PMC5836299_01
(a) CT scan of the patient in the case presented. The arrows point out the lesion in the tail of pancreas. (b) Endoscopic ultrasound (EUS) of the lesion followed by FNA biopsy.
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fig1
These findings were confirmed by CT scan which showed a 3.7 cm cystic tumor on the body and tail of the pancreas (Figure 1(a)). FNA ensured our previous suspicion for mucinous cystic neoplasm (Figure 1(b)). From the blood analysis, the major findings were amylase 69 U/L, CEA 219.1 ng/mL, and Ca 19-9 115.8 U/mL.
Intraoperative picture. S: spleen; TP: tail of the pancreas; LGA: left gastroepiploic artery; PW: the anterior surface of the pancreas which is also the posterior wall of the lesser sac.
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fig2
After dividing the splenic ligaments, the spleen with the tail of the pancreas elevated anteriorly (Figure 2).
Intraoperative picture. LK: left kidney; S: medially mobilized spleen; PL: retroperitoneal lesion of the posterior pancreatic surface. The distal pancreas is medially mobilized.
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fig3
Therefore, the resection margin was defined by direct vision without the necessity of laparoscopic ultrasound (Figure 3). The pancreas then was resected by an endoscopic linear stapler medially to the lesion.
CT angiography performed on the tenth postoperative day showed that there was no splenic ischemia.
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fig4
A CT angiography that performed on the 10th postoperative day to evaluate the spleen blood supply did not indicate any signs of splenic ischemia or infraction (Figure 4).
Specimen (a) after extraction and (b) after being divided. The dual cystic lesion is visible.
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fig5
The epithelium immunophenotype was EMA(+), CK18-8(+), CA19-9(+), MUC-1(+), MUC-6(+), and MUC-5AC(+-) (Figure 5).