Huang Jia-Yan, Yang Rui, Li Jia-Wu, Lu Qiang, Luo Yan
Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Clin Cases. 2022 Feb 26;10(6):1973-1980. doi: 10.12998/wjcc.v10.i6.1973.
Intrapancreatic accessory spleen (IPAS) is an uncommon condition, with the majority of cases presenting as solid lesions. Thus, this condition is frequently misdiagnosed as pancreatic solid neoplasm. Moreover, splenic cavernous hemangioma is a rare disorder, whereas lesions with a cystic appearance arising from IPAS have not been reported.
Herein, we present a case involving a 32-year-old male who had a complex cystic lesion in the tail of the pancreas revealed by conventional ultrasound. The lesion was misdiagnosed as a pancreatic cystadenoma because of its confusing anatomic location, as well as due to its peripheral nodular and internal septal enhancement patterns on contrast-enhanced ultrasound. After multidisciplinary discussion, the patient finally underwent laparoscopic pancreatic body and tail resections. Postoperative pathology demonstrated the lesion to be a cavernous hemangioma arising from the IPAS.
Cavernous hemangioma in the intrapancreatic accessory spleen may mimic pancreatic cystadenoma, which is a condition with the potential to be malignant. Imaging follow-ups or surgical interventions may be helpful for the exclusion of malignant risks in complicated cystic lesions, especially those with parietal and septal enhancements.
胰腺内副脾(IPAS)是一种罕见的情况,大多数病例表现为实性病变。因此,这种情况经常被误诊为胰腺实性肿瘤。此外,脾海绵状血管瘤是一种罕见的疾病,而由IPAS引起的具有囊性外观的病变尚未见报道。
在此,我们报告一例32岁男性患者,其胰腺尾部有一个复杂的囊性病变,经传统超声检查发现。由于其解剖位置令人困惑,以及在超声造影上其周边结节状和内部间隔强化模式,该病变被误诊为胰腺囊腺瘤。经过多学科讨论,患者最终接受了腹腔镜胰体尾切除术。术后病理显示该病变为起源于IPAS的海绵状血管瘤。
胰腺内副脾中的海绵状血管瘤可能类似于胰腺囊腺瘤,而胰腺囊腺瘤是一种有恶变可能的疾病。影像学随访或手术干预可能有助于排除复杂囊性病变中的恶性风险,尤其是那些有壁层和间隔强化的病变。