Abstract
A 58-year-old female patient presented with the sudden onset of left upper quadrant pain. The physical examination revealed the presence of shock status. Abdominal computed tomography revealed splenomegaly with a huge mass inside the spleen, and massive fluid collection in the abdominal cavity. After splenic artery embolization, laparotomy was performed. The operative findings revealed intra-abdominal hemorrhage and rupture of the lower pole of the spleen. Furthermore, a palpable solid mass was observed at the splenic hilum, and distal pancreatectomy with splenectomy was performed. The macroscopic findings revealed a pancreatic tail tumor at the splenic hilum directly invading the splenic parenchyma. Microscopic examinations showed the tumor to consist of squamous cell carcinoma. Furthermore, old and new thrombi were observed inside small splenic arteries. These findings were considered to represent invasion of pancreatic adenosquamous carcinoma to the spleen, and rupture of the spleen was attributed to splenic ischemia resulting from cancer invasion and splenic vein obstruction.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Cubilla AL, Fitzgerald PJ. Morphological patterns of primary nonendocrine human pancreas carcinoma. Cancer Res 1975;35: 2234–2248.
Madura JA, Jarman BT, Doherty MG, Yum MN, Howard TJ. Adenosquamous carcinoma of the pancreas. Arch Surg 1999;134:599–603.
Chung S, Park K, Li AK. A pancreatic tumor presenting as a ruptured spleen. HPB Surg 1989;1:161–163.
Patrinou V, Skroubis G, Zolota V, Vagianos C. Unusual presentation of pancreatic mucinous cystadenocarcinoma by spontaneous splenic rupture. Dig Surg 2000;17:645–647.
Yettimis E, Trompetas V, Varsamidakis N, Courcoutsakis N, Polymeropoulos V, Kalokairinos E. Pathologic splenic rupture: an unusual presentation of pancreatic cancer. Pancreas 2003;27:273–274.
Smith WM, Lucas JG, Frankel WL. Splenic rupture — a rare presentation of pancreatic carcinoma. Arch Pathol Lab Med 2004;128:1146–1150.
Gedik E, Girgin S, Aldemir M, Keles C, Tuncer MC, Aktas A. Non-traumatic splenic rupture: Report of seven cases and review of the literature. World J Gastroenterol 2008;14:6711–6716.
Lam KY, Tang V. Metastatic tumors to the spleen: a 25-year clinicopathologic study. Arch Pathol Lab Med 2000;124:526–530.
Debnath D, Valerio D. Atraumatic rupture of the spleen in adults. J R Coll Surg Edinb 2002;47:437–445.
Aoyagi S, Kosuga T, Ogata T, Yasunaga M. Spontaneous rupture of the spleen caused by a Bacillus infection: report of a case. Surg Today 2009;39:733–737.
Karakayali F, Basaran C, Soy EA, Karakus S, Yabanoglu H, Moray G, et al. Spontaneous spleen rupture and rectus sheath hematoma in a patient with Klippel-Trenaunay syndrome: report of a case. Surg Today 2010;40:154–157.
Bernat S, Garcia R, Guinot M. Pathological rupture of the spleen as the initial manifestation in acute leukemia. Haematologica 1998;83:760–761.
Debnath D, Valerio D. Atraumatic rupture of the spleen in adults. J R Coll Surg Edinb 2002;47:437–445.
Karakousis CP, Elius EG. Spontaneous rupture of the spleen in malignancies. Surgery 1974;76:674–677.
Malka D, Hammel P, Levy P, Sauvanet A, Ruszniewski P, Belghiti J, et al. Splenic complications in chronic pancreatitis: prevalence and risk factors in a medical-surgical series of 500 patients. Br J Surg 1998;85:1645–1649.
Wu SC, Chen RJ, Yang AD, Tung CC, Lee KH. Complications associated with embolization in the treatment of blunt splenic injury. World J Surg 2008;32:476–482.
Yagmur Y, Kara IH, Aldmir M, Buyukbayram H, Tacyildiz IH, Keles C. Spontaneous rupture of malarial spleen: two case reports and review of literature. Crit Care 2000;4:309–313.
Patel MI. Spontaneous rupture of malarial spleen. Med J Aust 1993;159:836–837.
Kayahara M, Nagakawa T, Ueno K, Ohta T, Takeda T, Miyazaki I. An evaluation of radical resection for pancreatic cancer based on the mode of recurrence as determined by autopsy and diagnostic imaging. Cancer 1993;72:2118–2123.
Staley CA, Lee JE, Cleary KR, Abbruzzese JL, Fenoglio CJ, Rich TA, et al. Preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for adenocarcinoma of the pancreatic head. Am J Surg 1996;171:118–124.
Sener SF, Fremgen A, Menck HR, Winchester DP. Pancreatic cancer: a report of treatment and survival trends for 100,313 patients diagnosed from 1985–1995, using the National Cancer Database. J Am Coll Surg 1999;189:1–7.
Aranha GV, Young S, Olson M. Adenosquamous carcinoma of the pancreas. Int J Pancreatol 1999;26:85–91.
Makiyama K, Takuma K, Zea Iriarte WL, Ikuno N, Kawatomi M, Mori N, et al. Adenosquamous carcinoma of the pancreas. J Gastroenterol 1985;30:798–802.
Morohoshi T, Held G, Kloppel G. Exocrine pancreatic tumors and their histological classification: a study based on 167 autopsy and 97 surgical cases. Histopathology 1983;7:645–661.
Chen J, Baithun S. Morphologic study of 391 cases of exocrine pancreatic tumors with special reference to the classification of exocrine pancreatic carcinoma. J Pathol 1985;146:17–26.
Motojima K, Tomioka K, Kohara N, Tsunoda T, Kanematsu T. Immunohistochemical characteristics of adenosquamous carcinoma of the pancreas. J Surg Oncol 1992;49:58–62.
Baylor SM, Berg JW. Cross-classification and survival characteristics of 5,000 cases of cancer of the pancreas. J Surg Oncol 1973;5:335–358.
Kardon DE, Thompson LD, Przygodzki RM, Heffess CS. Adenosquamous carcinoma of the pancreas: a clinicopathologic series of 25 cases. Mod Pathol 2001;14:443–451.
Chabit EP, Tubiana M. Relation between the pathological nature and the growth rate of human tumor. Eur J Cancer 1971;7:7–15.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Asai, K., Watanabe, M., Matsukiyo, H. et al. Pancreatic adenosquamous carcinoma presenting as splenic rupture: Report of a case. Surg Today 41, 872–876 (2011). https://doi.org/10.1007/s00595-010-4353-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-010-4353-6