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

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 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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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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Laparoscopic Spleen-Preserving Distal Pancreatectomy (LSPDP) versus Open Spleen-Preserving Distal Pancreatectomy (OSPDP): A Comparative Study

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2019/9367868 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Jing Huang ◽

Dipesh Kumar Yadav ◽

Chaojie Xiong ◽

Ye Sheng ◽

Xinhua’ Zhou ◽

...

Keyword(s):

Postoperative Complications ◽

Blood Loss ◽

Hospital Stay ◽

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Operative Time ◽

Malignant Tumors ◽

Low Grade ◽

Intraoperative Blood Loss ◽

Spleen Preserving

Objective. To compare outcomes between laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and open spleen-preserving distal pancreatectomy (OSPDP) for treatment of benign and low-grade malignant tumors of the pancreas and evaluate feasibility and safety of LSPDP. Methods. The clinical data of 53 cases of LSPDP and 44 cases of OSPDP performed between January 2008 and August 2018 were retrospectively analyzed. The clinical outcomes between the two groups were compared. Results. There was no significant difference in preoperative data between the two groups. However, the LSPDP group had statistically significant shorter operative time (145.3±55.9 versus 184.7±33.5, P=0.03) and lesser intraoperative blood loss (150.6±180.8 versus 253.5±76.2, P=0.03) than that of the OSPDP group. Moreover, the LSPDP group also had statistically significant earlier passing of first flatus (2.2±1.4 versus 3.1±1.9, P=0.01), earlier diet intake (2.3±1.8 versus 3.4±2.0, P=0.01), and shorter hospital stay (6.2±7.2 versus 8.8±9.3, 0.04) than that of the OSPDP group. However, postoperative pancreatic fistula (P=0.64) and total postoperative complications (P=0.59) were not significantly different between the groups. The rate of pancreatic fistula and total postoperative complications occurred in 62.5% and 64.5%, respectively, in LSPDP group and, similarly, 70% and 70.0%, respectively, in OSPDP group. Conclusion. This study confirms that LSPDP is safe, feasible, and superior to OSPDP in terms of operative time, intraoperative blood loss, hospital stay, and postoperative recovery. Hence, it is worth popularizing LSPDP for benign and low-grade malignant tumors of the pancreas.

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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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