Pancreatic Malignancy Masquerading as a Splenic Lesion: A Case Report

Abstract

Splenic metastases are rarely encountered in routine clinical practice, and they may be due to various reasons, such as anatomical or immunological factors. Splenic metastasis is usually seen in the setting of disseminated disease. It is rare for pancreatic malignancy to present as a predominant splenic mass. Hereby, the authors present a case of 65-year-old female who presented with a painful lump in the left hypochondrium, along with loss of appetite and weight loss over the past two months. Preoperative Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans diagnosed patient with a primary splenic tumour. She underwent enbloc resection of the spleen and adherent pancreatic tail, along with station 9d and 10 lymph nodes. Histopathological Examination (HPE) with Immunohistochemistry (IHC) revealed a small subcentimeter primary lesion in the pancreatic tail region with splenic extension and multiple metastases, including areas of central necrosis. Patient was then put on gemcitabine-based chemotherapy. Preoperative imaging modalities such as CT and MRI scans, as well as tumour markers, also failed to reveal the pancreatic lesion. The present case highlights a rare clinical scenario of a hidden pancreatic lesion with large and multiple splenic metastases. Splenic lesions can create diagnostic confusion between benign and malignant lesions on imaging, and it can be challenging to differentiate between primary or secondary lesions. When there is suspicion of splenic metastasis, particularly isolated secondaries, the pancreas should also be considered in the differentials, especially when no other primary is identified on routine imaging.