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Kang JG, Park JH, Park MS, Han K, Lee HS, Yang HK. Differentiation of intrapancreatic accessory spleen from pancreatic neuroendocrine tumor using MRI R2. Abdom Radiol (NY) 2025:10.1007/s00261-024-04758-y. [PMID: 39841231 DOI: 10.1007/s00261-024-04758-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Revised: 12/09/2024] [Accepted: 12/10/2024] [Indexed: 01/23/2025]
Abstract
PURPOSE To evaluate the performance of R2* in distinguishing intrapancreatic accessory spleens (IPASs) from pancreatic neuroendocrine tumors (PNETs). METHODS Two radiologists (R1 and R2) retrospectively reviewed the MRIs of 20 IPAS and 20 PNET patients. IPASs were diagnosed with uptake on 99mTc labeled heat-damaged red blood cell scintigraphy or characteristic findings on CT/MRI and ≥ 12 month-long-stability. PNETs were histopathologically diagnosed with resection. Using McNemar test, sensitivities and specificities of the diagnostic criterion based on R2* mass-to-spleen ratio (MSR) were compared with those of the other criteria using contrast-enhanced (CE) MRI and apparent diffusion coefficient (ADC) MSR. RESULTS The study included 40 patients (median age, 54; interquartile range, 43-65; 24 men, 16 women). IPASs exhibited spleen-isointensity on T2WI, late arterial and portal phases, and diffusion-weighted images more frequently than PNETs (p <.05). ADC MSRs were lower (p <.001) and R2* MSRs were higher (p <.001) in IPASs compared to PNETs. For R1, sensitivity and specificity were 45.0% and 100.0% for criterion 1 (spleen-isointensity on CE-MRI); 45.0% and 85.0% for criterion 2 (ADC MSR ≤ 1.08); 90.0% and 95.0% for criterion 3 (0.9 ≤ R2* MSR ≤ 1.7). For R2, 75.0% and 100.0%; 45.0% and 90.0%; 90.0% and 100.0%. Criterion 3 showed higher sensitivity than criterion 1 for R1 (p =.004), and criterion 2 for R1 and R2 (p =.012). There was no difference in specificity. CONCLUSION For differentiating IPAS from PNET, R2* showed higher sensitivity than, and similar specificity to CE-MRI and ADC.
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Affiliation(s)
- Jun Gu Kang
- Severance Hospital, Seoul, Republic of Korea
| | | | - Mi-Suk Park
- Severance Hospital, Seoul, Republic of Korea
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Peschard AL, Jamont W, Shields C, Cronin A. Ultrasonographic and colour Doppler features of intrapancreatic splenic tissue in a cat. JFMS Open Rep 2022; 8:20551169221116869. [PMID: 36110287 PMCID: PMC9469764 DOI: 10.1177/20551169221116869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Case summary A 2-year-old female neutered domestic longhair cat was referred for a 3-day history of lethargy and anorexia. Physical examination documented abdominal distension and pain, which, alongside marked electrolyte imbalances on blood biochemistry, was highly suspicious for a gastrointestinal obstruction. This was confirmed on diagnostic imaging, with abdominal ultrasonography also identifying an incidental, well-defined small lobular hypoechoic nodule adjacent to the tail of the spleen, with high vascularity on Doppler interrogation. This was identified as a focal nodule at the tip of the left limb of the pancreas at surgery, and resected via partial pancreatectomy. Histopathological examination confirmed intrapancreatic splenic tissue. Relevance and novel information This case report presents the first available ultrasonographic description and images of intrapancreatic splenic tissue in a cat. It is thought to be a benign lesion of low clinical significance and therefore defining its imaging characteristics may allow for improvement in diagnostic suspicion without resorting to excisional surgery.
