An unusual pancreatic tumor with prominent calcification in a middle-aged man: what is the diagnosis?

Sho Ishikawa; Mitsuhito Koizumi; Masahito Kokubu; Yuki Numata; Teru Kumagi; Yoichi Hiasa

doi:10.5946/ce.2025.014

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Boost Your Learning with Quiz An unusual pancreatic tumor with prominent calcification in a middle-aged man: what is the diagnosis?: Sho Ishikawa¹, Mitsuhito Koizumi¹, Masahito Kokubu¹, Yuki Numata¹, Teru Kumagi^1,2, Yoichi Hiasa¹; Clinical Endoscopy 2026;59(1):156-157.
DOI: https://doi.org/10.5946/ce.2025.014
Published online: October 1, 2025

¹Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan

²Postgraduate Medical Education Center, Ehime University Hospital, Toon, Japan

Correspondence: Mitsuhito Koizumi Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0204, Japan E-mail: koizumi.mitsuhito.na@ehime-u.ac.jp

• Received: June 30, 2025 • Revised: July 28, 2025 • Accepted: July 29, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Quiz

A 67-year-old male with a history of hyperlipidemia underwent a routine medical screening, during which a pancreatic head tumor was detected by abdominal ultrasonography. The patient was asymptomatic at presentation. He was referred to our facility for further evaluation, and his clinical laboratory data, including tumor biomarkers, were within normal limits. Contrast-enhanced computed tomography (CT) revealed a 40-mm tumor with coarse calcification surrounded by a low-density area in the pancreatic head (Fig. 1A, B). Fluorodeoxyglucose positron emission tomography/CT demonstrated a high level of glucose uptake in the tumor, with a maximum standardized uptake value of 3.8 (Fig. 1C, D). No other lesions with a significant uptake level were identified on positron emission tomography/CT. Endoscopic ultrasonography revealed a hypoechoic area surrounding the calcification within the tumor (Fig. 2). The patient underwent an endoscopic ultrasonography-guided tissue biopsy for histopathological diagnosis. The histopathological findings are shown in Figure 3.

What is the most likely diagnosis of this pancreatic tumor?

Answer

The histological examination revealed tumor cells with round nuclei proliferating in a solid pattern (Fig. 3A). Beta-catenin immunohistochemical staining demonstrated positive nuclear localization (Fig. 3B), confirming the diagnosis of solid pseudopapillary neoplasm (SPN). The patient underwent pancreaticoduodenectomy, with no evidence of recurrence during follow-up. SPN is an uncommon pancreatic tumor, accounting for only 0.9% to 2.7% of all exocrine pancreatic tumors. The mean age at presentation is 28.5 years, with a female-to-male ratio of 9.8:1.¹ CT imaging typically reveals cystic components and calcification, with tumors predominantly occurring in the pancreatic body and tail.² SPN demonstrates a substantial female predominance.³ Although the present case involves a pancreatic tumor with calcification, which is relatively uncommon, the case is particularly atypical due to the tumor’s location in the pancreatic head and its occurrence in a middle-aged male. Therefore, SPN should be considered in the differential diagnosis when evaluating pancreatic mass with calcification, even in middle-aged male patients.

Conflicts of Interest

The authors have no potential conflicts of interest.

Funding

None.

Acknowledgments

The patient provided informed consent for the publication of this case and any relevant images.

Author Contributions

Conceptualization: SI; Data curation: SI, MiK; Investigation: SI, MaK, YN, TK, YH; Methodology: SI, MiK; Writing–original draft: SI; Writing–review & editing: all authors.

Fig. 1.

Contrast-enhanced computed tomography (CT) and fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) findings of the tumor. (A) Pre-contrast enhancement CT image revealing the tumor with prominent calcification. (B) Portal venous phase of contrast-enhanced CT highlighting the same lesion. (C) FDG-PET/CT (coronal plane) revealing an abnormal level of FDG uptake in the tumor. (D) FDG-PET/CT (axial plane) confirming an increased level of uptake in the corresponding region.

Fig. 2.

Endoscopic ultrasonography revealing a tumor with a hypoechoic area surrounding the calcification (yellow circle).

Fig. 3.

Histological examination revealing tumor cells with small, round nuclei and poor intercellular adhesion. The nuclei are positive for beta (β)-catenin. (A) Hematoxylin and eosin staining (×400). (B) β-Catenin immunohistochemical staining (×400).

REFERENCES

1. Omiyale AO. Solid pseudopapillary neoplasm of the pancreas. World J Hepatol 2021;13:896–903.Article PubMed PMC
2. Zhao M, Wang J, Lai J, et al. Solid pseudopapillary neoplasms of the pancreas (SPNs): diagnostic accuracy of CT and CT imaging features. World J Surg Oncol 2024;22:225.Article PubMed PMC PDF
3. Nakamura K, Ishii Y, Serikawa M, et al. A case of middle-aged male with multicentric solid pseudopapillary neoplasm of the pancreas. Clin J Gastroenterol 2023;16:488–494.Article PubMed PDF

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