An Unusual Tumour of the Lesser Sac

Abstract

CASE REPORT:The patient was a 15 year old Negro girl who presented with a slowly enlarging, mobile, firm, left upper quadrant mass, first noticed eighteen month's previously. There were no other relevant clinical or laboratory findings; in particular, no metabolic or hormonal abnormalities were found.The urogram showed under-filling of the superior pole of the left kidney which was not displaced. Renal angiography was normal. The splenic flexure and transverse colon were displaced inferiorly and' the stomach was displaced upwards and to the right (Figure 1). Radioisotope scan revealed a normal spleen. Ultrasound showed a fluid-filled structure with multiple septations. The relevant angiography is shown in figures 2, 3 and 4. The tumour was vascular in its upper quarter and the remainder was relatively avascular. It displaced the coeliac axis and its branches upwards and to the right and caused stretching of the inferior branch of the splenic artery. The superior splenic artery branch was tortuous. A branch of the dorsal pancreatic artery thought to be in mesocolon was stretched around its inferior pole, and gave rise to several vessels which were stretched over the medial and lower poles of the tumour. This is an unexpected finding in the absence of tumour involvement in head or body of pancreas. These vessels were the main blood supply to the avascular lower part of the tumour. The main blood supply t o the vascular upper pole was via tumour vessels arising from branches of the splenic artery, particularly near the splenic hilus. No abnormality was shown in the'venous phase. The head and body of the pancreas were not