Robotic surgical resection of a pancreatic dermoid cyst: Case report and review of literature of an extremely rare pancreatic neoplasm

Introduction: Mature cystic teratomas, also called dermoid cysts, are benign, well-differentiated tumors originating from cells of all three dermal layers. Pancreatic dermoid cysts are extremely rare with the first published case by Kerr in 1918 and only 55 subsequent published cases since. Literature review was conducted using PubMed, Ovid, Clinical Key, Cochrane Library, Web of Science, and UpToDate; results were not limited by publication date. We reviewed the resulting literature to determine the incidence and prior reported cases, pathology, presentation, imaging findings, and management to previous literature. Case Report: Here we present the case of a 72-year-old male with history of left nephrectomy for a benign kidney cyst that during surveillance imaging, a pancreatic mass was identified. He was referred to us for this incidental finding of a possible pancreatic tail cyst that increased in size during surveillance. Computed tomography (CT) scan revealed a cystic focus at the pancreatic tail measuring 5.1 × 3.6 cm. Endoscopic ultrasound (EUS) revealed an anechoic lesion suggestive of a cyst with an overall impression of an intraductal papillary mucinous neoplasm-branch duct (IPMN-BD). Further fine-needle aspiration (FNA) pathology revealed amorphous material consistent with cyst contents and no epithelial cells identified. The patient underwent a robotic-assisted distal pancreatectomy with splenectomy. Pathology was consistent with a 5.5 cm dermoid cyst of the pancreas, negative for malignancy. We present a case of robotic-assisted surgical intervention for pancreatic tail dermoid cyst. Conclusion: Our case presents the first detailed report of a robotic distal pancreatectomy with splenectomy for dermoid cysts of the pancreas with prior retroperitoneal surgery. Robotic distal pancreatectomy with splenectomy is safe and feasible in patients with cystic lesions and prior history of ipsilateral retroperitoneal surgery. Further research should focus on pre-operative workup for proper diagnosis and further identification of incidence and prevalence.