Bok-Kyung Sohn, et al. had persisted over two weeks, as well as a mass which had increased in size for several days. The patient was not re- ceiving any specific medication and her medical history did not suggest any major disease. Nor was there any his- tory of alcohol usage or trauma. Physical examination re- vealed the presence of a huge mass in the upper left quad- rant of the abdomen, but without tenderness or rebound tenderness. Laboratory findings were all within normal limits. The abdominal X-ray examination showed no pres- ence of intestinal gas in the upper left quadrant and the normal location of the intestines was pushed toward the right, indicating the presence of a mass in the upper left quadrant (Fig. 1). An abdomino-pelvic computed tomog- raphy (CT) scan demonstrated a 15 × 10 cm, hypo-dense, well-capsulated and huge cystic lesion of unknown origin in the upper left quadrant (Fig. 2). A surgical procedure was decided upon because of com- pression symptoms and the possibility of the mass being malignant. Under general anesthesia, a median incision was performed in the upper abdominal region. The spleen ap- peared normal, while the presence of a mass was confirmed, firmly attached to the pancreatic tail. The mass was hard and uneven with tubercles of varying sizes. To perform en bloc resection of the mass, mobilization of the spleen was deemed necessary. Both the splenorenal and splenocolic lig- aments were detached from the retroperitoneum to mobi- lize the spleen. After removal of the pancreatic tail and the spleen from the abdominal cavity, excision of the mass and the pancreatic tail, as well as splenectomy, were performed to ensure en bloc resection (Fig. 3). No other abnormalities Fig. 1. Simple abdominal X-ray. Simple abdomen shows no bowel gas in the left upper quadrant with displacement of bowel to the right abdomen by the left upper quadrant mass. Fig. 3. Operative findings shows a huge, well-defined and cystic mass densely attached to the tail of the pancreas (arrow). 142 Fig. 2. Abdominal computed tomo- graphy (CT) scan. A contrast-enhan- ced helical CT scan of the abdomen at portal venous phase shows a huge, hypo-dense, well-capsulated and cy- stic lesion of unknown origin at the left upper quadrant of the abdomen (arrow). thesurgery.or.kr