A Case of Pancreatic Tail Carcinoma That Was Difficult to Differentiate from a Splenic Tumor with Penetration of the Colon

Abstract

A 77-year-old man was admitted to our hospital with high fever and left hypochondrial pain. Abdominal CT revealed a massive splenic tumor contiguous with the colon and adjacent to the pancreatic tail, but no tumor of the pancreas was detected. We planned to perform surgery after control of infection with antibiotics and endoscopic examinations. However, the patient’s pain worsened, fever persisted, and he developed arrhythmia and acute respiratory distress syndrome on the second hospital day. After his respiratory condition improved on the third hospital day, we decided to perform the emergency surgery for the purpose of diagnosis and treatment. The operative findings revealed a splenic tumor involving the pancreatic tail, transverse colon, and greater curvature of the stomach. Therefore, splenectomy, partial gastrectomy, distal pancreatectomy, and partial colectomy of the splenic flexure were performed. Histologically, the tumor was a poorly differentiated pancreatic adenocarcinoma invading the spleen, stomach, and colon. Even if no abnormalities of the pancreas are seen in imaging studies, pancreatic tumor invading the spleen should be considered in the differential diagnoses in patients presenting with a splenic tumor.