An Intrapancreatic Accessory Spleen That Was Difficult to Diagnose Due to Temporal Changes after Splenectomy

Uchida, Daisuke; Tsutsumi, Keisuke; Kato, Hironari; Okada, Hiroyuki

doi:10.2169/internalmedicine.9271-17

Cited by 6 publications

(2 citation statements)

References 10 publications

(9 reference statements)

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“…Hitherto, a total of 86 articles and 122 cases of IPAS were published in the English language. [9–14] In 2018, Li et al [9] reported that 87% of the cases were diagnosed with nonfunctioning PNET. The splenic parenchyma consisted of red and white pulp.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic spleen-preserving pancreatic resection for intrapancreatic accessory spleen

Liu

Chen

et al. 2019

Medicine

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Introduction: Intrapancreatic accessory spleen (IPAS) has been rarely noted radiologically because the spatial resolution of conventional images was low. The infrequent presence of the accessory spleen in the pancreatic tissue could lead to inappropriate diagnosis, thereby necessitating a therapeutic approach. The present study reported such cases and summarized the available imaging findings to reduce unnecessary invasive surgeries. Patient concerns: The patient's complaint was “a pancreatic mass was found for half a month.” Diagnosis: IPAS was eventually diagnosed by pathology. Interventions: Laparoscopic spleen-preserving pancreatic resection. Outcomes: Postoperative course was uneventful and the patient was discharged from our hospital after 10 days. Conclusions: When an asymptomatic pancreatic mass is detected, the diagnosis of IPAS should not be excluded, especially if the lesion has the same imaging features as the spleen. As a definite diagnosis of IPAS is difficult by a single examination, multiple techniques might be essential.

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Section: Discussionmentioning

confidence: 99%

“…Second, IPAS was found to be gradually increased after splenectomy. [13,14] Therefore, whether lesions can be excised together as AS is yet to be investigated. Third, when IPAS was highly suspected intraoperatively, laparotomy, biopsy, or surgical resection needs to be decided.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic spleen-preserving pancreatic resection for intrapancreatic accessory spleen

Liu

Chen

et al. 2019

Medicine

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Diagnosis of intrapancreatic accessory spleen by endoscopic ultrasound-guided fine-needle aspiration mimicking a pancreatic neoplasm: a case report and review of literature

Renno

Hill

Abdel-Aziz

et al. 2019

Clin J Gastroenterol

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Intrapancreatic accessory spleen

Patel¹,

Daitch²,

Heller³

et al. 2023

Medicine: Case Reports and Study Protocols

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Introduction: Intrapancreatic accessory spleen (IPAS) is a congenital focus of healthy splenic tissue present outside of the splenic parenchyma. There are numerous locations for IPAS and they are usually found incidentally. The location of ectopic splenic tissue is important as it can often mimic as a neoplasm, most commonly neuroendocrine tumor (NET) due to similar imaging characteristics on nuclear imaging and computed tomography (CT) scan. We report on the finding of an IPAS in the tail of the pancreas for which fine needle aspiration was performed. Patient concerns: A 66-year-old man with past medical history of prostate cancer managed with brachytherapy presented to his urologist for workup of persistently elevated prostate specific antigen. He underwent a nuclear medicine whole body scan which revealed uptake in the pancreatic tail for which follow up CT was recommended. The patient was seen by the gastroenterology and a CT scan was obtained. CT revealed a 4 cm × 3 cm isoenhancing mass in the tail of the pancreas without invasion to surrounding structures nor communication with the pancreatic ducts. No lymphadenopathy was noted. Intervention: The patient subsequently underwent endoscopic ultrasound (EUS) with fine needle aspiration (FNA) of the mass. EUS revealed a hypoechoic, oval, mass-like structure in the distal pancreatic tail measuring ~20 mm × 20 mm in maximal cross-sectional diameter. FNA of the mass was performed. Diagnosis: Cytopathology of the specimen revealed small mature lymphocytes and vessels suggestive of IPAS. Outcome: The patient remained asymptomatic through the duration of the workup. Lessons: All enhancing pancreatic lesions require further workup to rule out malignancy. Typically, patients undergo scintigraphy for further evaluation or FNA biopsy via EUS for confirmation. Currently, there are no established serum markers or radiographic findings with adequate specificity for diagnosing IPAS. It is important to recognize the impact of incidental findings as they frequently require further testing and often result in procedural intervention. IPAS is often confused with NET, frequently necessitating tissue sampling. While the prevalence of intrapancreatic accessory spleen is higher than initially thought, contrary to NET it carries no inherent risk unless its location compromises vital structures. This highlights the importance of recognizing this anomaly.

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An Intrapancreatic Accessory Spleen That Was Difficult to Diagnose Due to Temporal Changes after Splenectomy

Cited by 6 publications

References 10 publications

Laparoscopic spleen-preserving pancreatic resection for intrapancreatic accessory spleen

Laparoscopic spleen-preserving pancreatic resection for intrapancreatic accessory spleen

Diagnosis of intrapancreatic accessory spleen by endoscopic ultrasound-guided fine-needle aspiration mimicking a pancreatic neoplasm: a case report and review of literature

Intrapancreatic accessory spleen

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