Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2022; 14(5): 1057-1064
Published online May 15, 2022. doi: 10.4251/wjgo.v14.i5.1057
Successful treatment of pancreatic accessory splenic hamartoma by laparoscopic spleen-preserving distal pancreatectomy: A case report
Shao-Yan Xu, Bo Zhou, Shu-Mei Wei, Ya-Nan Zhao, Sheng Yan
Shao-Yan Xu, Bo Zhou, Sheng Yan, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
Shu-Mei Wei, Department of Pathology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
Ya-Nan Zhao, Department of Ultrasound, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
Author contributions: Xu SY collected case data and prepared the photos; Wei SM proofread the pathologic materials; Xu SY wrote the manuscript; Zhou B, Zhao YN and Yan S proofread and revised the manuscript; all authors approved the final version to be published.
Supported by the Chen Xiao-Ping Foundation for the Development of Science and Technology of Hubei Province, No. CXPJJH11900009-07.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sheng Yan, PhD, Chief Doctor, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Road, Hangzhou 310000, Zhejiang Province, China. shengyan@zju.edu.cn
Received: December 24, 2021
Peer-review started: December 24, 2021
First decision: March 13, 2022
Revised: March 26, 2022
Accepted: April 21, 2022
Article in press: April 21, 2022
Published online: May 15, 2022
Processing time: 136 Days and 23.5 Hours
Abstract
BACKGROUND

Pancreatic accessory spleen (PAS) is an uncommon congenital abnormality of the spleen. Spleen hamartoma (SH) is also rare. Moreover, hamartoma in the PAS has not been reported thus far. We report the first case here.

CASE SUMMARY

A 26-year-old male presented with a one-month history of left upper quadrant abdominal pain, and computerized tomography (CT) examination suggested a mass in the pancreas tail. The patient then attended our hospital for diagnosis and treatment. Ultrasonography, CT, and magnetic resonance imaging revealed a solid mass with cystic degeneration growing from the tail of the pancreas. The tumor marker carbohydrate antigen 19-9 (CA19-9) increased to 96.7 U/mL (normal range 0-37 U/mL). An epidermoid cyst in a PAS was considered preoperatively. However, a malignant tumor cannot be ruled out. We performed laparoscopic surgery, and two pancreatic masses were found growing from the pancreatic tail. The two masses were so closely connected that preoperative imaging examinations suggested only one mass. We carefully isolated the masses from the splenic artery and vein. A laparoscopic spleen-preserving distal pancreatectomy was successfully performed. On pathological examination, the masses were well-defined, homogeneous red-tan, 4 × 3, and 4.5 × 1.5 in size, respectively. One of them was cystically degenerated. On microscopical examination, the mass contained unorganized small slit-like vascular channels enclosing red blood cells and lined with plump endothelial cells. No area of cytologic atypia was identified. Focal lymphoid aggregates were found in the intravascular areas. White pulp or fibrosis was not observed. The final diagnosis was pancreatic accessory SH with cystic degeneration. After the operation, CA19-9 was reduced to normal. The patient recovered well, and the 34-mo follow-up period was uneventful.

CONCLUSION

Here, we report the first case of pancreatic accessory SH. A laparoscopic spleen-preserving distal pancreatectomy was successfully performed. The patient recovered well and had a good prognosis.

Keywords: Pancreatic accessory spleen; Splenic hamartoma; Cystic degeneration; Laparoscopic spleen-preserving distal pancreatectomy; Case report

Core Tip: Pancreatic accessory spleen (PAS) is an uncommon congenital abnormality of the spleen. Spleen hamartoma (SH) is also rale. Moreover, hamartoma in the PAS has not been reported thus far. Here, we report the first case of pancreatic accessory SH. The tumor marker carbohydrate antigen 19-9 was abnormal. A precise diagnosis was challenging to obtain preoperatively, and a malignant tumor could not be ruled out. We successfully performed laparoscopic spleen-preserving distal pancreatectomy. The patient recovered well and had a good prognosis.