Splenomegaly as the first manifestation of pancreatic adenosquamous carcinoma: a case report.

Adenosquamous carcinoma of the pancreas directly invading surrounding organs is rare. Here, we describe a case of pancreatic adenosquamous carcinoma directly invading the spleen and colon in a 44-year-old man. Imaging examinations revealed a huge heterogeneous mass in the enlarged spleen and a colonic lump, but showed no obvious space-occupying lesion in the pancreas. An exploratory laparotomy revealed that the enlarged spleen, pancreatic tail, and splenic flexure of the colon were firmly attached to one another. Splenectomy combined with resection of the distal pancreas and splenic flexure of the colon was performed. In the distal pancreatectomy specimen, a 0.8-cm solid mass was present in the tail. The tumor contained definite components of both adenocarcinoma and squamous cell carcinoma. The patient died of cachexia five months after admission. This case is unique in that the metastatic tumor involving the spleen was considerably larger than the primary tumor itself.