Epidermoid cyst of an intrapancreatic accessory spleen: a case report and literature review

Abstract

BackgroundAn epidermoid cyst in an intrapancreatic accessory spleen is a rare lesion. Despite advances in radiologic techniques, in most cases it has been diagnosed preoperatively as a possible pancreatic neoplasm.Case presentationHerein, we present a 63-year-old Caucasian woman, diagnosed preoperatively with enhanced-contrast abdominal computed tomography, as having a potential cystic tumor in the tail of the pancreas. The patient underwent a distal pancreatectomy and splenectomy, and the histological examination revealed the presence of an epidermoid cyst of an accessory intrapancreatic spleen.ConclusionsFamiliarity with the imaging features, the clinical presentation and the location of the cyst are important to consider if this rare entity is to be included in the differential diagnosis of cystic neoplasms of the pancreas.

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

“…The importance of this benign yet clinically challenging disease lies in the fact that in most cases, as in ours, CA 19-9 is elevated [10][11][12]. High CA 19-9 without pathognomonic imaging features makes preoperative differentiation between the ECIPAS and a malignancy exceptionally difficult.…”

Appendix epidermoid cyst: Presenting as an acute appendicitis

“…Clinical signs associated with intestinal epidermoid cysts vary from slow‐growing intraabdominal masses and vague gastrointestinal symptoms, to acute abdominal pain due to cyst rupture or volvulus 14, 15, 16. Diagnosis of epidermoid cyst based on imaging is not a significant and histological examination is high 17, 18. Differential diagnoses of abdominal masses such as acute inflammation, volvulus, obstruction, and neoplasms should be considered 14.…”

“…[14][15][16] Diagnosis of epidermoid cyst based on imaging is not a significant and histological examination is high. 17,18 Differential diagnoses of abdominal masses such as acute inflammation, volvulus, obstruction, and neoplasms should be considered. 14 Complete surgical excision is considered curative although recurrence after incomplete excision is possible.…”

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“…Epidermoid cysts are infrequent primary (true) splenic cysts and usually do not occur in the accessory spleen. First case of an epidermoid cyst within an IPAS was described in 1980 [3], with only 36 cases described so far [4,5]. Epidermoid cysts in IPAS occur with equal incidence among men and women, predominantly in the middle age group, and always located in the pancreatic tail [4].…”

“…First case of an epidermoid cyst within an IPAS was described in 1980 [3], with only 36 cases described so far [4,5]. Epidermoid cysts in IPAS occur with equal incidence among men and women, predominantly in the middle age group, and always located in the pancreatic tail [4]. Clinically, most patients remain asymptomatic and are diagnosed incidentally with imaging studies.…”