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

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.

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Rare Case of an Epithelial Cyst in an Intrapancreatic Accessory Spleen Treated by Robot-Assisted Spleen Preserving Distal Pancreatectomy

Case Reports in Gastrointestinal Medicine ◽

10.1155/2016/9475897 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Willemijn P. M. van Dijck ◽

Vincent P. Groot ◽

Lodewijk A. A. Brosens ◽

Jeroen Hagendoorn ◽

Inne H. M. Borel Rinkes ◽

...

Keyword(s):

Distal Pancreatectomy ◽

Accessory Spleen ◽

Magnetic Resonance Images ◽

Epithelial Cyst ◽

Robot Assisted ◽

Diagnostic Features ◽

Intrapancreatic Accessory Spleen ◽

Spleen Preserving ◽

Technetium 99M ◽

Radiological Features

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.

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Laparoscopic Resection of an Epithelial Cyst in an Intrapancreatic Accessory Spleen

Case Reports in Gastroenterology ◽

10.1159/000484134 ◽

2017 ◽

Vol 11 (3) ◽

pp. 803-811

Author(s):

Kazuhiro Suzumura ◽

Etsuro Hatano ◽

Toshihiro Okada ◽

Yasukane Asano ◽

Naoki Uyama ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Histopathological Examination ◽

Accessory Spleen ◽

Cystic Tumor ◽

Cystic Neoplasm ◽

Low Grade ◽

Epithelial Cyst ◽

Intrapancreatic Accessory Spleen ◽

Pancreatic Tail ◽

Splenic Parenchyma

An epithelial cyst in an intrapancreatic accessory spleen (ECIAS) is rare. We herein report a case of a patient with ECIAS who underwent laparoscopic surgery. A 57-year-old woman was referred to our hospital because of a pancreatic tail tumor. She was asymptomatic, and a physical examination revealed no remarkable abnormalities. The levels of the tumor marker carbohydrate antigen 19-9 (CA19-9) and s-pancreas-1 antigen (SPan-1) were elevated. Ultrasonography showed a well-defined homogeneous cystic tumor. Computed tomography showed a well-demarcated cystic tumor in the pancreatic tail. Magnetic resonance imaging showed that the cystic tumor exhibited low intensity on T1-weighted images and high intensity on T2-weighted images. The cystic tumor was diagnosed as mucinous cystic neoplasm preoperatively. The patient underwent laparoscopic spleen-preserving distal pancreatectomy. A histopathological examination revealed the cyst wall to be lined by stratified squamous epithelium within splenic parenchyma, and the ultimate diagnosis was ECIAS. The postoperative course was uneventful, and the patient was discharged on postoperative day 12. ECIAS is very difficult to diagnose preoperatively. Laparoscopic surgery is a safe and minimally invasive procedure for patients with difficult-to-diagnose pancreatic tail tumor suspected of having low-grade malignancy.

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Laparoscopic distal pancreatectomy for intrapancreatic accessory spleen: Case report

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1504195m ◽

2015 ◽

Vol 143 (3-4) ◽

pp. 195-198 ◽

Cited By ~ 2

Author(s):

Slavko Matic ◽

Djordje Knezevic ◽

Igor Ignjatovic ◽

Nikola Grubor ◽

Vladimir Dugalic ◽

...

Keyword(s):

Neuroendocrine Tumor ◽

Distal Pancreatectomy ◽

Histopathological Examination ◽

Preoperative Evaluation ◽

Accessory Spleen ◽

Laparoscopic Distal Pancreatectomy ◽

Pancreatic Tissue ◽

Intrapancreatic Accessory Spleen ◽

Pancreatic Tail ◽

Spleen Preserving

Introduction. Accessory spleens can be found in up to 10% of the population, and their intrapancreatic occurrence is considered uncommon. When present, the intrapancreatic accessory spleen is usually found in the tail of the pancreas in about 1.7% of adult individuals. The infrequent presence of the accessory spleen in the pancreatic tissue could lead to inappropriate diagnosis and hence therapeutic approach, as they are commonly presented as a hypervascular node in the tail of the pancreas on abdominal CT and MRI, mimicking a well differentiated tumor of the pancreas or non-functioning pancreatic neuroendocrine tumor. Case Outline. We present a 70-year-old female in whom a preoperative evaluation finding was highly suggestive of a non-functioning neuroendocrine tumor of the pancreatic tail. We performed spleen preserving laparoscopic distal pancreatectomy, and histopathological examination revealed the intrapancreatic accessory spleen. Conclusion. Although infrequent, the presence of the intrapancreatic accessory spleen must be considered in the differential diagnosis of pancreatic tail tumors.

