Successful treatment of pancreatic accessory splenic hamartoma by laparoscopic spleen-preserving distal pancreatectomy: A case report

Figure 1 Ultrasound findings. A: A well-defined, inhomogeneous echoic mass (red arrow) with a size of 5.9 cm × 3.8 cm was seen growing from the tail of the pancreas with both hyperechoic solid and hypoechoic cystic parts, dominated by a solid part; B: Color Doppler flow imaging showed dotted blood flow signals in the mass.

Figure 2 Computerized tomography findings. A: A well-defined, 6.8 cm × 3.7 cm mass (red arrow) with cystic change (green arrow), was found growing from the tail of the pancreas. The mass was isointense relative to the normal splenic parenchyma on plain scanning; B: After enhancement, the enhancement of parenchyma was similar to that of the spleen; C: The mass (red arrow) was close to splenic artery (yellow arrow); D: The mass (red arrow) was close to splenic vein (blue arrow).

Figure 3 Magnetic resonance imaging findings. A: The mass (red arrow) was isointense on T1-weighted magnetic resonance imaging (MRI); B: On T2-weighted MRI, heterogeneously hyperintense was found, and the signal in the middle of the tumor was higher (green arrow).

Figure 4 Microscopic examination. A: The mass grew from the pancreas [hematoxylin and eosin (HE), × 40]; B: 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 (HE, × 200). White pulp or fibrosis was not observed.

Figure 5 Immunohistochemical staining. A: CD8 immunostaining was positive in the lining cells and scattered lymphocytes (× 10); B: Immunohistochemistry for CD34 was positive in vascular lining cells (× 10).