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Sometimes things are what they seem.

, Eva Marín Serrano¹, Ana Barbado Cano²

¹Aparato Digestivo, Hospital Universitario La Paz, España.

Revista Espanola De Enfermedades Digestivas

|February 28, 2019

Summary

A rare case of intrapancreatic accessory spleen (IPAS) was found in a 74-year-old man. This congenital abnormality, often overlooked, mimicked a pancreatic tumor on initial imaging.

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Area of Science:

Gastroenterology and Radiology
Surgical Pathology

Background:

Accessory spleens are common congenital anomalies, arising from the failure of splenunculi fusion.
Intrapancreatic accessory spleen (IPAS) is a rare variant, often presenting as an incidental pancreatic finding.

Observation:

A 74-year-old male presented with a 1.8 cm x 1.5 cm pancreatic tail nodule.
CT revealed soft tissue attenuation with arterial hyperenhancement and low central uptake, low 18-FDG affinity, and no 111-In-octretide uptake.
Endoscopic ultrasound (EUS) characterized the nodule as solid, round, and well-circumscribed, with enhancement patterns similar to the spleen.

Findings:

EUS-guided biopsy material was initially consistent with a lymph node.
Histopathological analysis confirmed the nodule as an intrapancreatic accessory spleen (IPAS).

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Implications:

This case highlights the importance of considering IPAS in the differential diagnosis of pancreatic nodules.
Accurate diagnosis can prevent unnecessary pancreatic resections, emphasizing the role of advanced imaging and EUS.
Understanding IPAS imaging characteristics is crucial for differentiating it from pancreatic neoplasms.