Intrapancreatic Accessory Spleen: Two Case Reports of a Rare Entity.

Stylianos Kykalos,Ernesto P Molmenti,Nikolaos Machairas,Georgios Sotiropoulos

doi:10.7759/cureus.8797

Abstract

Intrapancreatic accessory splenic tissue constitutes a very unusual anatomical variation. It is encountered mostly in the splenic hilum or within the pancreatic tail. Given the diagnostic difficulty in excluding a pancreatic malignancy, a distal pancreatectomy is usually performed. We herein report two cases of intrapancreatic accessory spleen. The first patient presented with left upper quadrant abdominal pain radiating to the back, caused by a 2-cm focal lesion in the pancreatic tail. The second patient underwent a distal pancreatectomy due to a postsplenectomy symptomatic pseudocyst that could not be treated conservatively. In both cases, the histopathological examination of the specimens revealed a 2-cm accessory spleen within the pancreatic tail. Intra and peripancreatic spleens represent 10-16% of all accessory spleens, and their sizes range from a few millimeters up to 2-3 cm. CT, MRI, and nuclear scintigraphy are all useful in establishing the diagnosis. It is occasionally difficult to differentiate accessory spleens from hypervascular pancreatic neoplasms, metastatic lesions, or splenic hilar lymphadenopathy. The surgical resection of an intrapancreatic spleen is only indicated in the case of diagnostic uncertainty or spleen-related hemato-oncological conditions such as immune thrombocytopenia (ITP).

Highlights

Distal pancreatic tumors are characterized by their non-specific clinical presentation and late diagnosis
Surgical removal is indicated in malignant cases or in selected lesions such as hormonally active neuroendocrine tumors
The surgical resection of an intrapancreatic spleen is generally not indicated, the diagnostic difficulty in excluding a pancreatic malignancy often leads to a distal pancreatectomy

Summary

Introduction

Distal pancreatic tumors are characterized by their non-specific clinical presentation and late diagnosis. The surgical resection of an intrapancreatic spleen is generally not indicated, the diagnostic difficulty in excluding a pancreatic malignancy often leads to a distal pancreatectomy. We report two cases of intrapancreatic accessory spleens resected at our institution within a one-year period. A 54-year-old Caucasian male presented with left upper quadrant abdominal pain radiating to the back He had no significant past medical history and laboratory tests including serum amylase, lipase, carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA 19-9) were within normal range. Histopathological examination of the specimen showed a 2-cm accessory spleen within the pancreatic tail. A 53-year-old Caucasian male with a traumatic rupture of the spleen underwent an emergency splenectomy complicated by a 7 x 6-cm pancreatic pseudocyst (identified by ultrasonographic and CT imaging, Figure 2). The postoperative course was uneventful and the patient was discharged one week after the operation

Discussion

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Findings

Disclosures

Steer M