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Updated: Jul 5, 2025

Management of the Uncinate Process in No-Touch Laparoscopic Pancreaticoduodenectomy
Published on: May 5, 2023
Intrapancreatic accessory spleen: there can be smoke without fire
Luís Correia Gomes1, Margarida Rajão Saraiva2, António Figueiredo3
1Gastronterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Portugal.
Abstract:
Case 1: A 69-year-old male underwent magnetic resonance imaging (MRI) to evaluate hepatic hemangiomas that incidentally revealed a homogeneous hypervascular solid nodule (19 mm) in pancreatic tail. Differential diagnosis included neuroendocrine tumor (NET). Normal chromogranin A and CA19.9 levels. PET-68Ga-DOTANOC scan showed pancreatic tail enhancement consistent with NET. Suspicion of neoplasia persisted after two Endoscopic Ultrasounds with Fine-Needle Aspiration without neoplastic cells. Consequently, distal pancreatectomy was performed, revealing an accessory intrapancreatic spleen. Case 2: A 77-year-old female with dyspepsia performed an abdominal CT followed by MRI and both revealed a solid nodule (11.7 mm) in pancreatic tail with regular margins, suggestive of accessory spleen or pancreatic neoplasia. EUS confirmed a hypoechoic, homogeneous nodule consistent with accessory spleen (11.7mm). A scintigraphy using fragile erythrocytes (4) confirmed intrapancreatic accessory spleen, which requires no treatment.
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