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Affiliation(s)
| | - Wiktoria Jamont
- Wear Referrals Veterinary Specialist and Emergency Hospital, part of Linnaeus Veterinary Limited, Bradbury, UK
| | - Claire Shields
- Wear Referrals Veterinary Specialist and Emergency Hospital, part of Linnaeus Veterinary Limited, Bradbury, UK
| | - Anna Cronin
- Wear Referrals Veterinary Specialist and Emergency Hospital, part of Linnaeus Veterinary Limited, Bradbury, UK
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Vandekerckhove E, Ameloot E, Hoorens A, De Man K, Berrevoet F, Geboes K. Intrapancreatic accessory spleen mimicking pancreatic NET: can unnecessary surgery be avoided? Acta Clin Belg 2021; 76:492-495. [PMID: 32394810 DOI: 10.1080/17843286.2020.1762351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pancreatic nodules are frequently found incidentally and often pose a diagnostic and therapeutic challenge when surgery is considered. We present the case of a 66-year-old cirrhotic patient with a pancreatic nodule with signal intensity and contrast enhancement pattern suggestive for a non-functional neuroendocrine lesion. A 68Gallium-DOTATOC PET-CT scan revealed a correspondent focal tracer uptake in the pancreatic tail. After distal pancreatectomy, the specimen surprisingly revealed intrapancreatic splenic tissue. Nuclear imaging has previously been reported to produce a false-positive result for the presence of a neuroendocrine tumor when an intrapancreatic accessory spleen is present. This case reminds us of the diagnostic pitfalls in pancreatic nodules, to consider a broad differential diagnosis and to remain critical before referring the patient for surgery.
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Affiliation(s)
| | - Eline Ameloot
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Anne Hoorens
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Kathia De Man
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Frederik Berrevoet
- Department of Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium
| | - Karen Geboes
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
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Hernando D, Zhang Y, Pirasteh A. Quantitative diffusion MRI of the abdomen and pelvis. Med Phys 2021; 49:2774-2793. [PMID: 34554579 DOI: 10.1002/mp.15246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/05/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022] Open
Abstract
Diffusion MRI has enormous potential and utility in the evaluation of various abdominal and pelvic disease processes including cancer and noncancer imaging of the liver, prostate, and other organs. Quantitative diffusion MRI is based on acquisitions with multiple diffusion encodings followed by quantitative mapping of diffusion parameters that are sensitive to tissue microstructure. Compared to qualitative diffusion-weighted MRI, quantitative diffusion MRI can improve standardization of tissue characterization as needed for disease detection, staging, and treatment monitoring. However, similar to many other quantitative MRI methods, diffusion MRI faces multiple challenges including acquisition artifacts, signal modeling limitations, and biological variability. In abdominal and pelvic diffusion MRI, technical acquisition challenges include physiologic motion (respiratory, peristaltic, and pulsatile), image distortions, and low signal-to-noise ratio. If unaddressed, these challenges lead to poor technical performance (bias and precision) and clinical outcomes of quantitative diffusion MRI. Emerging and novel technical developments seek to address these challenges and may enable reliable quantitative diffusion MRI of the abdomen and pelvis. Through systematic validation in phantoms, volunteers, and patients, including multicenter studies to assess reproducibility, these emerging techniques may finally demonstrate the potential of quantitative diffusion MRI for abdominal and pelvic imaging applications.
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Affiliation(s)
- Diego Hernando
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Yuxin Zhang
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ali Pirasteh
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Pirasteh A, Lovrec P, Bodei L. Imaging of neuroendocrine tumors: A pictorial review of the clinical value of different imaging modalities. Rev Endocr Metab Disord 2021; 22:539-552. [PMID: 33783695 DOI: 10.1007/s11154-021-09631-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 02/07/2023]
Abstract
Neuroendocrine tumors (NETs) are multifaceted tumors occurring in a variety of organs and often present as metastatic at the time of diagnosis. Accurate staging is the most significant factor in therapy planning, but it remains a challenge. Imaging is established as the cornerstone for disease detection/diagnosis, staging, and follow up. To accurately assess and monitor tumor burden in patients with NETs, various imaging techniques have been developed and optimized. Current recommendations for the imaging of patients with NETs include a combination of both morphologic (or anatomic) and molecular imaging, but a final choice can be puzzling for clinicians. Recognizing that there is no uniform sequence consensus on the "best" imaging test, and the heterogeneity of technologic availability at different centers, we hope to provide a pictorial review of the different imaging techniques and their role and utility in management of patients with NETs, aimed to provide a practical guide for all clinicians.
