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

Abstract

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.

Challenging Diagnosis of Intrapancreatic Accessory Spleen in the Tail of the Pancreas: A Case Report

“…In the present case, the patient’s carbohydrate antigen (CA) 19-9 level was not abnormal. Although previous reports implied that IPAS might increase CA19-9 levels [ 48 , 49 ], this was not specific. Even though CA19-9 is a biomarker currently used to monitor pancreatic tumors, the phase-positive predictive value is only 72.3% [ 50 ].…”

Intrapancreatic accessory spleen with an epidermoid cyst: a malignant mimicry

“…Recently, Zheng et al reported laparoscopic spleen-preserving distal pancreatic resection in a 51-year-old man diagnosed with ECIPAS. It remains unclear why the authors chose to preserve spleen when the indication for surgery was reported as possible malignancy 17. Postoperative pancreatic fistula is an Achilles heel of pancreatic resections.…”

Histological and immunohistochemical analysis of epithelial cells in epidermoid cysts in intrapancreatic accessory spleen

“…Epidermoid cyst in intrapancreatic accessory spleen (ECI-PAS) is a rare cystic lesion in the pancreas. Since Davidson et al reported the first case of ECIPAS in 1980 (1), 63 cases have been reported (2)(3)(4). ECIPAS is considered a benign lesion, with only a single case having been reported to undergo malignant transformation (5), and usually does not require surgical treatment.…”