% in the hot spot together, these findings confirmed SPN with high-grade malignant transformation and hepatic metastases.

Clinical discussion: This case represents an aggressive and atypical presentation of an SPN. Advanced disease, extensive metastases, and underlying liver cirrhosis significantly limited therapeutic options; only palliative management was feasible.

Conclusion: High-grade metastatic SPNs may exhibit aggressive clinical behavior and a poor prognosis. Elderly male sex may represent a potential adverse prognostic factor for aggressive SPN variants. Early recognition and accurate diagnosis are essential, particularly in atypical populations with significant comorbidities.