A Case of Epidermoid Cyst in the Intrapancreatic Accessory Spleen Performed Hand-assisted Laparoscopic Partial Pancreatectomy

Kenichi Sakamoto, Hajime Hirose, Takuya Yamada, Mikio Yasumura, Hiroshi Matsuo, Tsuyoshi Shimamoto, Toyoo Nitta, Tomoo Mizutani, Naoki Futamura and Kuniyasu Shimokawa^*

First Department of Surgery, Gifu University School of Medicine
Clinical Laboratory, Gifu University School of Medicine^*

We report a case of epidermoid cyst in the intrapancreatic accessory spleen diagnosed during laparoscopic pancreatectomy under a diagnosis of pancreatic cystic tumor. An asymptomatic 40-year-old woman was found in hematology tests to have a high CA19-9 of 71.5 U/ml and abdominal computed tomography (CT) showed a tumor 20 mm in diameter with a clear border in the pancreatic tail. The lesion consisted of cystic and solid parts. A mural nodule was noted in part of the cystic wall. On endoscopic ultrasonography, the tumor appeared as an uniform low-echo area. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) showed no stenosis or dilation of the pancreatic duct. Arteriography showed an uniform tumor stain. Mucinous cystic tumor of the pancreas was suspected, necessitating manually assisted laparoscopic partial resection of the pancreatic tail preserving the spleen. The tumor consisted of 2 parts-1 dark red, representing spleen tissue, and the other yellowish brown, indicating a cyst covered with stratified squamous epithelium without obvious cornification or skin appendage components. The final diagnosis was intrapancreatic accessory spleen accompanying an epidermoid cyst.

Key words
epidermoid cyst, intrapancreatic accessory spleen, laparoscopic surgery

Reprint requests
Kenichi Sakamoto Department of Surgery I, Gifu University School of Medicine 40 Tsukasa-machi, Gifu, 500-8705 JAPAN

Accepted
November 27, 2002

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