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

Renno, Anas; Hill, Michael C.; Abdel-Aziz, Yousef; Meawad, Hany; Lenhard, Amanda; Nawras, Ali

doi:10.1007/s12328-019-01045-y

Cited by 8 publications

(13 citation statements)

References 20 publications

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“…1 The most common location is the splenic hilum (80%), followed by the pancreatic tail (16.7%). 1 There have been multiple reports of intrapancreatic accessory spleen mimicking pancreatic NET. [1][2][3][4] Both accessory spleen and pancreatic NET show hyperattenuation in the arterial phase of contrast-enhanced CT.…”

Section: Intrapancreatic Accessory Spleenmentioning

confidence: 99%

“…1 There have been multiple reports of intrapancreatic accessory spleen mimicking pancreatic NET. [1][2][3][4] Both accessory spleen and pancreatic NET show hyperattenuation in the arterial phase of contrast-enhanced CT. However, the attenuation of the accessory spleen remains stable throughout the arterial and portal venous phases, and the accessory spleen shows persistently high attenuation similar to that of the spleen.…”

Section: Intrapancreatic Accessory Spleenmentioning

confidence: 99%

“…EUS-FNA can be helpful in obtaining tissue for pathological diagnosis, and 17.6% of intrapancreatic accessory spleen cases have been successfully diagnosed with EUS-FNA. 1 Chromogranin-A level is elevated in NETs, and its measurement can be helpful for differential diagnosis. However, elevated chromogranin-A level caused by chronic use of proton-pump inhibitors and liver cirrhosis was reported in a patient with intrapancreatic accessory spleen.…”

Section: Intrapancreatic Accessory Spleenmentioning

confidence: 99%

“…Accessory spleens can be found in about 10% of the population [ 1 ]. The most common location is the splenic hilum (80%), followed by the pancreatic tail (16.7%) [ 1 ].…”

Section: Answermentioning

confidence: 99%

“…Accessory spleens can be found in about 10% of the population [ 1 ]. The most common location is the splenic hilum (80%), followed by the pancreatic tail (16.7%) [ 1 ]. There have been multiple reports of intrapancreatic accessory spleen mimicking pancreatic NET [ 1 - 4 ].…”

Section: Answermentioning

confidence: 99%

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Pancreatic Tail Mass: A Diagnostic Challenge

Han

2020

Clin Endosc

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A 61-year-old female presented with an incidental finding of a pancreatic tail mass. She had been admitted for acute diarrhea and undergone abdominal computed tomography (CT) with contrast enhancement. CT showed a 2.6-cm, round, enhancing mass in the pancreatic tail (Fig. 1A). The patient had been diagnosed with essential hypertension two years ago, and she was taking antihypertensive medication. She was a non-smoker and remained abstinent for 10 years. There was no unintentional weight loss, fever, or abdominal pain. Abdominal examination showed no palpable mass. Complete blood count and liver function tests were all within the normal range. The cancer antigen 19-9 level was 9.1 U/mL (reference: < 37 U/mL). Endoscopic ultrasonography (EUS) with radial echoendoscope showed a 1.9 cm × 2.3 cm, round, hypoechoic mass with well-defined margins at the pancreatic tail (Fig. 1B). There was no invasion of vascular structures or pancreatic duct dilatation. Contrast-enhanced EUS demonstrated homogenous enhancement of the mass (Fig. 1C). EUS-guided fine needle aspiration (EUS-FNA) of the mass was performed (Fig. 1D), but cytology did not reveal any malignant cells (Fig. 1E). What is the most likely diagnosis?

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Section: Intrapancreatic Accessory Spleenmentioning

confidence: 99%

Section: Intrapancreatic Accessory Spleenmentioning

confidence: 99%

Section: Intrapancreatic Accessory Spleenmentioning

confidence: 99%

“…Accessory spleens can be found in about 10% of the population [ 1 ]. The most common location is the splenic hilum (80%), followed by the pancreatic tail (16.7%) [ 1 ].…”

Section: Answermentioning

confidence: 99%

Section: Answermentioning

confidence: 99%

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Pancreatic Tail Mass: A Diagnostic Challenge

Han

2020

Clin Endosc

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Splenopancreatic Fusion

Al-Salem

2023

The Spleen

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

Cited by 8 publications

References 20 publications

Pancreatic Tail Mass: A Diagnostic Challenge

Pancreatic Tail Mass: A Diagnostic Challenge

Splenopancreatic Fusion

Intrapancreatic accessory spleen

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