Epidermoid cyst in an intrapancreatic accessory spleen in the pancreas head: a case report
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CASE REPORT
Epidermoid cyst in an intrapancreatic accessory spleen in the pancreas head: a case report Hyo Jung Ko1, Jae Ryong Shim1, Tae Beom Lee1, Byung Hyun Choi1, Jung‑Hee Lee2, Je Ho Ryu1 and Kwangho Yang1,3*
Abstract Background: An epidermoid cyst in an intrapancreatic accessory spleen (ECIPAS) in the pancreas head is an extremely rare condition. The natural course of this condition is not well known, and it is difficult to diagnose before surgery due to the lack of specific imaging findings. Case presentation: A tumor was found in the head of the pancreas in a 68-year-old man with abdominal distension and discomfort. Magnetic resonance imaging (MRI) suggested a malignant tumor, such as a colloid cancer. The tumor was removed surgically, with pathologic examination showing that it was an ECIPAS. Conclusion: ECIPAS cannot be easily distinguished from other pancreatic cystic tumors, making it necessary to include ECIPAS in the differential diagnosis of these tumors. Unnecessary surgical resection may be avoided by more accurate preoperative diagnosis based on clinical and imaging characteristics. Keywords: Epidermoid cyst in an intrapancreatic accessory spleen, Pancreatic cystic tumor, Case report Background Accessory spleen is found in about 10% of the general population, with 20% of accessory spleens located in or attached to the tail of the pancreas [1]. Epidermoid cysts account for about 10% of benign and non-parasitic cysts of the spleen [2]. However, epidermoid cyst in an intrapancreatic accessory spleen (ECIPAS) is very rare, with a prevalence of 1.7% in the general population [1]. Differential diagnosis of cystic tumors of the pancreas is difficult because they often show findings similar to other conditions on imaging modalities [3]. It is also difficult to differentiate ECIPAS from other cystic tumors, such as pancreatic pseudocysts, serous cystic neoplasms, *Correspondence: [email protected] 1 Division of Hepato‑Biliary‑Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam‑do 50612, Republic of Korea Full list of author information is available at the end of the article
mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, and lymphoepithelial cysts, or from solid pancreatic tumors [4]. Of 56 patients with ECIPAS described to date, only five have been diagnosed accurately before surgery. Herein we report a 68-year-old man with an ECIPAS on the head of the pancreas and review the literature on this rare condition.
Case presentation A 68-year-old man visited a local physician because of abdominal distension and abdominal discomfort of several months’ duration. Abdominal ultrasound and computed tomography showed a mass lesion on the head of the pancreas. He was admitted to our hospital for further examination and treatment. The patient had no specific medical or surgical history. He was a 40 pack-year smoker, but had stopped drinking alcohol about 30 years
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