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

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.

Imaging findings of ruptured abdominal and pelvic tumors

“…Pancreatic malignancy rarely presents as splenic rupture; several cases of pancreatic adenocarcinomas, mucinous cystadenocarcinomas, and one case of adenosquamous carcinoma have been reported in the literature (14,15). Additionally, we observed a case of splenic rupture caused due to non-functioning islet cell carcinoma (Fig.…”

“…6). Splenic infarction or ischemia secondary to thrombosis of the splenic vein caused by tumor invasion is regarded as the most important mechanism for the development of splenic rupture (14,15). The presence of co-existing splenic abscess is likely when the tumor invades directly into the stomach or colon (Fig.…”