Download PDF
CC BY 4.0 · Endoscopy 2023; 55(S 01): E951-E952
DOI: 10.1055/a-2127-4890
E-Videos

Endoscopic ultrasound-guided radiofrequency ablation for solid pseudopapillary neoplasm of the pancreas

Antoine Coupier
1   Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
,
Tawfik Khoury
1   Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
2   Galilee Medical Center, Gastroenterology, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
,
Rodica Gincul
1   Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
,
Fabien Fumex
1   Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
,
Andrea Lisotti 
3   Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy
,
Sarah Leblanc
1   Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
,
Bertrand Napoléon
1   Department of Gastroenterology, Hôpital privé Jean Mermoz, Ramsay Santé, Lyon, France
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

A solid pseudopapillary neoplasm (SPN) is considered a low-grade malignant neoplasm, more often composed of both solid and cystic components with pseudopapillary areas but predominantly solid in 15 % of cases [1]. It is estimated to account for 1 % to 3 % of all pancreatic tumors [2]. Immunostaining of SPNs for beta-catenin is specific [3]. The natural history of these lesions is unknown, but the malignant potential is demonstrated especially in large lesions. The gold standard therapy is surgical resection. Nonetheless, an alternative such as endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA), which is less invasive [4], should be discussed, especially for young patients with small lesions [5]. All cases of SPN seen and treated with EUS-RFA between 2018 and 2020 were reviewed (IRB 00010835).

Herein, we report on three women, ages 26, 27, and 63, who had pancreatic head lesions (19, 11, and 20 mm, respectively). The case of the 63-year-old woman is described ([Fig. 1]). EUS fine needle biopsy (FNB) diagnosed an SPN ([Fig. 2 a, b]). [Video 1] demonstrates the initial appearance of the lesion in B mode and contrast harmonic mode. The procedure was successfully performed (four shots) with no remaining vascularization in contrast harmonic mode after RFA. At the 3-month follow-up, EUS evidenced hyperechoic nonvascularized necrotic tissue ([Fig. 3]). No remaining lesion was seen on magnetic resonance imaging (MRI), computed tomography (CT), and EUS at 1 and 2 years.

Zoom Image
Fig. 1 Computed tomography scan showing hypodense pancreatic head lesion (red arrow).
Zoom Image
Fig. 2 a Biopsy showing monomorphic cells on histology. b Cells are positively stained for beta-cathenin.

Video 1 Endoscopic ultrasound-guided radiofrequency ablation for solid pseudopapillary neoplasm of the pancreas.


Quality:
Zoom Image
Fig. 3 Biopsy showing inflammatory and necrotic cells not stained for beta-cathenin (red arrow).

For the two other cases, one and two RFA sessions were respectively required to completely destroy the lesions. EUS-RFA procedures were uneventful with no post-procedural adverse events. No recurrence was noted at the 24-month follow-up. This treatment option should be considered in patients unfit for pancreatic surgery and could be discussed for small lesions ≤ 2 cm.

Endoscopy_UCTN_Code_TTT_1AS_2AD

Endoscopy E-Videos
https://eref.thieme.de/e-videos

E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/).

This section has its own submission website at https://mc.manuscriptcentral.com/e-videos



Publication History

Article published online:
21 August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Karsenti D, Caillol F, Chaput U. et al. Safety of endoscopic ultrasound-guided fine-needle aspiration for pancreatic solid pseudopapillary neoplasm before surgical resection: A European multicenter registry-based study on 149 patients. Pancreas 2020; 49: 34-38
    CrossrefPubMedGoogle Scholar
  • 2 Sacco Casamassima MG, Gause CD, Goldstein SD. et al. Pancreatic surgery for tumors in children and adolescents. Pediatr Surg Int 2016; 32: 779-788
    CrossrefPubMedGoogle Scholar
  • 3 Kim EK, Jang M, Park M. et al. LEF1, TFE3, and AR are putative diagnostic markers of solid pseudopapillary neoplasms. Oncotarget 2017; 8: 93404-93413
    CrossrefPubMedGoogle Scholar
  • 4 Napoleon B, Lisotti A, Caillol F. et al. Risk factors for endoscopic ultrasound-guided radiofrequency ablation adverse events in patients with pancreatic neoplasms: a large national French study (RAFPAN study). Gastrointest Endosc 2023; DOI: 10.1016/j.gie.2023.04.003.
    CrossrefPubMedGoogle Scholar
  • 5 Salvia R, Bassi C, Festa L. et al. Clinical and biological behavior of pancreatic solid pseudopapillary tumors: report on 31 consecutive patients. J Surg Oncol 2007; 95: 304-310
    CrossrefPubMedGoogle Scholar