Intrapancreatic accessory spleen: a diagnostic dilemma

Abstract

Although rare, IPAS should be considered in the differential of patients with suspected incidental p-net, especially if there has been a past history of splenectomy. Preoperative diagnosis is important as unnecessary surgery can be avoided. As it is difficult to make a definite diagnosis of IPAS by one single examination, multiple techniques may be required.

Intrapancreatic accessory spleen: an enigmatic entity

“…Almost 87% of patients with IPAS were suspected as NEN in a study 3. NEN on CECT also appears as a hyperenhancing lesion with/out lymphadenopathy.…”

“…In an autopsy study conducted on 311 patients, the most common site of accessory spleen was splenic hilum (80%), followed by proximity to pancreatic tail (17%) 2. To date, only 105 cases have been reported worldwide as per a search conducted on MEDLINE, of which 73% cases were detected incidentally 3…”

“…It can be seen that almost all the patients have been managed for NEN or pancreatic adenocarcinoma. Up to 55% of patients underwent surgical management in a study with 105 patients due to missed diagnosis preoperatively 3. This can possibly change if a suspicion of IPAS arises on CECT/CEUSG/MR characteristics as described above.…”

“…Intrapancreatic accessory spleen (IPAS) is a rare differential diagnosis of a solitary hypervascular lesion in body/tail of pancreas 1 2. A literature review reveals only around 105 cases worldwide as per a search conducted on MEDLINE 3. The entity is very important to suspect preoperatively because we can avoid surgery, if it is detected with certainty.…”

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

“…In the literature, it is stated that intra and peripancreatic AS may mimic various neoplasms radiologically; and this may lead to unnecessary surgical resections. 2,3,8,9 Besides its radiological diagnostic pitfalls, intra or peripancreatic AS also has several cytological diagnostic pitfalls. The most important one is not considering this entity in the differential diagnosis.…”