Accessory spleen after splenectomy mimicking adrenal tumor: a case report

Accessory spleen is a congenital anomaly, those asymptomatic generally do not need surgical intervention. Retroperitoneal heterotopic accessory spleens are often misdiagnosed, especially in cases that have undergone splenectomy for various reasons. In these cases, most patients are received unnecessary resection for misdiagnosed as adrenal gland tumors, ganglioblastomas or paragangliomas preoperatively. We report on a case of accessory spleen mimicking a left adrenal tumor. A 47-year-old man who had undergone splenectomy 25 years ago was referred to our department because of hypertension, CT scan revealed a mass about 4 cm in the left adrenal gland. The mass was confirmed nonfunctional through hormonal evaluation of the adrenal gland. We found the mass was not originated from the adrenal gland intraoperation even they were close together. Histopathologic examination of the surgical specimen revealed an accessory spleen. The differences between the case and other accessory spleen patients include a history of hypertension, the location of the mass and a history of splenectomy, and these also are the main reasons for our misdiagnosis. This case remind us that an accessory spleen should be considered for the biochemically inactive mass in left adrenal area, even the splenectomy has been performed before.