Epidermoid cyst in an intrapancreatic accessory spleen: a case report

Ectopic splenic tissue in the abdominal cavity is a common entity, with a reported incidence of 10% in the general population. However, an intrapancreatic accessory spleen is a rare disease, and moreover cyst formation in it is exceedingly rare. A 58-year-old woman with a 25-mm multilocular cyst in the tail of the pancreas detected incidentally by ultrasonography was admitted for further evaluation. Because malignancy could not be ruled out, a spleen-preserving distal pancreatectomy was performed. The cut surface of the surgical specimen showed a multilocular cyst surrounded by brown solid tissue resembling normal spleen. Pathological examination revealed it was stratified squamous epithelium and was surrounded by splenic tissue. The final pathological diagnosis was epidermoid cyst in an accessory spleen in the pancreas. This cyst has no characteristic features on diagnostic imaging. Consequently, it is not possible to make a definite preoperative diagnosis in most cases. Epidermoid cyst in intrapancreatic splenic tissue is another lesion to be considered in the differential diagnosis of pancreatic tail tumors.     

Epidermoid cyst originating from an intrapancreatic accessory spleen

We report a rare case of an epidermoid cyst originating from an intrapancreatic accessory spleen, in a 40-year-old Japanese man with no clinical symptoms. A cystic tumor in the pancreatic tail was detected incidentally by abdominal ultrasonography. The patient was referred to the KKR Tachikawa Hospital for further examination of the tumor. Preoperative imaging findings suggested that the tumor was an epidermoid cyst originating from an intrapancreatic accessory spleen. On both pre-and post-contrast computed tomography and magnetic resonance images, the solid compartment of the tumor had the same X-ray attenuation and intensity as the spleen. Upon surgical excision, the mass consisted of solid and cystic components that were macroscopically evident on the preoperative images. Microscopic analysis revealed that the solid component was an accessory spleen in the pancreatic tail, whereas the cystic component was lined with stratified epithelium representative of an epidermoid cyst. This is the thirteenth report (in English) of an epidermoid cyst originating from an intrapancreatic accessory spleen, and the first case to be diagnosed prior to surgery.     

Epidermoid cyst in intrapancreatic accessory spleen: A systematic review

Background/Objectives

Due to its rarity, epidermoid cyst in intrapancreatic accessory spleen (ECIPAS) is still a diagnostic dilemma during clinical practice. The aim of this review was to summarize the epidemiologic features and management of ECIPAS.

Epidermoid cyst of the intrapancreatic accessory spleen producing CA19‐9

We report a rare case of an epidermoid cyst in an accessory spleen at the pancreatic tail with producing CA19‐9. A 55‐year‐old female was admitted to our hospital, Cancer Research Institute, Kanazawa University, for close examination of a cystic lesion at the pancreatic tail and a high serum CA19‐9‐value (176 U/mL). There were almost no abdominal symptoms related to the cystic lesion. A cystic tumor approximately 3 cm in diameter and composed of multilocular cysts without a protruding portion of the inner surface was found at the pancreatic tail by ultrasound sonography, computed tomography, and magnetic resonance imaging. Endoscopic retrograde pancreatography revealed that the main pancreatic duct shifted at the pancreatic tail and there was no communication between the main pancreatic duct and cystic lesion. Based on a preoperative diagnosis of mucinous cystic tumor, distal pancreatectomy with splenectomy was performed. Histological ?ndings suggested an epidermoid cyst (3.5 × 3.0 cm) originating from an intrapancreatic accessory spleen. Immunohistochemical analysis of CA19‐9 in the epidermoid cyst showed clear staining of the inner epithelium of the cyst and amorphous or hyalinous cystic contents. The serum CA19‐9 value was con?rmed to decline to normal 2 months after resection. Physicians should not forget this disease during differential diagnosis related to pancreatic cystic lesions with elevated levels of serum tumor markers, such as CA19‐9 or carcinoembryonic antigen, although this disease is extremely rare.     

A case of an epithelial cyst arising in the intrapancreatic accessory spleen]

A 59-year old woman was admitted to our hospital for further examination of a cystic lesion detected in the tail of the pancreas. Imaging studies showed a 35-mm-diameter cystic lesion with septa and mural nodule at the same site. The mural nodule of the cyst was thick and was enhanced. Partial resection of the tail pancreas was performed with a preoperative diagnosis of pancreatic cystic tumor. The resected specimen showed mulitlobular cyst. Histologically, the internal surface of the cyst was covered with stratified squamous cells and the mural nodule of the cyst was spleen tissue. The final diagnosis was an epithelial cyst derived from an accessory spleen in the pancreas.     

Epithelial cyst arising in an intrapancreatic accessory spleen: a diagnostic dilemma

An epithelial cyst in an intrapancreatic accessory spleen (ECIAS) is a rare disease that is commonly misdiagnosed preoperatively. To identify the clinical and imaging features of ECIAS, we reviewed the relevant medical literature. Twenty-one cases of ECIAS were identified, including our own. The cases were mainly diagnosed as mucinous cystic neoplasm (MCN) preoperatively based on clinical and imaging features, such as, a woman in middle age; elevation of serum CA19-9 levels; location in the tail of the pancreas; and a solid component resembling a mural nodule. ECIAS is another lesion to be considered in the differential diagnosis of MCN.     

