Luo Jieli, Chen Jianshe, Huang Fengbo, Zhou Panpan, Huang Pintong
Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China.
Department of Pathology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China.
Ann Transl Med. 2020 Apr;8(7):507. doi: 10.21037/atm.2020.03.79.
A 49-year-old female undergoing a periodic health examination at other hospital revealed a mass in the tail of pancreas. The patient denied any personal history of surgery except subtotal hysterectomy because of multiple myomas in uterus 7 years ago, family history of abdominal cancer and trauma. Physical examination and laboratory finding (including tumor marker) were unremarkable. Chest X-ray result was normal. Contrast enhanced ultrasound (CEUS) examination showed a well-defined hypoechoic pancreatic mass which was suggestive of solid pseudopapillary tumor. Contrast enhanced computed tomography (CE-CT) of the abdomen revealed a mass of hypodensity suggestive of intraductal papillary mucinous neoplasm. Because of the risk of bleeding and exclusion of surgical contraindications, patient underwent laparoscopic surgery. Intraoperatively, a solid mass was identified in the tail of pancreas, the intraoperative frozen pathological examination suggested a heterotopic accessary spleen (HAS) with squamous epithelial cyst. Partial pancreatectomy was performed. The uniqueness of this case is that the spleen can be ectopic to the pancreas, what is even more unexpected is that the HAS undergone cystic change. When encountering a pancreatic mass, we need to think about the possibility of HAS. In conclusion, it is important to diagnose HAS with squamous cyst in the pancreatic tail presenting as other pancreatic masses.
一名49岁女性在其他医院进行定期健康检查时发现胰腺尾部有一个肿块。患者否认有任何手术史，仅7年前因子宫多发肌瘤行子宫次全切除术，否认有腹部癌症家族史及外伤史。体格检查和实验室检查结果（包括肿瘤标志物）均无异常。胸部X线检查结果正常。超声造影（CEUS）检查显示胰腺有一个边界清晰的低回声肿块，提示实性假乳头状肿瘤。腹部增强计算机断层扫描（CE-CT）显示一个低密度肿块，提示导管内乳头状黏液性肿瘤。由于存在出血风险且排除手术禁忌证，患者接受了腹腔镜手术。术中在胰腺尾部发现一个实性肿块，术中冰冻病理检查提示为伴有鳞状上皮囊肿的异位副脾（HAS）。行部分胰腺切除术。该病例的独特之处在于脾脏可异位至胰腺，更意想不到的是HAS发生了囊性变。遇到胰腺肿块时，需要考虑HAS的可能性。总之，对于表现为其他胰腺肿块的胰腺尾部伴有鳞状囊肿的HAS进行诊断很重要。
