[An epidermoid cyst derived from an intrapancreatic accessory spleen].

A 43-year-old female patient had high levels of CA19-9 marker; an abdominal ultrasound revealed a cyst. Further investigations with computed tomography (CT), magnetic resonance imaging, and endoscopic ultrasound CT identified a multilocular cystic lesion on the pancreatic tail. An abnormal wall was noted, and different signal strengths were measured in each cyst. Thus, a mucinous cystic tumor was diagnosed, and distal pancreatectomy combined with splenectomy was performed. During the surgery, we identified a multilocular pancreatic cyst with internal bleeding at its distal end. The lesion was ultimately diagnosed as an epidermoid cyst of an intrapancreatic accessory spleen. This diagnosis was based on the histological observation that the vascular construction of the cystic wall was equivalent to that of the spleen, and that its internal tissue was covered by squamous epithelium.

[A study of the usefulness of pancreatic juice cytology obtained via an endoscopic nasal pancreatic drainage (ENPD) tube].

We studied the usefulness of pancreatic juice cytology obtained via an indwelling endoscopic nasal pancreatic drainage (ENPD) tube. In general, cytology was performed three times. The sensitivity was 0.35 on the first time and 0.59 after three times (p<0.01). The sensitivity in relation to tumor size of pancreatic cancer was 0.77 for Tis (3 cases) and TS1 (10 cases), 0.76 for TS2 (29 cases), 0.56 for TS3 (9 cases) and 0 for TS4 (4 cases). A significant difference of p=0.01 was recognized among the 4 groups, and the sensitivity for small tumors was higher than that for large tumors. The pancreatic juice can be obtained repeatedly via the ENPD tube and that contributes to improving the diagnostic accuracy. It is useful as a definitive diagnosis method in early stage pancreatic cancer because it is easier to detect positive results in smaller tumor, furthermore, it is possible to diagnose carcinoma in situ.