Epidermoid cyst of the cecum: A case report

Pure, benign epidermoid cysts of the abdominal viscera are rare. There have been only six reports of epidermoid cysts of the cecum in the literature. A 31-year-old female with a previous cesarean delivery was admitted to our hospital with inguinal pain. After admission to the hospital, she was operated with the initial diagnosis of adnexal mass. During the operation, no adnexal pathology was identified. A heterogeneous mass originated from the posterior surface of the cecum was observed. It had no connection with the lumen. The mass was then removed with dissection. Macroscopically, the mass was 9x7 cm in diameter and wall thickness was 0.1 cm. The inner and outer surfaces were smooth. It was filled with a dense yellow, thick-fatty material with no tooth, hair, bone, or calcification areas. On microscopic examination, the inner lining was composed of mature keratinized stratified squamous epithelium with a granular layer. In view of the later findings, the case was reported as epidermoid cyst of the cecum. Although epidermoid cysts are rarely seen in visceral organs, this case is the seventh case of cecum-originated epidermoid cyst that has been reported in the literature. The histogenesis of epidermoid cyst is unknown. These cysts are generally accepted to be sequestration cysts that may be either congenital or acquired. Acquired epidermoid cysts are believed to be traumatic or iatrogenic. The cesarean delivery may have been a cause of this condition in the present case. On ultrasonographic examination, these cysts can be misdiagnosed as ovarian cysts.     

Myelofibrosis with marked subcapsular bleeding of the spleen--a case report

A 22-year old male was admitted to Ashikaga Red Cross Hospital because of the progressing abdominal distension in May 1988. The physical examinations disclosed marked hepato-splenomegaly, lymphadenopathy and cachexic state. In the laboratory examinations, anemia, leukocytosis with left shift of nuclei and severe inflammatory reactions were found. Bone marrow aspirations were dry taps, and the biopsy showed myelofibrotic changes. Abdominal computed tomography and ultrasonography revealed a marked hepatomegaly and a giant splenomegaly with subcapsular hematoma. Philadelphia chromosome was negative and neutrophilic alkaline phosphatase score was slightly high. A little amount of peritoneal effusions was obtained and yielded S. aureus. A diagnosis of myelofibrosis with subcapsular hematoma due to spontaneous rupture of spleen and peritonitis of unknown cause was made. Operative indication was considered, but his family did not agree with it. Then conservative therapies for general conditions, those are, administrations of antibiotics and diuretics, and blood transfusions were taken. On the enlarged spleen, total irradiation was done. After the therapies, his spleen got smaller and hematoma was going to be absorbed. A rare case of myelofibrosis with splenic hematoma is reported and the conservative therapies were effective to this case.     

Epidermoid splenic cyst a in child. Report of a case

The authors present a case of epidermoid splenic cyst in masculine patient of 13 years, that presented decrease of appetite, fever and alimentary vomits and tangible abdominal mass in the physical exam. Abdominal ultrasonography demonstrated expansible lesion in the topography of the spleen, and computerized tomography revealed intrinsic homogeneous lesion of the spleen, without communication with pancreas. To the laparotomy, cystic mass of great extension was observed, submitted total esplenectomy, being diagnosed in the histopatological exam epidermoid splenic cystic. In the follow-up patient developed with disappearance of the symptoms. The epidermoid splenic cyst are rare, they can be seen mainly in children and young adults, what proposes a congenital origin for this disease.     

Epidermoid cyst of the cecum of an elderly man with no previous history of surgery: a case report and review of literature

BACKGROUND: Pure, benign epidermoid cysts of the abdominal viscera are rare. There have been only four reports of epidermoid cysts of the cecum in the literature, two following appendectomies and attributed to the surgical procedure, and two in female patients, raising the possibility of dermoid cysts related to the ovaries. PATIENTS AND METHODS: We report the first case of epidermoid cyst of the cecum in an elderly man with no previous history of trauma or surgery, detected by computed tomography as an incidental finding of extraluminal cystic cecal mass. It was treated by partial colectomy. Pathologically the cyst was roughly spherical, extending from and expanding the serosal surface of the cecum with no communication through the muscularis wall. Histologically the inner lining of the cyst was composed of benign, mature, keratinized, stratified squamous epithelium with a well formed granular layer. No calcification, hair, teeth, or bone elements was detected. RESULTS: The interesting finding in our case is the unusual anatomical location and the age and sex of the patient. The patient had no history of any abdominal surgical procedures. The most likely explanation for the presence and development of an epidermoid cyst in this location is the result of an aberrant ectodermal implantation during embryogenesis. CONCLUSION: Awareness of the possibility of the presence of epidermoid cysts in this area with distinctive radiological findings consistent with a well circumscribed benign cyst should be considered in the differential diagnosis of cysts within the abdomen.     

Prenatal diagnosis of an adrenal cyst: a case report

We report a rare case of fetal adrenal cyst, diagnosed prenatally during routine ultrasound screening at 36 weeks' gestation. Serial ultrasonographic evaluations demonstrated a slight increase in the size of the cyst during pregnancy. A healthy female baby, weighing 2,810 g with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively, was delivered vaginally at term. She underwent successful surgery at the age of 10 days. The postoperative course was smooth and the baby is currently doing well. Histology revealed an adrenal cyst.