Liver Transplantation for Liver Metastasis of a Pseudopapillary Pancreatic Neoplasm in a Male Patient

Patient: Male, 60-year-old Final Diagnosis: Pseudopapillary pancreatic neoplasm with liver metastasis Symptoms: Jaundice Clinical Procedure: Biopsy • CT scan • liver resection • MRI • transplantation • ultrasonography • Whipple procedure Specialty: Transplantology OBJECTIVE: Unusual clinical course BACKGROUND: Solid pseudopapillary neoplasm (SPN) of the pancreas, which predominantly affects young women, is an uncommon condition with low malignant potential. It is often asymptomatic. This tumor has a low metastatic rate and a good prognosis in contrast to other pancreatic tumors. Approximately 14% of SPNs develop liver metastasis, but for SPNs with malignant features liver metastasis has been reported to occur in over 55% of cases. Complete surgical resection is the treatment of choice for increasing the survival rate in metastatic recurrent disease. When surgical resection is impossible, liver transplantation has shown promising results in a few cases. The purpose of this article is to present the first case of a male patient who underwent liver transplantation for this indication. CASE REPORT: We present the case of a 60-year-old male patient who previously had pancreas surgery, numerous liver re-sections, and chemotherapy for SPN, but nevertheless developed recurrence of multiple liver metastases. His metastatic liver disease was regarded as unresectable. The lymphatic structure was also affected. The patient underwent orthotopic liver transplantation with a deceased donor graft after multidisciplinary evaluation. At 2-year follow-up, the patient was alive and recurrence free. CONCLUSIONS: This is the first published report of a male patient who underwent liver transplantation due to SPN metastasis. Our case demonstrates that liver transplantation should be further investigated for selected cases of SPN of the pancreas with liver metastatic disease when surgical resection is deemed unattainable.