Intrapancreatic accessory spleen mimicking malignant tumor: three case reports

Area of Science:

• Gastroenterology
• Radiology
• Pathology

Background:

• Intrapancreatic hypervascular lesions present a diagnostic challenge, potentially indicating metastases, neuroendocrine tumors, or intrapancreatic accessory spleens.
• Distinguishing benign intrapancreatic accessory spleens from malignant lesions like neuroendocrine tumors or metastases is clinically significant.

Observation:

• Three cases are presented where pancreatic lesions initially suspected of malignancy on imaging led to surgical intervention.
• Histological examination confirmed all three lesions as intrapancreatic accessory spleens, not malignant tumors.

Findings:

• The study highlights the difficulty in differentiating intrapancreatic accessory spleens from malignant neoplasms based solely on conventional imaging.
• Single-photon emission computed tomography (SPECT) using heat-damaged Tc-99m-pertechnetate labeled erythrocytes is recommended for identifying splenic tissue.

Implications:

• Accurate preoperative diagnosis of intrapancreatic hypervascular lesions is essential to prevent unnecessary pancreatic surgery.
• SPECT imaging can aid in the definitive diagnosis of intrapancreatic accessory spleens, although small lesions may yield false-negative results.