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Laparoscopic Spleen-Preserving Distal Pancreatectomy for Epidermoid Cyst in An Intrapancreatic Accessory Spleen: A Case Report

10.21203/rs.3.rs-127790/v1 ◽

2020 ◽

Author(s):

Xiang Zheng ◽

Bo Zhou ◽

Qing jing Sun ◽

Ming Jin ◽

Sheng Yan

Keyword(s):

Distal Pancreatectomy ◽

Epidermoid Cyst ◽

Correct Diagnosis ◽

Accessory Spleen ◽

Uneventful Recovery ◽

Imaging Features ◽

Cystic Lesions ◽

Intrapancreatic Accessory Spleen ◽

Pancreatic Tail ◽

Spleen Preserving

Abstract BACKGROUNDPancreatic tail cystic lesions are increasingly encountered in clinical practice, however it is difficult to make a correct diagnosis preoperatively because there are many types of pancreatic neoplastic and non-neoplastic cysts. Epidermoid cyst in an intrapancreatic accessory spleen (ECIPAS) is a rare non-neoplastic cyst and located in the pancreatic tail. Therefore, it should be considered in the differential diagnosis of pancreatic tail cystic lesions. CASE PRESENTATION A 51-year-old man was admitted for investigation of abdominal pain. The physical examination and laboratory tests found no abnormalities, except for an elevation of carbohydrate antigen (CA)19-9. Imaging revealed a 2.6-cm cystic lesion within the pancreatic tail, and the solid component surrounding the cyst was enhanced similarly to those of the splenic tissue. ECIPAS was speculated. With regards to the symptoms and difficulty to completely exclude a malignant tumor, laparoscopic spleen-preserving distal pancreatectomy was performed. The final pathological diagnosis was epidermoid cyst arising from an intrapancreatic accessory spleen. The patient was discharged at day 5 postoperatively after an uneventful recovery. CA19-9 returned to normal after surgery. During 2-years follow-up, there was no evidence of tumor recurrence.CONCLUSIONWe describe typical imaging features of ECIPAS and showed that laparoscopic distal pancreatectomy was safe and effective for treating ECIPAS.

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Spleen Scan for 68Ga-DOTATOC PET-Positive Pancreatic Tail Lesion: Differential Diagnosis of Neuroendocrine Tumor from Accessory Spleen

Nuclear Medicine and Molecular Imaging ◽

10.1007/s13139-019-00626-6 ◽

2019 ◽

Vol 54 (1) ◽

pp. 43-47 ◽

Cited By ~ 1

Author(s):

Hyun Gee Ryoo ◽

Hongyoon Choi ◽

Gi Jeong Cheon

Keyword(s):

Differential Diagnosis ◽

Neuroendocrine Tumor ◽

Accessory Spleen ◽

Pancreatic Tail

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Epidermoid Cyst in the Intrapancreatic Accessory Spleen: A Case Report and Review of the Literature

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz122.005 ◽

2019 ◽

Vol 152 (Supplement_1) ◽

pp. S119-S119

Author(s):

Yukihiro Nakanishi ◽

Preeti Behl ◽

Abida Kadi ◽

Byron Crawford

Keyword(s):

