Skip to main content

Advertisement

SpringerLink
Log in

The Effectiveness of Open Distal Pancreatectomy with Spleen Vessels Preservation for the Treatment of Pancreatic Mucinous Cystic Neoplasm: Report of a Case

  • Case Report
  • Published:
Hellenic Journal of Surgery

Abstract

Mucin cyst neoplasms (MCNs) of the pancreas are rare, potentially malignant lesions accounting for about 1–2% of exocrine pancreatic tumours. They occur almost exclusively in middle-aged women and are usually located in the body and tail of pancreas. Histologically, the cyst is comprised of ovarian-type stroma which is unique among the cystic neoplasms of the pancreas. Herein, we report a case of a 25-year-old female that presented with epigastric pain. The diagnostic work-up with ultrasound, contrast-enhanced computed tomography and endoscopic ultrasound guided fine-needle aspiration revealed a cystic tumour in the body and the tail of the pancreas. The patient underwent an open distal pancreatectomy with spleen preservation and the histologic examination confirmed the presence of a MCN. We also emphasise the technical challenges to preserve the spleen vessels during distal pancreatectomy and highlight the surgical benefits of this surgical technique.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Testini M, Gurrado A, Lissidini G, et al. Management of mucinous cystic neoplasms of the pancreas. World J Gastroenter 2010;16:5682–91.

    Article  Google Scholar 

  2. Crippa S, Salvia R, Warshaw AL, et al. Mucinous cystic neoplasm of the pancreas in not an aggressive entity: lessons from 163 resected patients. Ann Surg 2008; 247:571–9.

    Article  Google Scholar 

  3. Schechter S, Shi J. Simple mucinous cyst of the pancreas: review and update. Arch Pathol Lab Med 2017;141:1330–5.

    Article  Google Scholar 

  4. Murakami Y, Uemura K, Morifuzi M, et al. Mucinous cystic neoplasm of the pancreas with ovarian-type stroma arising in the head of the pancreas: case report and review of the literature. Dig Dis Sci 2006;51:629–33.

    Article  Google Scholar 

  5. Naveed S, Qari H, Banday T, et al. Mucinous cystic neoplasm of pancreas. Gastroenterology Res 2014;7:44–50.

    PubMed  PubMed Central  CAS  Google Scholar 

  6. Kloppel G, Solcia E, Longnecker DS, et al. World Health Organization. International Histological Classification of Tumors. Berlin, Heidelberg, New York: Springer; 1996. Histological typing of tumors of the exocrine pancreas. Available from: https://apps.who.int/iris/handle/10665/37470.

    Google Scholar 

  7. Zamboni G, Kloppel G, Hruban RH. Mucinous cystic neoplasms of the pancreas. World Health Organization classification of tumors. In: Hamilton SRAL, editor. Pathology and Genetics of Tumors of the Digestive System. Lyon: IARC Press; c2000. p. 237–40.

    Google Scholar 

  8. Pendola F, Gade R, Ripat C, et al. Distal pancreatectomy for benign and low — grade malignant tumors: Short-term postoperative outcomes of spleen preservation-A systematic review and update meta-analysis. J Surg Oncol 2017;115:137–43.

    Article  Google Scholar 

  9. Kimura W, Inoue T, Futakawa N, et al. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. Surgery 1996;120:885–90.

    Article  CAS  Google Scholar 

  10. Warshaw AL. Conservation of the spleen with distal pancreatectomy. Arch Surg 1988;123:350–3.

    Article  Google Scholar 

  11. Sun N, Lu G, Zhang L, et al. Clinically efficacy of spleen-preserving distal pancreatectomy with or without splenic vessels preservation. A meta-analysis. Medicine (Baltimore). 2017;96:e8600.

    Article  Google Scholar 

  12. Kang CM, Matsushita A, Hwang KH, et al. Experience-based surgical approach to pancreatic mucous cystic neoplasms with ovarian-type stroma. Oncol Let 2018;15:2451–8.

    Google Scholar 

  13. Volkan Adsay N. Cystic lesions of the pancreas. Mod Pathol 2007;20:S71–S93.

    Article  Google Scholar 

  14. Reddy RP, Smyrk TC, Zapiach M, et al. Pancreatic mucinous cystic neoplasm defined by ovarian stroma: Demographics, clinical featurs and prevalence of cancer. Clin Gasroenterol Hepatol 2004;2:1026–31.

    Article  Google Scholar 

  15. European Study Group on Cystic Tunours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut 2018;67:789–804.

    Article  Google Scholar 

  16. Tanaka M, Fernández-de Cstillo C, Adsay V, et al. Consensus guidelines 2012 for the management of IPM and MCN of the pancreas. Pancreatology 2012;12:193–7.

    Article  Google Scholar 

  17. Park WC, Mascarenhas R, Palaez-luna M, et al. Diagnostic performance of cyst fluid carcinoembryonic antigen and amylase in histologically conformed pancreatic cysts. Pancreas 2011;40:42–5.

    Article  CAS  Google Scholar 

  18. Beane JD, Pitt HA, Nakeeb A, et al. Preserving distal pancreatectomy: Does vessel preservation matter? J Am Coll Surg 2011;212:651–7.

    Article  Google Scholar 

  19. Lee SY, Goh BK, Tan YM, et al. Spleen- preserving distal pancreatectomy. Singapore Med J 2008;49:883–5.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, Rimini Street 1, 124 62, Athens, Greece

    N. Zavras & Anastasia Dimopoulou

  2. Third Department of Surgery, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Anna Paspala, D. Papakonstantinou & N. Machairas

Authors
  1. N. Zavras
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna Paspala
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anastasia Dimopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Papakonstantinou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. N. Machairas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anastasia Dimopoulou.

Ethics declarations

The authors declare that the study has been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. Also all patients gave their written informed consent prior to their inclusion to the study.

Additional information

Conflict of interest

The authors declare that there is no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zavras, N., Paspala, A., Dimopoulou, A. et al. The Effectiveness of Open Distal Pancreatectomy with Spleen Vessels Preservation for the Treatment of Pancreatic Mucinous Cystic Neoplasm: Report of a Case. Hellenic J Surg 92, 201–204 (2020). https://doi.org/10.1007/s13126-020-0578-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13126-020-0578-z

Key words

Search

Navigation