Atypical Presentation of Advanced Tail Pancreatic Adenocarcinoma – Splenic Abscess Mimicking a Pseudocyst: Case Report

Abstract

Introduction: Pancreatic cancer is highly lethal and occurs at similar rates in men and women, with a slight predominance in males. In Brazil, it accounts for a small fraction of cancer diagnoses but represents a disproportionately high share of cancer-related deaths. Due to its complex and predominantly late diagnosis, therapeutic options are often limited. Case report: A 64-year-old female patient with a history of systemic arterial hypertension, prior cholecystectomy, and tobacco use presented to the emergency department with left flank abdominal pain and signs of peritoneal irritation. Contrast-enhanced abdominal computed tomography revealed a splenic abscess associated with pancreatic tail necrosis, with imaging features suggestive of a pancreatic pseudocyst, whose histopathological analysis confirmed a diagnosis of poorly differentiated pancreatic adenocarcinoma. This report describes an atypical presentation of pancreatic tail adenocarcinoma with extensive tissue necrosis and splenic abscess formation. Conclusion: The association between pancreatic necrosis and splenic abscess secondary to neoplasia indicates locally advanced or metastatic disease and is associated with a poorer prognosis, including reduced disease-free survival and overall survival. This case highlights the importance of considering differential diagnoses and atypical clinical presentations. Cystic lesions complicated by abscess formation may mimic pseudocysts but may in fact represent tumors with atypical presentation.