Fateme Fazeli - Department of Pediatrics, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran.
Emad Asgari Jafarabadi - Department of Pediatrics, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran.
Amir Hossein Zardast - Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.
Marjan Joodi - Department of Pediatric Surgery, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Ghodsiyeh Azarkar - Department of Radiology, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran.

Background: The incidence of pancreatic neoplasms in infants and children is ۱.۸ cases per ۱۰۰۰۰۰۰. Three of children’s most common primary pancreatic neoplasms are pancreatoblastoma, solid pseudopapillary neoplasm of the pancreas, and pancreatic endocrine neoplasms. Solid pseudopapillary neoplasm of the pancreas is a low-grade malignant tumor. Solid pseudopapillary neoplasm in children is presented with a palpable mass (۶۰%), followed by abdominal pain (۳۳.۳%). Although duodenal invasion frequently occurs in patients with pancreatic cancer, massive gastrointestinal bleeding is seldom encountered. The most helpful imaging technique is the CT scan. Surgical resection is the treatment of choice for solid pseudopapillary neoplasms. Case Presentations: A ۱۴ years old male adolescent was presented to our pediatric emergency department with fatigue, dizziness, fever, vomiting, and tachycardia. He had melena ۵ days before admission. Crystalloids, pantoprazole, and packed red blood cells were administered to stabilize the patient. As the initial resuscitation measures stabilized the patient, endoscopic gastroduodenoscopy was performed, and a vascular lesion measuring ۶۰×۷۰ mm was noted in the second part of the duodenum. CT scan of the abdomen with intravenous and oral contrast showed a mass with solid and cystic components measuring ۷۵×۵۲ mm between the head of the pancreas and gallbladder origination from the head of the pancreas. The patient underwent Whipple surgery. The diagnosis of the pathologic evaluation was a solid pseudopapillary tumor of the pancreas. Conclusions: Most pediatric pseudopapillary tumors of the pancreas present with a palpable mass and abdominal pain, and gastrointestinal bleeding is a rare presentation not mentioned in previous case reports.

Solid pseudopapillary tumor, Pancreas, Melena