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

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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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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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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Giant Epidermoid Cyst Within an Intrapancreatic Accessory Spleen Mimicking a Cystic Neoplasm of the Pancreas

Pancreas ◽

10.1097/mpa.0b013e3181359e36 ◽

2008 ◽

Vol 36 (1) ◽

pp. 98-100 ◽

Cited By ~ 27

Author(s):

Elliot L. Servais ◽

Inderpal S. Sarkaria ◽

Garron J. Solomon ◽

Pramod Gumpeni ◽

Michael D. Lieberman

Keyword(s):

Epidermoid Cyst ◽

Accessory Spleen ◽

Cystic Neoplasm ◽

Intrapancreatic Accessory Spleen

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Epidermoid Cyst in an Intrapancreatic Accessory Spleen: Case Report and Literature Review of the Preoperative Imaging Findings

Internal Medicine ◽

10.2169/internalmedicine.55.7140 ◽

2016 ◽

Vol 55 (23) ◽

pp. 3445-3452 ◽

Cited By ~ 12

Author(s):

Shin Kato ◽

Hideki Mori ◽

Moriya Zakimi ◽

Koki Yamada ◽

Kenji Chinen ◽

...

Keyword(s):

Case Report ◽

Literature Review ◽

Epidermoid Cyst ◽

Accessory Spleen ◽

Preoperative Imaging ◽

Imaging Findings ◽

Intrapancreatic Accessory Spleen

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A Case of Epidermoid Cyst in the Intrapancreatic Accessory Spleen Mimicking Pancreas Mucinous Cystic Neoplasm

The Korean Journal of Pancreas and Biliary Tract ◽

10.15279/kpba.2014.19.3.142 ◽

2014 ◽

Vol 19 (3) ◽

pp. 142-146

Author(s):

Pyung Hwa Park ◽

Jae Hee Cho ◽

Pil Kyu Jang ◽

Jung Yoon Han ◽

Seung Ik Lee ◽

...

Keyword(s):

Epidermoid Cyst ◽

Accessory Spleen ◽

Mucinous Cystic Neoplasm ◽

Cystic Neoplasm ◽

Intrapancreatic Accessory Spleen

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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

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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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