Solid Pseudopapillary Tumor of the Pancreas with Massive Cystic Degeneration; Source of Diagnostic Confusion

Introduction: Typically found in young women, solid pseudopapillary tumors of the pancreas (SPTP) are part of the differential diagnosis for solid and cystic neoplasms of the pancreas. SPTP may cause diagnostic confusion when presenting with massive cystic degeneration. Case Report: A 59 year-old woman undergoing surveillance PET-CT was found to have a 9 cm, calcified, complex cyst arising in the pancreatic tail. Endoscopic ultrasound, as well as cytology and fluid analysis from fine needle aspiration findings were thought to be consistent with pancreatic pseudocyst; however, after referral to a specialty surgical clinic, resection was offered because the unusual appearance and presentation of the pseudocyst triggered concern for an underlying neoplasm. After distal pancreatectomy with splenectomy, histologic examination of the cyst revealed SPTP with necrosis and no evidence of pancreatic pseudocyst. Discussion: SPTP may be confused for pancreatic pseudocyst when significant tumor necrosis and cystic degeneration has occurred. Clinicians evaluating pancreas cysts must keep a high index of suspicion for cystic neoplasm particularly when the history lacks the common causes of pancreatic pseudocyst.