胰腺的实性假乳头状上皮性肿瘤(SPEN)是一种罕见的肿瘤,约占胰腺外分泌肿瘤的1%-2%。它主要影响女性的第二个和第三个十年。在这个案例报告中,我们介绍了一个21岁的孕妇的临床情景,她偶然发现了胰腺中的一个实性囊性病变,表现出暗示SPEN的特征。患者在妊娠中期接受了手术。由于缺乏明确的治疗指南,对患有SPEN的孕妇的管理提出了挑战。特别是在确定手术干预的理想时机时。值得注意的是,怀孕期间,小SPEN的存在不一定需要立即切除.然而,如果肿瘤很大,它会引起并发症,如肿瘤破裂,多脏器切除,复发,自然流产,宫内生长受限,或过早交货,如果没有解决。在现有文献中,一个常见的发现是,大约三分之二的妊娠女性在妊娠中期接受了手术,通常对母亲或胎儿没有并发症。所有这些肿瘤都大于8cm。出生前或出生后手术的决定可以根据团队讨论个性化。然而,手术延迟可能会导致更大的肿瘤和更高的出血风险,破裂,多脏器切除,和复发。因此,孕中期手术似乎更安全,减少危险,急诊手术,和肿瘤复发。
The solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas is an uncommon tumor that accounts for approximately 1%-2% of exocrine pancreatic neoplasms. It predominantly affects female in their second and third decades of life. In this
case report, we present a clinical scenario of a 21-year-old pregnant woman who incidentally discovered a solid cystic lesion in her pancreas, exhibiting features suggestive of SPEN. The patient underwent surgery during the second trimester. Management of pregnant females with SPEN poses challenges due to the absence of definitive treatment guidelines, particularly in determining the ideal timing for surgical intervention. Notably, during pregnancy, the presence of a small SPEN does not necessarily require immediate resection. However, if the tumor is of significant size, it can give rise to complications such as tumor rupture, multivisceral resection, recurrence, spontaneous abortion, intrauterine growth restriction, or premature delivery if not addressed. In the existing literature, a common finding is that approximately two-thirds of pregnant females with SPEN underwent surgery in the second trimester, often without complications for the mother or fetus. All these tumors were larger than 8 cm. The decision to operate before or after birth can be individualized based on team discussion. However, delay in surgery may lead to larger tumors and higher risks like bleeding, rupture, multivisceral resection, and recurrence. Therefore, second-trimester surgery seems safer, and lessens dangers, emergency surgery, and tumor recurrence.