Epidermoid Cyst ◽

Sickle Cell Trait ◽

Accessory Spleen ◽

Splenic Tissue ◽

Cystic Tumor ◽

Cystic Degeneration ◽

Cystic Neoplasm ◽

Surgical Specimen ◽

Intrapancreatic Accessory Spleen ◽

Pancreatic Parenchyma

Abstract Epidermoid cyst in the intrapancreatic accessory spleen (ECIAS) is an exceedingly rare nonneoplastic entity. It generally does not require therapeutic intervention, but it is often misdiagnosed preoperatively as a cystic tumor, such as a mucinous cystic neoplasm or a cystic degeneration in a solid pancreatic neuroendocrine tumor or solid pseudopapillary neoplasm. We herein report a rare case of ECIAS in a 33-year-old African American man with a history of end-stage renal disease secondary to IgA nephropathy, congestive heart failure, and sickle cell trait who was referred to our facility for a renal transplant workup. A contrast-enhanced abdominal computed tomography during the workup revealed a bilobed low attenuating mass (3.4 × 3.4 × 2.5 cm) in the tail of the pancreas. Because malignancy could not be excluded, the patient underwent a distal pancreatectomy and splenectomy. Gross examination of the surgical specimen revealed a smooth-walled, multiloculated cyst (3.7 × 2.7 × 2.0 cm), containing serous fluid within the pancreatic parenchyma. Microscopically, the cyst was lined by nonkeratinizing stratified squamous epithelium without skin appendages, surrounded by benign splenic tissue in the pancreatic parenchyma. No dysplasia or malignancy was seen. Immunohistochemically, the lining epithelium was positive for p63, CK5/6, and CEA and negative for CA19-9, which supports the above diagnosis. The postoperative course was uneventful. In conclusion, ECIAS is a rare benign entity that can mimic malignant conditions and should be considered in the differential diagnosis of cystic lesions in the tail of pancreas.

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Two cases of laparoscopic resection of epithelial cyst in an intrapancreatic accessory spleen

HPB ◽

10.1016/j.hpb.2020.11.572 ◽

2021 ◽

Vol 23 ◽

pp. S228

Author(s):

S. Amano ◽

H. Nitta ◽

T. Takahara ◽

Y. Hasegawa ◽

H. Katagiri ◽

...

Keyword(s):

Laparoscopic Resection ◽

Accessory Spleen ◽

Epithelial Cyst ◽

Intrapancreatic Accessory Spleen

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Laparoscopic Spleen-Preserving Pancreatic Tail Resection for an Intrapancreatic Accessory Spleen Mimicking a Nonfunctioning Endocrine Tumor: Report of a Case

Surgery Today ◽

10.1007/s00595-004-2839-9 ◽

2004 ◽

Vol 34 (10) ◽

Cited By ~ 18

Author(s):

Takashi Hamada ◽

Shuji Isaji ◽

Shugo Mizuno ◽

Masami Tabata ◽

Kentaro Yamagiwa ◽

...

Keyword(s):

Accessory Spleen ◽

Endocrine Tumor ◽

Intrapancreatic Accessory Spleen ◽

Pancreatic Tail ◽

Spleen Preserving ◽

Nonfunctioning Endocrine Tumor

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Epidermoid Cyst within an Intrapancreatic Accessory Spleen Mimicking a Pancreatic Cystic Neoplasm

Surgical Case Reports ◽

10.31487/j.scr.2020.01.07 ◽

2020 ◽

pp. 1-3

Author(s):

Venu G Pillarisetty ◽

Arezou Abbasi ◽

Florencia G Jalikis ◽

Lisa K Koch ◽

Venu G Pillarisetty

Keyword(s):

Epidermoid Cyst ◽

Accessory Spleen ◽

Cystic Mass ◽

Preoperative Imaging ◽

Cystic Neoplasm ◽

Histopathological Analysis ◽

Intrapancreatic Accessory Spleen ◽

Splenic Parenchyma ◽

Characteristic Features ◽

Accessory Spleens

Although intra-abdominal accessory spleens are commonly found in 10-30% of the general population, epidermoid cyst within an intrapancreatic accessory spleen (ECIPAS) is an extremely rare entity and is often misdiagnosed preoperatively as a cystic malignancy. We present the case of a 51-year-old man who was referred to our clinic because of an incidentally found pancreatic tail cystic mass. Due to CA 19-9 level over 2000 and high suspicion of malignancy, the patient underwent distal pancreatectomy with splenectomy. Histopathological analysis revealed a squamous epithelial lining with splenic parenchyma within the cyst wall, which was consistent with ECIPAS. The patient was discharged on postoperative day 4 without any complication. As this disease may mimic malignancy with no characteristic features in preoperative imaging, it should be considered in the differential diagnosis of pancreatic cystic lesions.

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