Enlarged accessory spleen presenting stomach submucosal tumor

Area of Science:

• Gastroenterology and Radiology

Background:

• Submucosal tumors (SMTs) of the upper gastrointestinal tract require accurate diagnosis to differentiate benign from malignant conditions.
• Extragastric origins of SMTs can present diagnostic challenges, necessitating advanced imaging modalities.

Observation:

• A 62-year-old man presented with upper abdominal discomfort, leading to upper gastrointestinal endoscopy.
• Gastroscopy and endoscopic ultrasonography identified a homogenous echogenic submucosal tumor (SMT) of extragastric origin.
• Contrast-enhanced computed tomography (CT) revealed a well-marginated, 6 cm ovoid mass with homogenous enhancement similar to splenic parenchyma.

Findings:

• Technetium sulfur colloid scintigraphy confirmed the splenic nature of the mass.
• The imaging findings led to a diagnosis of an accessory spleen mimicking a gastric SMT.
• The patient's condition was managed conservatively with uneventful follow-up, avoiding splenectomy.

Implications:

• This case highlights the importance of a comprehensive diagnostic approach, including nuclear medicine, for SMTs of unclear origin.
• Accessory spleens can present as extragastric SMTs, and accurate diagnosis can prevent invasive procedures.
• Non-operative management is a viable option for accessory spleens mimicking gastric SMTs, reducing patient morbidity.