Original Article Peripancreatic lymphadenopathy on preoperative radiologic images predicts malignancy in pancreatic solid pseudopapillary neoplasm

Objective: To identify clinicopathological characters and risk factors of malignant pancreatic solid pseu- dopapillary neoplasm (SPN). Methods: All patients with complete clinicopathological records who underwent sur- gery for SPN between 2000 and 2010 were retrospective reviewed. Furthermore, we reviewed and classified the histopathology slides of all patients according to the 2010 World Health Organization criteria. Results: Of the 10 0 patients identified, 84 (84.0%) were female, and the median age was 31 (range, 13-68) years old. Median tumor size was 6.5 (range, 1.5-18) cm. Twenty-four patients (24.0%) were classified to have malignant SPN. Forty-nine patients had lymph node removed in surgery, and four (8.2%) had nodal metastases. On univariate analysis, peri- pancreatic lymphadenopathy on preoperative computed tomography (CT) and/or magnetic resonance (MR) images was significant risk factor of malignancy ( P = 0.025). In the long-term follow up, two patients had evidence of liver metastases and underwent a second laparotomy for metastatic tumor. These two patients were followed up for 24 and 32 months respectively, and never presented with tumor recurrence again. Conclusions: Peripancreatic lymph- adenopathy on preoperative radiologic images was associated with malignancy in patients with SPN. Close follow-up and review periodically were recommended for patients with malignant SPN.