title: Pancreatic adenosquamous carcinoma presenting as splenic rupture: report of a case.
abstract: A 58-year-old female patient presented with the sudden onset of left upper quadrant pain. The physical examination revealed the presence of shock status. Abdominal computed tomography revealed splenomegaly with a huge mass inside the spleen, and massive fluid collection in the abdominal cavity. After splenic artery embolization, laparotomy was performed. The operative findings revealed intra-abdominal hemorrhage and rupture of the lower pole of the spleen. Furthermore, a palpable solid mass was observed at the splenic hilum, and distal pancreatectomy with splenectomy was performed. The macroscopic findings revealed a pancreatic tail tumor at the splenic hilum directly invading the splenic parenchyma. Microscopic examinations showed the tumor to consist of squamous cell carcinoma. Furthermore, old and new thrombi were observed inside small splenic arteries. These findings were considered to represent invasion of pancreatic adenosquamous carcinoma to the spleen, and rupture of the spleen was attributed to splenic ischemia resulting from cancer invasion and splenic vein obstruction.
authors.affiliation: Department of Surgery, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro, Tokyo, 153-8515, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Asai
authors.forename: Manabu
authors.initials: M
authors.lastname: Watanabe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsukiyo
authors.forename: Akihiro
authors.initials: A
authors.lastname: Osawa
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Saito
authors.forename: Osahiko
authors.initials: O
authors.lastname: Hagiwara
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Saida
authors.forename: Shinya
authors.initials: S
authors.lastname: Kusachi
authors.forename: Yuki
authors.initials: Y
authors.lastname: Yokouchi
authors.forename: Jiro
authors.initials: J
authors.lastname: Nagao
mesh_terms: D018196:Carcinoma, Adenosquamous / Q000150:complications / Q000556:secondary / Q000601:surgery*; D004621:Embolization, Therapeutic; D005260:Female; D006465:Hemoperitoneum / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012771:Shock, Hemorrhagic / Q000209:etiology; D013156:Splenectomy; D013157:Splenic Artery; D013160:Splenic Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery*; D013161:Splenic Rupture / Q000209:etiology / Q000601:surgery* / Q000628:therapy