Intrapancreatic accessory spleen versus a neuroendocrine pancreas tumor: a diagnostic challenge

García, Lucia Diego; Vázquez, Alba Manuel; Durán, Emilio; Ángel, José Manuel Ramia

doi:10.17235/reed.2020.6558/2019

Cited by 2 publications

(1 citation statement)

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“…Although previous studies have indicated that imaging data is an essential basis for diagnosing IPAS [7,36,37], in our case, CT, MRI, PET-CT, and EUS were not good for the differential diagnosis of IPAS. The previous studies found that IPAS should be considered when a smooth, round, solid hypervascular mass appears in the tail of the pancreas on abdominal CT [11,38].…”

Section: Discussioncontrasting

confidence: 87%

Challenging Diagnosis of Intrapancreatic Accessory Spleen in the Tail of the Pancreas: A Case Report

Xiao

Sun

et al. 2023

Am J Case Rep

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Objective:Rare disease Background:Intrapancreatic accessory spleen, or splenunculus, is a congenital condition that occurs in up to 2% of the population, with the tail of the pancreas being the second most common site. Imaging alone may not confirm the diagnosis as this can mimic a hypervascular tumor on contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI). This report presents a challenging case of intrapancreatic accessory spleen in the tail of the pancreas in a 64-year-old man. Case Report:A 64-year-old man was admitted for a space-occupying lesion in the tail of the pancreas. CT, MRI, and positron emission tomography-CT could not confirm the diagnosis. Endoscopic ultrasound-guided fine-needle aspiration biopsy was not performed given the potential for greater risk. The mass in the patient's pancreatic tail was considered benign or low-grade malignant. The patient then underwent a robotic pancreatectomy to remove the tumor in the tail of the pancreas. We performed intraoperative ultrasound scanning and detected a hypoechoic nodule in the body of the pancreas. This nodule had a clear boundary, and color Doppler flow imaging showed that there was no definite blood flow signal in it. The pathology diagnosis after surgery was intrapancreatic accessory spleen. The patient recovered without other complications and was discharged 5 days later. Conclusions:This report highlights the importance of considering the diagnosis of intrapancreatic accessory spleen in hypervascular lesions seen on imaging alone and of confirming the diagnosis with definitive cytopathology or histopathology.

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