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Pitfall of the accessory spleen
J P Sels1, R M Wouters, R Lamers
1Department of Endocrinology, University Hospital Maastricht, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. jse@sint.azm.nl
The Netherlands Journal of Medicine
|March 23, 2000
Summary
Radiologic imaging of pancreatic islet cell tumors and adrenal adenomas can mimic accessory spleens. Definitive diagnosis required surgical exploration for insulinoma and iodine-131-iodocholesterol scintigraphy for Cushing
Area of Science:
- Endocrinology
- Radiology
- Surgical Oncology
Background:
- Insulinoma and Cushing's syndrome are rare endocrine disorders.
- Accurate diagnosis relies on biochemical and imaging studies.
- Radiologic interpretation can be challenging due to atypical presentations.
Observation:
- Computed tomography (CT) and magnetic resonance imaging (MRI) findings of a pancreatic islet cell tumor and an adrenal adenoma were initially misinterpreted.
- The lesions were mistakenly identified as accessory spleens based on their imaging characteristics.
- Biochemical evaluations strongly suggested the underlying endocrine disorders.
Findings:
- Laparotomy confirmed the pancreatic islet cell tumor causing insulinoma.
- Iodine-131-iodocholesterol scintigraphy successfully identified the adrenal adenoma in the patient with Cushing's syndrome.
- Both patients underwent successful surgical treatment.
Implications:
- This case highlights the potential for misinterpretation of endocrine tumors on CT and MRI.
- It underscores the importance of integrating biochemical data with imaging findings for accurate diagnosis.
- Advanced imaging techniques like scintigraphy can be crucial for resolving diagnostic ambiguities in endocrine surgery.