Figure 1
Axial CT scan during hepatic arterial phase.
A well-defined nodule of 1.6 centimeters showed slight enhancement in the arterial phase.
Intrapancreatic accessory spleen causing mass: A case report and review of the literature
SectionAbdominal imaging
Case TypeClinical Cases
Authors
Pereira Barreiro, David 1 ; Orihuela Palomino, Amelia 1 ; Álvarez Álvarez, Carlos 2 Verdini Montemuíño, Rut Virginia 1 ; San Luis González, Ángel 1 ;
1 Servicio de Radiodiagnóstico.
2 Servicio de Anatomía patológica.
Connected authors
48 years, female
Clinical History
A 48-year-old woman with persistent and unspecific abdominal pain, arterial hypertension and depression. Surgical history includes left ooforectomy. Non significative analytic alteration was found.
Imaging Findings
Due to the clinical concern, a CT study was decided upon.
This contrast enhanced abdominal CT showed the presence of a well defined nodule of 1.6 centimetres. This nodule had slight enhancement in the arterial phase related to the pancreatic parenchyma with partial wash out in portal phase.
Incidentally a hiatal hernia was found.
With these findings a non-functional neuroendocrine pancreatic tumour was suspected. When the situation was explained to the patient, she felt quite anxious and chose the immediate surgical removal of the lesion before other diagnosis tests were implemented, so the patient underwent distal pancreatectomy.
This contrast enhanced abdominal CT showed the presence of a well defined nodule of 1.6 centimetres. This nodule had slight enhancement in the arterial phase related to the pancreatic parenchyma with partial wash out in portal phase.
Incidentally a hiatal hernia was found.
With these findings a non-functional neuroendocrine pancreatic tumour was suspected. When the situation was explained to the patient, she felt quite anxious and chose the immediate surgical removal of the lesion before other diagnosis tests were implemented, so the patient underwent distal pancreatectomy.
Discussion
Accessory spleen is defined as congenital healthy spleen's tissue separated from the main body of the spleen, and can be found in the autopsy of 10%- 30% of the population. [1] Usually they are located in the spleen's hilum, the tail of the pancreas being the second localisation [2] in order of frequency reaching 20%.
The size and shape are variable [1], from millimetres to several centimetres, and in case of splenectomy they could raise and also be a place for recurrence.
The detection of accessory spleens is especially important in those cases where all the splenic tissue of the body should be removed. Good examples of this are haematologic diseases like myeloproliferative syndromes, haemolitic anemias, and purpuras.
Usually they appear incidentally in CT, MRI or US as a well-defined nodule with an enhancement similar to the main body of the spleen in the different phases of the study.
These characteristics added to their multiple possible locations they may simulate pancreatic, gastric, intestinal or adrenal pathologies.
Surrounded by pancreatic tissue we should include in the differential diagnosis papillary epithelial neoplasm, neuroendocrinal tumours and hypervascular metastases [2, 3].
Some non-invasive techniques like MRI with RES-specific contrast or scintigraphy with Technentium-99m Heat-Damaged Red Blood Cell are able to clarify the diagnosis in these cases, so they could prevent surgery. [4]
The size and shape are variable [1], from millimetres to several centimetres, and in case of splenectomy they could raise and also be a place for recurrence.
The detection of accessory spleens is especially important in those cases where all the splenic tissue of the body should be removed. Good examples of this are haematologic diseases like myeloproliferative syndromes, haemolitic anemias, and purpuras.
Usually they appear incidentally in CT, MRI or US as a well-defined nodule with an enhancement similar to the main body of the spleen in the different phases of the study.
These characteristics added to their multiple possible locations they may simulate pancreatic, gastric, intestinal or adrenal pathologies.
Surrounded by pancreatic tissue we should include in the differential diagnosis papillary epithelial neoplasm, neuroendocrinal tumours and hypervascular metastases [2, 3].
Some non-invasive techniques like MRI with RES-specific contrast or scintigraphy with Technentium-99m Heat-Damaged Red Blood Cell are able to clarify the diagnosis in these cases, so they could prevent surgery. [4]
Differential Diagnosis List
Histological examination demonstrated accessory spleen.
Papillary epithelial neoplasm
Neeuroendocrinal tumours
Hypervascular metastases
Final Diagnosis
Histological examination demonstrated accessory spleen.
References
[1] Guo W, Han W, Liu J, Jin L, Li JS, Zhang ZT, Wang Y. (2009) Intrapancreatic accessory spleen: a case report and review of the literature. World J Gastroenterol Mar 7;15(9):1141-3. (PMID: 19266611)
[2] Kim SH, Lee JM, Han JK, Lee JY, Kim KW, Cho KC, Choi BI. (2008) Intrapancreatic accessory spleen: findings on MR Imaging, CT, US and scintigraphy, and the pathologic analysis. Korean J Radiol Mar-Apr;9(2):162-74. Review. (PMID: 18385564)
[3] Xue HD, Liu W, Xiao Y, Sun H, Wang X, Lei J, Jin ZY. (2011) Pancreatic and peri-pancreatic lesions mimic pancreatic islet cell tumor in multidetector computed tomography. Chin Med J (Engl) Jun;124(11):1720-5. Review. (PMID: 21740785)
[4] Kim SH, Lee JM, Han JK, et al (2006) MDCT and superparamagnetic iron oxide (SPIO)-enhanced MR findings of intrapancreatic accessory spleen in seven patients. Eur Radiol 16(9):1887–1897. (PMID: 16547707)
Case information
| URL: | https://www.eurorad.org/case/10405 |
| DOI: | 10.1594/EURORAD/CASE.10405 |
| ISSN: | 1563-4086 |
Figure 2
Curved sectional imaging. Arterial phase
The nodule was located in the pancreatic tail, near the spleen hilum.
Figure 3
Axial TC during portal vein phase.
Partial wash out in portal phase.
Figure 4
Curved sectional imaging. Portal vein phase
In this phase, the nodule becames similar to the nearby pancreatic tissue.
Figure 5
Comparative
Similar enhancement to the main body of the spleen in the different phases of the study
Axial CT scan during hepatic arterial phase.
A well-defined nodule of 1.6 centimeters showed slight enhancement in the arterial phase.
San Luis González A, Servicio de Radiodiagnóstico, CHOP, Pontevedra, España
San Luis González A, Servicio de Radiodiagnóstico, CHOP, Pontevedra, España
Curved sectional imaging. Arterial phase
The nodule was located in the pancreatic tail, near the spleen hilum.
San Luis González A, Servicio de Radiodiagnóstico, CHOP, Pontevedra, España
San Luis González A, Servicio de Radiodiagnóstico, CHOP, Pontevedra, España
Axial TC during portal vein phase.
Partial wash out in portal phase.
San Luis González A, Servicio de Radiodiagnóstico, CHOP, Pontevedra, España
San Luis González A, Servicio de Radiodiagnóstico, CHOP, Pontevedra, España
Curved sectional imaging. Portal vein phase
In this phase, the nodule becames similar to the nearby pancreatic tissue.
San Luis González A, Servicio de Radiodiagnóstico, CHOP, Pontevedra, España
San Luis González A, Servicio de Radiodiagnóstico, CHOP, Pontevedra, España
Comparative
Similar enhancement to the main body of the spleen in the different phases of the study
San Luis González A, Servicio de Radiodiagnóstico, CHOP, Pontevedra, España.
San Luis González A, Servicio de Radiodiagnóstico, CHOP, Pontevedra, España.