Korean J Gastroenterol.  2020 Nov;76(5):265-267. 10.4166/kjg.2020.131.

Epidermoid Cyst Arising from Intrapancreatic Accessory Spleen

• Ryoo JA
• Kim SS

• KMID: 2508878
• DOI: http://doi.org/10.4166/kjg.2020.131

Figure

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  Fig. 1 Axial computed tomography image obtained at an outside hospital shows an approximately 1.3-cm-size cystic lesion (arrow) in the tail of the pancreas.

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  Fig. 2 Endoscopic ultrasound image shows an approximately 1.3-cm-size cystic lesion (arrow) in the tail of the pancreas.

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  Fig. 3 Axial pancreatic phase computed tomography image obtained after 6 months shows that the size of the cystic lesion (arrow) in the tail of the pancreas increased in size from 1.3 cm to 1.7 cm.

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  Fig. 4 MRI images obtained after 12 months. (A, B) Coronal and axial T2-weighted images show that the cystic lesion (arrow) in the tail of the pancreas increased in size from 1.7 cm to 2.5 cm. There is a solid component (open arrow) around the cystic lesion (arrow). The signal intensity of the solid component (open arrow) is similar to the spleen (arrowhead) but different from the pancreas parenchyma (open arrowhead). (C) Diffusion-weighted image (b-value 800 s/mm2) demonstrates the solid component (open arrow) with similar signal intensity to the spleen (arrowhead). (D) Axial gadolinium-enhanced arterial phase image shows a zebra enhancement pattern of the solid component (open arrow), like the spleen (arrowhead). Note the cystic lesion (arrow) without enhancement in the pancreatic tail. (E, F) On axial gadolinium-enhanced portal venous and 3-minutes delayed phase images, the enhancement of the solid component (open arrow) is similar to that of the spleen (arrowhead).

Reference

1. Halpert B, Alden ZA. 1964; Accessory spleens in or at the tail of the pancreas. A survey of 2,700 additional necropsies. Arch Pathol. 77:652–654. PMID: 14130052.

2. Freeman JL, Jafri SZ, Roberts JL, Mezwa DG, Shirkhoda A. 1993; CT of congenital and acquired abnormalities of the spleen. Radiographics. 13:597–610. DOI: 10.1148/radiographics.13.3.8316667. PMID: 8316667.

3. Kato S, Mori H, Zakimi M, et al. 2016; Epidermoid cyst in an intrapancreatic accessory spleen: case report and literature review of the preoperative imaging findings. Intern Med. 55:3445–3452. DOI: 10.2169/internalmedicine.55.7140. PMID: 27904107. PMCID: PMC5216141.

4. Kim SH, Lee JM, Han JK, et al. 2008; Intrapancreatic accessory spleen: findings on MR Imaging, CT, US and scintigraphy, and the pathologic analysis. Korean J Radiol. 9:162–174. DOI: 10.3348/kjr.2008.9.2.162. PMID: 18385564. PMCID: PMC2627219.

5. Kim SS, Choi GC, Jou SS. 2018; Pancreas ductal adenocarcinoma and its mimics: review of cross-sectional imaging findings for differential diagnosis. J Belg Soc Radiol. 102:71. DOI: 10.5334/jbsr.1644. PMID: 30386851. PMCID: PMC6208287.

6. Horibe Y, Murakami M, Yamao K, Imaeda Y, Tashiro K, Kasahara M. 2001; Epithelial inclusion cyst (epidermoid cyst) formation with epithelioid cell granuloma in an intrapancreatic accessory spleen. Pathol Int. 51:50–54. DOI: 10.1046/j.1440-1827.2001.01155.x. PMID: 11148465.

7. Higaki K, Jimi A, Watanabe J, Kusaba A, Kojiro M. 1998; Epidermoid cyst of the spleen with CA19-9 or carcinoembryonic antigen productions: report of three cases. Am J Surg Pathol. 22:704–708. DOI: 10.1097/00000478-199806000-00007. PMID: 9630177.

8. Zhang Z, Wang JC. 2009; An epithelial splenic cyst in an intrapancreatic accessory spleen. A case report. JOP. 10:664–666. PMID: 19890189.

9. Sonomura T, Kataoka S, Chikugo T, et al. 2002; Epidermoid cyst originating from an intrapancreatic accessory spleen. Abdom Imaging. 27:560–562. DOI: 10.1007/s00261-001-0145-1. PMID: 12172998.