Intrapancreatic Accessory Spleen Masquerading as a Pancreatic Mucinous Neoplasm

Poola, Shiva; Kragel, Peter J.; Regan, Kara

doi:10.1055/s-0040-1710342

Cited by 4 publications

(3 citation statements)

References 12 publications

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“…It is difficult to diagnose ECIPAS preoperatively using conventional imaging, thus it is commonly misdiagnosed as another cystic neoplasm, such as a mucinous cystic neoplasm (MCN), solid pseudopapillary tumor (SPT), intraductal papillary mucinous neoplasm (IPMN), or cystadenocarcinoma. [6][7][8][9] ECIPAS was thought to be benign until recently when it was found to develop into a malignant tumor during 6-years follow-up, [10] which highlights its malignant potential. Thus, it would be necessary to make a definitive diagnosis of this disease as well as to differentiate it from other potentially malignant pancreatic tail cystic neoplasms.…”

Section: Introductionmentioning

confidence: 99%

“…ECIPAS should therefore be considered in the differential diagnosis of pancreatic tail cystic lesions. It is difficult to diagnose ECIPAS preoperatively using conventional imaging, thus it is commonly misdiagnosed as another cystic neoplasm, such as a mucinous cystic neoplasm (MCN), solid pseudopapillary tumor (SPT), intraductal papillary mucinous neoplasm (IPMN), or cystadenocarcinoma [6–9] . ECIPAS was thought to be benign until recently when it was found to develop into a malignant tumor during 6-years follow-up, [10] which highlights its malignant potential.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic spleen-preserving distal pancreatectomy for epidermoid cyst in an intrapancreatic accessory spleen

et al. 2021

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Rationale: Pancreatic 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 locating in the pancreatic tail, and it is commonly misdiagnosed as another cystic neoplasm. Patient concerns: 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 cystic lesion within the pancreatic tail, and the solid component surrounding the cyst was enhanced similarly to those of the splenic tissue. Diagnosis: ECIPAS was diagnosed based on the pathology after surgery. The mass was composed of a cyst and brown solid spleen-like tissue. The microscopic analysis demonstrated that the solid component was accessory splenic tissue, and the cyst wall was lined with a thin stratified squamous epithelium. Interventions: Laparoscopic spleen-preserving distal pancreatectomy was performed. Outcomes: The patient was discharged on day 5 postoperatively after an uneventful recovery. CA19-9 returned to normal after surgery. During a 2-years follow-up, there was no evidence of tumor recurrence. Lessons: Although rare ECIPAS should be considered in the differential diagnosis of pancreatic tail cystic lesions, and the typical imaging features might facilitate the preoperative diagnosis. Laparoscopic distal pancreatectomy is a safe and effective approach for treating ECIPAS.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Laparoscopic spleen-preserving distal pancreatectomy for epidermoid cyst in an intrapancreatic accessory spleen

et al. 2021

View full text Add to dashboard Cite

show abstract

“…ECIPAS should therefore be considered in the differential diagnosis of pancreatic tail cystic lesions. It is di cult to diagnose ECIPAS preoperatively using conventional imaging, thus it is commonly misdiagnosed as another cystic neoplasm, such as a mucinous cystic neoplasm (MCN), solid pseudopapillary tumor (SPT), intraductal papillary mucinous neoplasm (IPMN) or cystadenocarcinoma [6][7][8][9]. ECIPAS was thought to be benign until recently when it was found to develop into a malignant tumor during 6-years follow-up [10], which highlights its malignant potential.…”

Section: Introductionmentioning

confidence: 99%

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

Zheng

Zhou

Sun

et al. 2020

Preprint

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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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Epidermoid Cyst arising within an Intrapancreatic Accessory Spleen [ECIPAS] mimicking a pancreatic mucinous cystic neoplasm-a case report with literature review

Pramath,

Dana,

Rani

2024

Arch Clin Gastroenterol

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Background: Accessory spleens are congenital embryological aberrations usually found within the splenic hilum with no clinical significance. An Intra Pancreatic Accessory Spleen (IPAS) is an uncommon benign pancreatic lesion encountered clinically. The occurrence of an Epidermoid Cyst arising within an IPAS (ECIPAS) is exceedingly rare and is often misdiagnosed as a pancreatic pathology such as mucinous cystic neoplasm, cystic degeneration within a solid tumor such as a neuroendocrine tumor, or a lymph node. Case report: A 68-year-old male presented with intermittent post-prandial abdominal pain for over 2 years. Abdominal computer tomography identified a 5.2 cm calcified cyst within the pancreatic tail and a mucinous pancreatic neoplasm/pancreatic pseudocyst was considered in the differential diagnosis. The results of endoscopic ultrasound and fine needle aspiration were indeterminate. Due to persistent abdominal pain, the patient underwent a laparoscopic distal pancreatectomy with splenectomy. A gross examination of the distal pancreatic/splenectomy specimen confirmed a well-demarcated cystic lesion with brownish fluid within the pancreatic tail. Microscopic examination revealed a nonpathological pancreas separated by a fibrous capsule with a large cyst arising within an intrapancreatic accessory spleen. The cyst was lined with multilayered non-keratinized stratified squamous epithelium positive for pancytokeratin, CA 19-9, CK5/6, and p63 with no lymphocytic infiltrates and absent hair/ dermal appendages confirming an epidermoid cyst. CD8 outlined the dendritic network of the littoral cells of the splenic tissue in the cyst wall. Post-operative follow-up at 6 weeks was uneventful. Conclusion: The preoperative diagnosis of ECIPAS is extremely difficult as this entity shares overlapping radiological features with other cystic lesions such as mucinous pancreatic cysts. It is important for anatomic pathologists to recognize and consider the intrapancreatic compartment as a possible site for accessory spleen. As histopathology is the final determinant of this diagnosis, increased clinical awareness with an accurate diagnosis of this entity may prevent patients from unnecessary surveillance and/or extensive oncological-based surgical resection.

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Intrapancreatic Accessory Spleen Masquerading as a Pancreatic Mucinous Neoplasm

Cited by 4 publications

References 12 publications

Laparoscopic spleen-preserving distal pancreatectomy for epidermoid cyst in an intrapancreatic accessory spleen

Laparoscopic spleen-preserving distal pancreatectomy for epidermoid cyst in an intrapancreatic accessory spleen

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

Epidermoid Cyst arising within an Intrapancreatic Accessory Spleen [ECIPAS] mimicking a pancreatic mucinous cystic neoplasm-a case report with literature review

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