Umang Makhijani, MD1, Ganesh Ramaprasad, MD2, Chetan Pai, DO2 1Mary Washington Healthcare, Ashburn, VA; 2Mary Washington Healthcare, Fredericksburg, VA Introduction: Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare, low-grade malignant tumor predominantly affecting non-Caucasian women in their 30s–40s. It features pseudopapillary structures and is often found incidentally. While generally indolent with excellent prognosis after resection, SPN can show local invasion or metastasis. We report an 18-year-old African American woman diagnosed with SPN after a motor vehicle accident, highlighting its underreported incidence in the U.S. and importance in differential diagnoses.
Case Description/
Methods: An 18-year-old African American woman with no significant medical history presented after a high-speed motor vehicle accident, reporting cervical tenderness. Initial trauma evaluation and FAST ultrasound were unremarkable. However, a pan-scan, including contrast-enhanced abdominal CT revealed a 1.4 cm low-attenuating mass in the pancreatic head. Eight months later, EGD with endoscopic ultrasound (EUS) identified a 2.0 x 2.9 cm oval mass in the uncinate process without local invasion. Fine-needle aspiration confirmed a low-grade neoplasm consistent with SPN. Immunohistochemistry was positive for β-catenin. The patient is currently awaiting surgical consultation. Discussion: SPN is classified by the WHO as a low-grade malignant pancreatic tumor primarily affecting young non-Caucasian women. It accounts for 0.2%–2.7% of all pancreatic neoplasms. Though five times more common in women, SPN may follow a more aggressive course in men. Most SPNs are discovered incidentally—such as during trauma work-ups. Symptoms may include abdominal pain, nausea, palpable mass, or jaundice.
Diagnosis often involves EUS-guided FNA. Histologic features include pseudopapillary structures with fibrovascular cores, nuclear grooves, and eosinophilic cytoplasmic globules. A key molecular feature is mutation of the CTNNB1 gene, causing nuclear β-catenin accumulation—confirmable by immunohistochemistry and essential for distinguishing SPN from other pancreatic tumors.
Surgical resection is the preferred treatment, achieving 5-year survival rates above 90%. Around 15% of cases may exhibit high-grade features, including vascular invasion or liver metastases. In such cases, targeted therapies show promise, though more research is needed. As imaging becomes more prevalent, SPN incidence may rise. This case highlights the need for awareness, particularly among underrepresented groups such as African American women in the U.S.
Disclosures: Umang Makhijani indicated no relevant financial relationships. Ganesh Ramaprasad indicated no relevant financial relationships. Chetan Pai indicated no relevant financial relationships.
Umang Makhijani, MD1, Ganesh Ramaprasad, MD2, Chetan Pai, DO2. P0150 - Incidental Finding of Solid Pseudopapillary Neoplasm (SPN) Following a Motor Vehicle Accident: A Case Study, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
