Intrapancreatic accessory spleen false positive to 68Ga-Dotatoc: case report and literature review

Lancellotti, Francesco; Sacco, L.; Cerasari, Saverio; Bellato, Vittoria; Cicconi, Simone; Ciardi, Antonio; Muttillo, Edoardo Maria; Feola, Tiziana; Caronna, Roberto; Chirletti, Piero

doi:10.1186/s12957-019-1660-2

Cited by 18 publications

(13 citation statements)

References 40 publications

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“…Literature documents many case reports of false positives on PET-CT NETSPOT due to ectopic splenic anomalies [12][13][14][15][16][17]. One case report with a literature review showed that 66.7% of patients with intrapancreatic accessory spleen ended up undergoing unnecessary pancreatic resections [13]. With advanced imaging techniques and early detection, fear of overtreatment of this benign incidental process exists [18,19].…”

Section: Discussionmentioning

confidence: 99%

Intrapancreatic Accessory Spleen Diagnosed As Neuroendocrine Tumor: The Dangers of False Positives and Their Implications in Subsequent Management

Kripalani

Patel

Joneja

et al. 2021

Cureus

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This case serves as a reminder to consider ectopic splenic tissue in the differential diagnosis of pancreatic masses. The literature shows a lack of awareness and overtreatment of this condition due to clinical and radiologic concern for malignancy, namely neuroendocrine tumors (NETs) identified on positron emission tomography (PET)-CT NETSPOT. Given the vast difference in management and prognosis of ectopic splenic anomalies and malignant neoplasms involving the pancreas, accurate diagnosis is imperative to avoid unnecessary invasive procedures such as Whipple or distal pancreatectomy and splenectomy, which are associated with increased morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Intrapancreatic Accessory Spleen Diagnosed As Neuroendocrine Tumor: The Dangers of False Positives and Their Implications in Subsequent Management

Kripalani

Patel

Joneja

et al. 2021

Cureus

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“…68 Galabeled somatostatin analogs (DOTA-TOC, DOTA-TATE, DOTA-NOC) for Positron Emission Tomography/Computed Tomography (PET/CT) has emerged as a reliable imaging modality for well-differentiated neuroendocrine tumors [53][54][55]. However, since splenic tissue also demonstrates high uptake of somatostatin analogs, this modality does not enable the differentiation of IPS from PNETs [56,57]. Our clinical implementation of feMRI resulted in reliable distinction between IPS and PNETs.…”

Section: Discussionmentioning

confidence: 99%

Ferumoxytol-enhanced MR imaging for differentiating intrapancreatic splenules from other tumors

et al. 2020

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Objectives Ferumoxytol is an ultra-small superparamagnetic iron oxide (USPIO) agent that is taken up by splenic tissue. This study describes our initial institutional experience of ferumoxytol-enhanced MRI (feMRI) for differentiating intrapancreatic splenules (IPS) from other pancreatic lesions. Methods In this retrospective study, patients with computed tomographic imaging that identified small enhancing lesions in the tail of the pancreas subsequently underwent feMRI for further characterization. The feMRI protocol included T2-weighted (T2w) imaging with and without fat suppression (FS), R2* mapping, diffusion-weighted imaging (DWI), and T1-weighted (T1w) imaging with FS, prior to contrast injection. Immediately after slow intravenous infusion with 3 mg/kg body weight ferumoxytol, T1w was repeated. Delayed imaging with all sequences were obtained 24–72 h after ferumoxytol administration. Results Seven patients underwent feMRI. In two patients, the pancreatic lesions were presumed as pancreatic neuroendocrine tumor (PNET) from feMRI and in the remaining 5 IPS. One of the two patients with PNET was symptomatic for NET. In another symptomatic patient with pathologically proven duodenal NET and suspected PNET, the pancreatic lesion was proven to be an IPS on feMRI. IPS demonstrated strong negative enhancement in feMRI on T2w and increased R2* values consistent with splenic tissue, while the presumed PNETs did not enhance. T2w FS was helpful on the pre-contrast images to identify IPS, while R2* did on post-contrast images. Neither DWI nor T1w contributed to differentiating PNETs from IPS. Conclusions This study demonstrates the potential utility of feMRI as a helpful adjunct diagnostic tool for differentiating IPS from other pancreatic lesions. Further studies in larger patient cohorts are needed.

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“…It is usually asymptomatic so that most of the cases are diagnosed incidentally, except for some cases with abdominal pain or idiopathic thrombocytopenic purpura after splenectomy [14]. It is 1-3 cm in size, well-delimited, homogenous, and hypervascular on CT and MRI [15,16]. Tumoral and neuroendocrine markers are usually negative in IPAS, but there has been a report with slightly elevated tumoral markers in the patient with IPAS [17].…”

Section: Discussionmentioning

confidence: 99%

Spleen Scan for 68Ga-DOTATOC PET-Positive Pancreatic Tail Lesion: Differential Diagnosis of Neuroendocrine Tumor from Accessory Spleen

Ryoo

Choi

Cheon

2019

Nucl Med Mol Imaging

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Ga-DOTATOC PET/CT is widely used as a functional imaging technique in the detection and characterization of neuroendocrine tumors (NETs). Pancreatic NET and intrapancreatic accessory spleen (IPAS) have similar radiologic characteristics in anatomical imaging and usually show high uptake of 68 Ga-DOTATOC. Thus, it is challenging to make a differential diagnosis between NET and IPAS when the tumor-like lesion is located in the pancreatic tail. Here, we present a case of 68 Ga-DOTATOC PET-positive pancreatic tail lesion with high arterial enhancement on CT and MRI. Since 99m Tc-labeled damaged red blood cell does not accumulate on NET, a negative spleen scan finding was a crucial diagnostic step to decide surgical resection, which was histologically proven as insulinoma. Our case shows a promising role of additional use of spleen scan with SPECT/CT for the differential diagnosis of 68 Ga-DOTATOC PET-positive pancreatic NET from the accessory spleen.

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Intrapancreatic accessory spleen false positive to 68Ga-Dotatoc: case report and literature review

Cited by 18 publications

References 40 publications

Intrapancreatic Accessory Spleen Diagnosed As Neuroendocrine Tumor: The Dangers of False Positives and Their Implications in Subsequent Management

Intrapancreatic Accessory Spleen Diagnosed As Neuroendocrine Tumor: The Dangers of False Positives and Their Implications in Subsequent Management

Ferumoxytol-enhanced MR imaging for differentiating intrapancreatic splenules from other tumors

Spleen Scan for 68Ga-DOTATOC PET-Positive Pancreatic Tail Lesion: Differential Diagnosis of Neuroendocrine Tumor from Accessory Spleen

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