Solid and Papillary Epithelial Neoplasm of the Pancreas

Solid and papillary epithelial neoplasm (SPEN) of the pancreas is a rare, low-grade malignant tumor that rarely metastasizes and carries a good prognosis.

It occurs predominantly in young women (mean age=25 years), most commonly of African or east Asian heritage.

SPENs are large masses that tend to occur in the body and tail of the pancreas and have areas of hemorrhagic degeneration. Fluid-debris levels may be seen with cystic hemorrhagic degeneration. Peripheral calcifications can be seen in 1/3 of cases.

Differential considerations include:

• Non-hyperfunctioning islet cell tumors: This is the most difficult to differentiate from SPEN. They may have cystic areas and areas of internal hemorrhage and contain calcification, but tend to occur in an older age group without the female predominance.
• Serous cystadenoma: Composed predominantly of microscopic cystic spaces and found in older women. Unlike SPEN, they are multilocular and have thin septations. Usually located in the pancreatic head. May have central calcification.
• Mucinous cystic neoplasm: Can contain large cystic spaces and fluid-debris levels that demonstrate a hematocrit effect. Unlike SPEN, they are multilocular and have thin septations.
• Pleomorphic carcinoma of the pancreas:
• Pancreaticoblastoma: Disease of childhood. May have internal necrosis, cystic components. Often seen with liver metastases at the time of diagnosis.
• Pseudocyst: May calcify peripherally due to internal hemorrhage and mimic SPEN.

References

• Buetow PC, Buck JL, Pantongrag-Brown L, Beck KG, Ros PR, Adair CF. Solid and papillary epithelial neoplasm of the pancreas: imaging-pathologic correlation on 56 cases. Radiology. 1996 Jun;199(3):707-11.
• Choi BI, Kim KW, Han MC, Kim YI, Kim CW. Solid and papillary epithelial neoplasms of the pancreas: CT findings. Radiology. 1988 Feb;166(2):413-6.