An Operative Case of Metastatic Solid-Pseudopapillary Tumor in the Liver after Curative Resection

A 45-year-old woman who underwent distal pancreatectomy and splenectomy for a solid-pseudopapillary tumor of the pancreas (PSPT) 2 years and 5 months earlier was found to have multiple liver metastases in follow-up CT, necessitating curative anterior segmentectomy and radiofrequency ablation. PSPT is a rare neoplasm with distinctive pathological features and low-grade malignant potential that preferentially affects young women, although cases developing into metastatic disease mostly involving the liver and peritoneum are increasingly reported. Based on maximal data, we analyzed and summarized clinical features of 50 cases with liver metastasis reported. in Japan as follows: average age was approximately 15 years older than that of the cases without hepatic metastasis; location of the primary tumor in the pancreas head is rare; tumors are about 15mm bigger than those of the cases without hepatic metastasis; metastasis took an average of 6.8 years to develop; 56% of cases showed multiple hepatic metastases; the prognosis for patients undergoing surgical treatment was good; and chemotherapy was not effective. These results indicated the need for longterm postoperative follow-up and aggressive surgical treatment in liver metastasis. Molecular biology recently revealed that pancreatic ductal carcinoma and PSPT progress genetically through two pathways, distinctly reflecting both prognosis and gender preference, but PSPT remains a surgical enigma.