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Intrapancreatic Accessory Spleen Masquerading as a Pancreatic Mucinous Neoplasm
Shiva Poola1, Shachar Laks2, Peter Kragel3
1Department of Internal Medicine/Pediatrics, Vidant Medical Center/Brody School of Medicine, Greenville, North Carolina.
Surgery Journal (New York, N.Y.)
|June 23, 2020
Summary
Pancreatic cysts found incidentally are increasingly common. This case details a rare mucinous epidermoid cyst in an intrapancreatic accessory spleen with high-risk features, emphasizing advanced imaging and endoscopic ultrasound for risk stratification.
Area of Science:
- Gastroenterology and Radiology
- Oncology
- Surgical Pathology
Background:
- Incidental pancreatic cysts are more frequently detected due to advances in abdominal cross-sectional imaging.
- Accurate risk stratification of pancreatic cysts is crucial for appropriate management.
- Advanced imaging like CT and MRI, along with endoscopic ultrasound (EUS), aid in characterizing cysts.
Observation:
- A rare case of a mucinous epidermoid cyst was found within an intrapancreatic accessory spleen (IPAS).
- High-risk features were identified on endoscopic ultrasound (EUS).
- Pancreatic cyst fluid analysis for carcinoembryonic antigen (CEA) can help identify mucinous cysts.
Findings:
- The cyst exhibited characteristics of a mucinous epidermoid cyst.
- Endoscopic ultrasound (EUS) revealed high-risk features necessitating further investigation.
- Analysis of cyst fluid via EUS-guided fine-needle aspiration (FNA) is a key diagnostic tool.
Implications:
- This case underscores the importance of comprehensive evaluation for incidentally discovered pancreatic cysts, even in rare locations like IPAS.
- Advanced imaging and EUS are vital for identifying high-risk features and guiding clinical decisions.
- Understanding rare cystic lesions aids in refining diagnostic and management strategies for pancreatic diseases.
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