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

Abstract

An epidermoid cyst arising within an intrapancreatic accessory spleen (ECIAS) is rare, and also difficult to correctly diagnose before surgery. It is mostly misdiagnosed as a cystic tumor, such as a mucinous cystic neoplasm or as a solid tumor with cystic degeneration, such as a neuro endocrine tumor. We herein report a case of ECIAS and also perform a literature review of 35 reports of ECIAS. Although the preoperative diagnosis of ECIAS using conventional imaging is relatively difficult to make, careful preoperative examinations of the features on computed tomography and magnetic resonance imaging could lead to a correct preoperative diagnosis of ECIAS which might thereby reduce the number of unnecessary resections.

Epidermoid cyst within an intrapancreatic accessory spleen

“…Approximately 60% are found at the splenic hilum and 33% at the lower pole of the spleen 2. Other locations of accessory spleens, although more rare, include the fundus of the stomach,3 pancreatic tail,4 greater omentum,5 retroperitoneum6 7 and pelvis 8…”

An Unusual Cause of a Solid-Cystic Pancreatic Lesion

“…1 An epidermoid cyst of an intrapancreatic accessory spleen (ECIAS) is an extremely rare cause of a cystic lesion within the pancreas. 2 A recent study found only 39 cases of ECIAS reported. 2 Twenty-four patients were female and the median age was 48 years.…”

“…2 A recent study found only 39 cases of ECIAS reported. 2 Twenty-four patients were female and the median age was 48 years. All 39 reported ECIAS were in the pancreatic tail and the average size was 4.5 cm.…”

“…All 39 reported ECIAS were in the pancreatic tail and the average size was 4.5 cm. 2 Preoperative diagnosis of ECIAS is frequently difficult if not impossible and only 4 of 39 cases (10.3%) were successfully diagnosed preoperatively. 2 A supporting feature of an ECIAS on CT scan and MRI were that the solid component had a similar density on enhanced CT scanning and intensity on MRI as the spleen.…”

“…2 Preoperative diagnosis of ECIAS is frequently difficult if not impossible and only 4 of 39 cases (10.3%) were successfully diagnosed preoperatively. 2 A supporting feature of an ECIAS on CT scan and MRI were that the solid component had a similar density on enhanced CT scanning and intensity on MRI as the spleen. 2 Although EUS-FNA has been reported to be useful in the diagnosis of intrapancreatic accessory spleens, 3 it seems to be less useful for the diagnosis of ECIAS.…”