Abstract
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.
Highlights
Splenosis and accessory spleen are both ectopic splenic anomalies
positron emission tomography (PET)-CT NETSPOT involves the injection of Ga-68 dotatate (NETSPOT) to target somatostatin receptor (SSTR) that are present on the majority of neuroendocrine tumors (NETs), at least well-differentiated types [9,10]
False-positive PET-CT NETSPOT has been seen with some pathologic processes such as osteoblastic osseous processes, inflammatory processes in lymph nodes, and other tumors such as meningiomas and pheochromocytomas [11]
Summary
Splenosis and accessory spleen are both ectopic splenic anomalies. Splenosis or autotransplantation of splenic tissue occurs after trauma or surgery in locations outside of the spleen, most commonly in the abdominal and pelvic cavity [1]. Intrapancreatic location of ectopic splenic tissue may mimic primary and secondary pancreatic malignant neoplasms such as pancreatic neuroendocrine tumor (NET), acinar cell carcinoma, ductal adenocarcinoma, and metastatic carcinoma [4,5,6]. Physical exam showed a non-distended abdomen with diffuse tenderness and normal bowel sounds He underwent an upper GI endoscopy that revealed mild chronic inactive gastritis without Helicobacter pylori (H. pylori) organisms. In an attempt for further characterization of the mass, a positron emission tomography (PET)-CT NETSPOT was performed (Figure 2) This showed radiotracer accumulation in the pancreatic tail mass, compatible with somatostatin receptor (SSTR) avid tumor suggestive of a NET without evidence of metastatic disease. With a high pre-test probability of NET, a repeat EUS with FNA was performed and cytology findings showed benign splenic tissue and pancreatic acinar cells without evidence of malignancy (Figure 3).
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