Intrapancreatic accessory spleen: Findings on MR imaging and CT

Epithelial cyst in an intrapancreatic accessory spleen (ECIPAS) is exceedingly rare with only 57 cases reported since the first publication in 1980. Comprehensive clinical and diagnostic features remain to be clarified. We present a case of ECIPAS in a 21-year-old Philippine woman who was admitted with right upper quadrant abdominal pain. A cystic lesion in the pancreatic tail was discovered and evaluated by computed tomography and magnetic resonance images. Based on clinical and radiological features a solid pseudopapillary neoplasm was suspected. The patient underwent robot-assisted spleen preserving distal pancreatectomy. Pathological evaluation revealed a 26 mm intrapancreatic accessory spleen with a 16 mm cyst, lined by multilayered epithelium in the tail of the pancreas. The postoperative course was uneventful. Differentiating ECIPAS from (pre)malignant cystic pancreatic neoplasms based on clinical and radiological features remains difficult. When typical radiological signs can be combined with scintigraphy using Technetium-99m labelled colloid or Technetium-99m labelled erythrocytes, which can identify the solid component of the lesion as splenic tissue, it should be possible to make the right diagnosis noninvasively. When pancreatectomy is inevitable due to symptoms or patient preference, minimally invasive laparoscopic or robot-assisted spleen preserving distal pancreatectomy should be considered.

Download Full-text

Epidermoid cyst in intrapancreatic accessory spleen: A systematic review

Pancreatology ◽

10.1016/j.pan.2018.10.008 ◽

2019 ◽

Vol 19 (1) ◽

pp. 10-16 ◽

Cited By ~ 1

Author(s):

Bing-Qi Li ◽

Jun Lu ◽

Samuel Seery ◽

Jun-Chao Guo

Keyword(s):

Systematic Review ◽

Epidermoid Cyst ◽

Accessory Spleen ◽

Intrapancreatic Accessory Spleen

Download Full-text

Epithelial cyst arising in an intrapancreatic accessory spleen: a case report of robotic surgery and review of minimally invasive treatment

BMC Surgery ◽

10.1186/s12893-020-00927-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Tomokatsu Kato ◽

Yoichi Matsuo ◽

Goro Ueda ◽

Yoshinaga Aoyama ◽

Kan Omi ◽

...

Keyword(s):

Differential Diagnosis ◽

Minimally Invasive ◽

Distal Pancreatectomy ◽

Accessory Spleen ◽

Cystic Neoplasm ◽

Epithelial Cyst ◽

Robot Assisted ◽

Invasive Treatment ◽

Intrapancreatic Accessory Spleen ◽

Pancreatic Tail

Abstract Background An epithelial cyst in an intrapancreatic accessory spleen (ECIPAS) is rare. We report a case of ECIPAS that was treated with robot-assisted distal pancreatectomy with splenectomy. Case presentation The case was a 59-year-old woman who was referred to our hospital after a pancreatic tail tumor was found on computed tomography prior to surgery for small bowel obstruction at another hospital. A cystic lesion in the pancreatic tail was discovered and evaluated by magnetic resonance imaging and endoscopic ultrasonography. Based on clinical and radiological features, mucinous cystic neoplasm was included in the differential diagnosis. The patient underwent robot-assisted distal pancreatectomy with splenectomy. The postoperative course was uneventful. Pathological evaluation revealed a 20-mm ECIPAS in the pancreatic tail. Conclusions If a pancreatic tail tumor is present, ECIPAS should be included in the differential diagnosis. However, preoperative diagnosis is difficult, and a definitive diagnosis is often not obtained until after surgery. Surgery should be minimally invasive. Laparoscopic distal pancreatectomy has become a standard surgical procedure because it is minimally invasive. Robot-assisted surgery is not only minimally invasive, but also advantageous, because it has a stereoscopic magnifying effect and allows the forceps to move smoothly. Robot-assisted distal pancreatectomy may be a good option, when performing surgery for a pancreatic tail tumor.

Download Full-text