Intrapancreatic accessory spleen: a diagnostic dilemma

Area of Science:

• Gastroenterology
• Surgical Pathology
• Radiology

Background:

• Intrapancreatic accessory spleen (IPAS) is an uncommon clinical finding.
• Accurate diagnosis and treatment strategies for IPAS are not well-established.

Purpose of the Study:

• To review and summarize the epidemiology, diagnosis, and treatment of IPAS.
• To improve clinical recognition and management of IPAS.

Main Methods:

• Systematic literature search of MEDLINE and EMBASE databases for IPAS cases.
• Analysis of epidemiological features, diagnostic methods, and treatment outcomes.

Main Results:

• 105 patients with IPAS were identified; 73% were incidental findings.
• IPAS size was larger in patients with prior splenectomy (2.5 cm vs 1.5 cm).
• Definitive preoperative diagnosis was challenging; 55% underwent surgery, often misdiagnosed as pancreatic neuroendocrine tumors (p-NET).

Conclusions:

• IPAS should be considered in the differential diagnosis of incidental pancreatic lesions, particularly in patients with a history of splenectomy.
• Accurate preoperative diagnosis is crucial to avoid unnecessary surgery.
• Multimodal diagnostic approaches may be necessary for definitive IPAS identification.