Intrapancreatic accessory spleen: an enigmatic entity.

Area of Science:

• Gastroenterology
• Surgical Pathology
• Diagnostic Imaging

Background:

• Solitary hypervascular pancreatic lesions pose diagnostic challenges.
• Common differentials include neuroendocrine neoplasms (NENs) and renal cell carcinoma metastases.
• Intrapancreatic accessory spleen (IPAS) is a rare but important differential diagnosis.

Observation:

• A 56-year-old male presented with non-specific abdominal symptoms and a pancreatic body/tail mass.
• Preoperative diagnosis suggested NEN based on elevated chromogranin and CT findings.
• The patient underwent spleen-preserving distal pancreatectomy.

Findings:

• Histopathology revealed the pancreatic lesion to be an IPAS.
• This contrasts with the preoperative diagnosis of NEN.
• IPAS can mimic other pancreatic space-occupying lesions.

Implications:

• This case underscores the importance of considering rare differentials like IPAS.
• Accurate preoperative diagnosis of pancreatic lesions is crucial for appropriate management.
• Understanding IPAS as a mimic aids in surgical planning and patient outcomes.