Pancreatic adenosquamous carcinoma presenting as splenic rupture: Report of a case

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. Afte...

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Bibliographic Details
Published in:Surgery today (Tokyo, Japan) Japan), 2011-06, Vol.41 (6), p.872
Main Authors: Asai, Koji, Watanabe, Manabu, Matsukiyo, Hiroshi, Osawa, Akihiro, Saito, Tomoaki, Hagiwara, Osahiko, Nakamura, Yoichi, Okamoto, Yasushi, Saida, Yoshihisa, Kusachi, Shinya, Yokouchi, Yuki, Nagao, Jiro
Format: Article
Language:English
Subjects:
Carcinoma, Adenosquamous - complications
Carcinoma, Adenosquamous - secondary
Carcinoma, Adenosquamous - surgery
Case Report
Embolization, Therapeutic
Female
Hemoperitoneum - etiology
Humans
Medicine
Medicine & Public Health
Middle Aged
Pancreatectomy
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - surgery
Shock, Hemorrhagic - etiology
Splenectomy
Splenic Artery
Splenic Neoplasms - complications
Splenic Neoplasms - secondary
Splenic Neoplasms - surgery
Splenic Rupture - etiology
Splenic Rupture - surgery
Splenic Rupture - therapy
Surgery
Surgical Oncology
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Summary: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.
ISSN:0941-1291
1436-2813
DOI:10.1007/s00595-010-4353-6