case_images: PMC5836299_01
case_images: (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.
case_images: CRIS2018-1978362.001.jpg
case_images: PMC5836299_01_CRIS2018-1978362.001.jpg
case_images: fig1
case_images: 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.
case_images: 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.
case_images: CRIS2018-1978362.002.jpg
case_images: PMC5836299_01_CRIS2018-1978362.002.jpg
case_images: fig2
case_images: After dividing the splenic ligaments, the spleen with the tail of the pancreas elevated anteriorly (Figure 2).
case_images: Intraoperative picture. LK: left kidney; S: medially mobilized spleen; PL: retroperitoneal lesion of the posterior pancreatic surface. The distal pancreas is medially mobilized.
case_images: CRIS2018-1978362.003.jpg
case_images: PMC5836299_01_CRIS2018-1978362.003.jpg
case_images: fig3
case_images: 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.
case_images: CT angiography performed on the tenth postoperative day showed that there was no splenic ischemia.
case_images: CRIS2018-1978362.004.jpg
case_images: PMC5836299_01_CRIS2018-1978362.004.jpg
case_images: fig4
case_images: 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).
case_images: Specimen (a) after extraction and (b) after being divided. The dual cystic lesion is visible.
case_images: CRIS2018-1978362.005.jpg
case_images: PMC5836299_01_CRIS2018-1978362.005.jpg
case_images: fig5
case_images: The epithelium immunophenotype was EMA(+), CK18-8(+), CA19-9(+), MUC-1(+), MUC-6(+), and MUC-5AC(+-) (Figure 5).