Intrapancreatic Accessory Spleen: A Diagnosis Not to Forget!

Marques, Susana; Bispo, Miguel; Noia, Lariño

doi:10.1159/000452760

Cited by 10 publications

(16 citation statements)

References 14 publications

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“…4 Other studies have suggested the usage of contrast-enhanced EUS and EUS-elastography as a useful tool for diagnosis of IPAS. 5 Appearance of the lesion in this case was a very unusual presentation for anIPAS, given its association within a mucinous cyst. This is a rare diagnosis with less than 60 reported cases.…”

Section: Discussionmentioning

confidence: 65%

Intrapancreatic Accessory Spleen Masquerading as a Pancreatic Mucinous Neoplasm

2020

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AbstractIncidentally discovered pancreatic cysts have become more common with increasing use of abdominal cross-sectional imaging. Tools that help us to better risk stratify a pancreatic cyst include advanced imaging techniques, such as pancreatic protocol computed tomography (CT) scan or magnetic resonance imaging (MRI) with cholangiopancreatography. Endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) are invasive measures to better define and sample cysts especially if high-risk features are present. EUS may also yield pancreatic cyst fluid for analysis of carcinoembryonic antigen (CEA) which is elevated in mucinous cysts. This case highlights a rare finding of a mucinous, epidermoid cyst in an intrapancreatic accessory spleen (IPAS) with high-risk features on EUS.

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Section: Discussionmentioning

confidence: 65%

Intrapancreatic Accessory Spleen Masquerading as a Pancreatic Mucinous Neoplasm

2020

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“…Ectopic splenic tissue can arise either from autotransplation via trauma (“splenosis”) or from a failure of a portion of the spleen to fuse with the main splenic tissue during development (“accessory spleen [AS],” “splenule,“ or “splenunculus”). [123] The prevalence of AS ranges from 10%–30%,[24] with the most recent 2017 meta-analysis of over 22,000 patients reporting 14.5% prevalence of AS. [5] It can be found anywhere from the vicinity of its original location to ovaries and testes, the most common location being the splenic hilum (62.1%) followed by the pancreatic tail (5.5%).…”

Section: Introductionmentioning

confidence: 99%

“…[12567] The latter especially can present as a diagnostic dilemma, as it can look similar to other pancreatic pathologies on imaging, such as pancreatic adenocarcinoma and neuroendocrine tumors. Since AS is usually an incidental finding that requires no treatment,[24] it is important to distinguish intrapancreatic AS (IPAS) from other pancreatic neoplasms to avoid unnecessary interventions.…”

Section: Introductionmentioning

confidence: 99%

“…Endosonographically, IPAS presents as a round homogenous echotexture similar to the adjacent spleen with increased vascularity, possibly more hypoechoic compared to the surrounding pancreas. [4891011] These characteristics may also be suspicious for a pancreatic neoplasm, and previous studies have shown that it is still difficult to distinguish benign lesions such as pancreatic cysts from pancreatic malignancies through EUS. [121314]…”

Section: Introductionmentioning

confidence: 99%

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Recognizing intrapancreatic accessory spleen via EUS: Interobserver variability

et al. 2019

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Background and Objective:Accessory spleen (AS) may be encountered as an intrapancreatic lesion on EUS. This can look similar to other pancreatic pathologies and may lead to unnecessary interventions. The goal of this study was to evaluate the accuracy of EUS in distinguishing intrapancreatic AS (IPAS) from other pancreatic lesions.Materials and Methods:Twelve sets of endoscopic images of the spleen and various pancreatic lesions confirmed on histology or cytology were gathered. Ten endosonographers were asked to characterize and identify the lesions. The responses were analyzed via Excel and the interobserver agreement was analyzed using Gwet's agreement coefficient statistic via Stata I/C v15.Results:In our sample, the interobserver agreement was 0.37 (−1–1; 0–0.2 poor, 0.2–0.4 fair, 0.4–0.6 moderate, 0.6–0.8 substantial, and 0.8–1.0 almost perfect) for determining whether or not the pancreatic lesion is IPAS. The reviewers were able to correctly determine IPAS endosonographically with a sensitivity of 77%, specificity of 74%, and positive and negative predictive values of 50% and 92%, respectively.Conclusion:There is a moderate-to-substantial interobserver agreement in describing the sonographic characteristics of the pancreatic lesions, such as the shape, echogenicity compared to spleen, echotexture, and border of the lesions. However, the interobserver agreement is only fair when deciding if the pancreatic lesion is an IPAS. The similar profile of IPAS and pancreatic neuroendocrine tumor could confound the diagnosis of IPAS, thus contributing to the decreased interobserver agreement. This study demonstrates that EUS criteria alone are not accurate for IPAS diagnosis. Fine-needle aspiration (FNA) may be required for a confirmatory diagnosis.

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“…3,4 Eighty percent of the reported IPAS cases have had the radiological diagnosis of PEN. 1,5,6 The typical cytological characteristic of AS is the presence of small lymphocytes representing the white pulpa. Mixed inflammatory cells admixed with the small lymphocytes, endothelial cells and histiocytes are the other components of AS.…”

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confidence: 99%

Intrapancreatic Accessory Spleen Diagnosed by EUS/FNA Cytology: One Can Only Perceive What the Mind is Prepared to Comprehend

Şahin¹,

Hacısalihoğlu²,

Songür³

2019

Turkiye Klinikleri J Med Sci

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ccessory spleen (AS) is a congenital developmental anomaly which is formed as a result of an insufficiency in splenic precursor mesenchymal cell fusion. It occurs in 10-30% of the population. 1,2 AS is mostly seen in the splenic hilus. 2,3 Intrapancreatic AS (IPAS) is a relatively rare entity with a prevalance of 2%, reported in autopsy series. 1 AS is a clinically quiescent entity which is usually asyptomatic and does not require follow up or resection. Thanks to the current advanced radiological tech

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Intrapancreatic Accessory Spleen: A Diagnosis Not to Forget!

Cited by 10 publications

References 14 publications

Intrapancreatic Accessory Spleen Masquerading as a Pancreatic Mucinous Neoplasm

Intrapancreatic Accessory Spleen Masquerading as a Pancreatic Mucinous Neoplasm

Recognizing intrapancreatic accessory spleen via EUS: Interobserver variability

Intrapancreatic Accessory Spleen Diagnosed by EUS/FNA Cytology: One Can Only Perceive What the Mind is Prepared to Comprehend

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