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

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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A Rapidly Growing Epidermoid Cyst in an Intrapancreatic Accessory Spleen Treated by Laparoscopic Spleen-Preserving Distal Pancreatectomy: Case Report

International Surgery ◽

10.9738/intsurg-d-14-00278.1 ◽

2019 ◽

Vol 103 (9-10) ◽

pp. 482-488 ◽

Cited By ~ 1

Author(s):

Yusuke Kumamoto ◽

Takashi Kaizu ◽

Hiroshi Tajima ◽

Hidefumi Kubo ◽

Ryo Nishiyama ◽

...

Keyword(s):

Distal Pancreatectomy ◽

Epidermoid Cyst ◽

Malignant Tumors ◽

Accessory Spleen ◽

Histopathological Diagnosis ◽

Low Grade ◽

Intrapancreatic Accessory Spleen ◽

Spleen Preserving ◽

One Year ◽

Enhanced Computed Tomography

Epidermoid cysts arising in an intrapancreatic accessory spleen are exceedingly rare; furthermore, the natural course of them is hardly known. We report a case correctly diagnosed with epidermoid cyst in an intrapancreatic accessory spleen, followed by 1 year of observation, that underwent surgical treatment. The patient presented with diarrhea. Contrast-enhanced computed tomography (CT) revealed a pancreatic cyst 20 mm in diameter, surrounded by a solid component showing the same enhancement as the spleen, suggesting the presence of an epidermoid cyst in an intrapancreatic accessory spleen. One year later, back discomfort developed and a CT scan revealed that the cyst had grown to 38 mm in diameter. To obtain a definitive diagnosis, we performed a laparoscopic spleen-preserving distal pancreatectomy. The histopathological diagnosis was compatible with an epidermoid cyst in an intrapancreatic accessory spleen, which is benign. The postoperative course was uneventful. This case demonstrates that an epidermoid cyst arising in an intrapancreatic accessory spleen can rapidly grow, even if it is benign. Laparoscopic spleen-preserving distal pancreatectomy can be a useful procedure, with the advantages of low invasiveness and organ preservation, for the treatment of benign or low-grade malignant tumors located in the pancreatic body or tail.

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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

Medicine ◽

10.1097/md.0000000000026379 ◽

2021 ◽

Vol 100 (26) ◽

pp. e26379

Author(s):

Xiang Zheng ◽

Bo Zhou ◽

Jing-Qing Sun ◽

Ming Jin ◽

Sheng Yan

Keyword(s):

Distal Pancreatectomy ◽

Epidermoid Cyst ◽

Accessory Spleen ◽

Intrapancreatic Accessory Spleen ◽

Spleen Preserving

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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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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.

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