Journal of the Pancreas Open Access

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Laparoscopic Distal Pancreatectomy for Multiple Epithelial Cysts in an Intrapancreatic Accessory Spleen. A Case Report and Review of Literature

Masaki Wakasugi, Masayuki Tori, Hiroki Akamatsu, Shigeyuki Ueshima, Takeshi Omori, Mitsuyoshi Tei, Toru Masuzawa, Masahiko Tsujimoto, Toshirou Nishida

Context Accessory spleen is a congenital abnormality consisting of normal splenic tissue in ectopic sites that is found inapproximately 10-15% of the general population. However, an intrapancreatic accessory spleen has seldom been reportedand multiple epithelial cysts in the intrapancreatic accessory spleen are extremely rare. Case report A 37-year-old womanwith no clinical manifestations presented with two cystic lesions in the tail of the pancreas. The tumor markers CA 19-9 (251U/mL) and SPAN-1 (38 U/mL) were increased. Computed tomography showed a multilocular cyst, 40 mm in size, and aunilocular cyst, 20 mm in size, in the tail of the pancreas and gallstones. The cystic component was hypointense onT1-weighted magnetic resonance images and hyperintense on T2-weighted magnetic resonance images. A laparoscopicdistal pancreatectomy was performed with the presumptive diagnosis of a mucinous cystic neoplasm or an intraductalpapillary mucinous neoplasm with gallstones. The pathological examination showed that the walls of the two cysts werecovered with non-keratinized stratified squamous epithelium, surrounded by normal splenic tissue. The final pathologicaldiagnosis was two epithelial cysts originating from an intrapancreatic accessory spleen. Conclusions Even though multiplemasses were detected in the pancreatic tail, the possibility of epithelial cysts originating from an accessory spleen should beconsidered. Laparoscopic distal pancreatectomy might be a safe and effective procedure and provide good cosmetic resultfor a benign or low-grade malignant tumor in the pancreas.