title: Adenocarcinoma in an intrapancreatic accessory spleen: report of a case.
abstract: 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.
authors.affiliation: Department of Surgery, Takamatsu Red-Cross Hospital, 4-1-3 Bancho, Takamatsu, Kagawa, 760-0017, Japan.
authors.forename: Ryoya
authors.initials: R
authors.lastname: Yamaoka
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Nishihira
authors.forename: Toshihide
authors.initials: T
authors.lastname: Shimada
authors.forename: Mitsutaka
authors.initials: M
authors.lastname: Nishimura
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Inoue
authors.forename: Katsutaro
authors.initials: K
authors.lastname: Yasuda
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Ishikawa
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Hirose
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Ogino
authors.forename: Mitsushige
authors.initials: M
authors.lastname: Shibatoge
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000368:Aged; D001707:Biopsy, Needle; D002828:Choristoma / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging / Q000379:methods; D010179:Pancreas / Q000473:pathology / Q000601:surgery*; D011856:Radiographic Image Enhancement; D035583:Rare Diseases; D018570:Risk Assessment; D013156:Splenectomy / Q000379:methods*; D013160:Splenic Neoplasms / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler