Department of Surgery, Takamatsu Red-Cross Hospital, 4-1-3 Bancho, Takamatsu, Kagawa, 760-0017, Japan.
Surg Today. 2011 Nov;41(11):1552-5. doi: 10.1007/s00595-010-4534-3. Epub 2011 Oct 4.
We report a case of adenocarcinoma in an intrapancreatic accessory spleen (IPAS). A 78-year-old woman presented with abdominal discomfort, and investigations revealed an elevated serum carbohydrate antigen 19-9 level, to 161.8 U/ml (normal, <37 U/ml). Ultrasonography showed a heterogeneous echogenic tumor with a vascular hilum. Computed tomography showed a heterogeneously enhanced tumor, 8 cm in diameter, adjacent to the pancreatic body, accompanying a feeding artery arising from the splenic artery, and a drainage vein flowing into the splenic vein. We performed a distal pancreaticosplenectomy. The tumor was surrounded by a fibrous capsule and was in contact with the pancreatic body. Histological examinations revealed invasive growth of adenocarcinoma in a structure identical to the spleen. The results of both radiological and histological examinations suggested that the tumor originated from an intrapancreatic accessory spleen. Extensive examinations revealed no other malignancy, based on which we concluded that the adenocarcinoma was primary. Surgical intervention is strongly recommended when a malignancy in an IPAS cannot be ruled out.
我们报告一例发生于胰内副脾（IPAS）的腺癌病例。一名 78 岁女性因腹部不适就诊，检查发现血清糖链抗原 19-9 水平升高，达 161.8 U/ml（正常值<37 U/ml）。超声检查显示一个伴血管蒂的混杂回声瘤，直径 8 厘米，位于胰体部附近。CT 检查显示一个不均匀强化的肿瘤，直径 8 厘米，与胰体相邻，伴发自脾动脉的供养动脉和流入脾静脉的引流静脉。我们实施了胰体尾脾切除术。肿瘤被纤维囊包围，与胰体接触。组织学检查显示腺癌呈侵袭性生长，结构与脾脏相同。影像学和组织学检查结果提示肿瘤来源于胰内副脾。广泛检查未发现其他恶性肿瘤，据此我们推断该腺癌为原发性。当无法排除 IPAS 中的恶性肿瘤时，强烈建议进行手术干预。
