Solid Pseudopapillary Carcinoma of the Pancreas Presenting with Acute Kidney Injury and Metastatic Disease in an Elderly Male: A Case Report

Background: Solid pseudo-papillary neoplasm (SPN) of the pancreas is a rare malignant neoplasm, typically affecting young females. Occurrence in elderly males is exceedingly uncommon and often associated with aggressive behavior and advanced disease at presentation. Case Presentation: We report a 75-year-old male with a history of type 2 diabetes mellitus, hypertension, coronary artery disease, and prior coronary bypass surgery, who presented with abdominal distension. Initial evaluation, including laboratory tests and abdominal ultrasonography, was unremarkable. He was discharged with symptomatic treatment following relief in his symptoms. Five months later, the patient presented to the emergency department with nausea, vomiting, and abdominal pain. Laboratory tests revealed severe acute kidney injury (urea 258 mg/dL, creatinine 23 mg/dL, potassium 7 mmol/L). Therefore, emergent hemodialysis was initiated. Abdominal imaging revealed hepatic metastases, a duodenal wall mass, and a large retroperitoneal mass encasing major abdominal vessels (Sonography of the abdomen 5 months ago was normal). Ultrasound-guided biopsy of the retroperitoneal mass demonstrated histological features (variable admixture of solid and pseudopapillary areas) consistent with solid pseudo-papillary carcinoma. Due to poor performance status, palliative care was recommended. The patient died three months after establishing the diagnosis. Conclusion: This case elaborated the aggressive nature and atypical presentation of SPN in elderly males, including retroperitoneal involvement and severe renal impairment due to obstructive vascular compression.