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Affiliation(s)
- Ali Pirasteh
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States.
| | - Petra Lovrec
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Lisa Bodei
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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Essentials of Insulinoma Localization with Selective Arterial Calcium Stimulation and Hepatic Venous Sampling. J Clin Med 2020; 9:jcm9103091. [PMID: 32992761 PMCID: PMC7601191 DOI: 10.3390/jcm9103091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 12/25/2022] Open
Abstract
Insulinomas are the most common functional pancreatic neuroendocrine tumor. Most insulinomas can be localized non-invasively with cross-sectional and nuclear imaging. Selective arterial calcium stimulation and hepatic venous sampling is an effective and safe minimally-invasive procedure for insulinoma localization that may be utilized when non-invasive techniques are inconclusive. The procedure’s technical success and proper interpretation of its results is dependent on the interventional radiologist’s knowledge of normal and variant pancreatic arterial perfusion. Accurate pre-operative localization aids in successful surgical resection. Technical and anatomic considerations of insulinoma localization with selective arterial calcium stimulation and hepatic venous sampling are reviewed.
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Gilani SM, Muniraj T, Farrell JJ, Aslanian HR, Cai G. Endoscopicultrasound‐guidedfine needle aspiration of accessory spleen: Cytomorphologic features and diagnostic considerations. Diagn Cytopathol 2020; 48:623-628. [DOI: 10.1002/dc.24434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/09/2020] [Accepted: 03/27/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Syed M. Gilani
- Department of PathologyYale School of Medicine New Haven Connecticut USA
| | - Thiruvengadam Muniraj
- Department of Internal Medicine, Section of Digestive DiseasesYale School of Medicine New Haven Connecticut USA
| | - James J. Farrell
- Department of Internal Medicine, Section of Digestive DiseasesYale School of Medicine New Haven Connecticut USA
| | - Harry R. Aslanian
- Department of Internal Medicine, Section of Digestive DiseasesYale School of Medicine New Haven Connecticut USA
| | - Guoping Cai
- Department of PathologyYale School of Medicine New Haven Connecticut USA
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Lancellotti F, Sacco L, Cerasari S, Bellato V, Cicconi S, Ciardi A, Muttillo EM, Feola T, Caronna R, Chirletti P. Intrapancreatic accessory spleen false positive to 68Ga-Dotatoc: case report and literature review. World J Surg Oncol 2019; 17:117. [PMID: 31288823 PMCID: PMC6617599 DOI: 10.1186/s12957-019-1660-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/28/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Intrapancreatic accessory spleen (IPAS) is an uncommon finding of pancreatic mass. Differential diagnosis with pancreatic tumor, especially with non-functional neuroendocrine tumor (NF-NET), may be very hard and sometimes it entails unnecessary surgery. A combination of CT scan, MRI, and nuclear medicine can confirm the diagnosis of IPAS. 68-Ga-Dotatoc PET/CT is the gold standard in NET diagnosis and it can allow to distinguish between IPAS and NET. CASE PRESENTATION A 69-year-old man was admitted to our hospital for an incidental nodule in the tail of the pancreas with focal uptake of 68-Ga-dotatate at PET/CT. NET was suspected and open distal splenopancreatectomy was performed. Pathologic examination revealed an IPAS. CONCLUSION This is the second IPAS case in which a positive 68Ga-Dotatoc uptake led to a false diagnosis of pancreatic NET. Here is a proposal of a literature review.
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Affiliation(s)
- Francesco Lancellotti
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Luca Sacco
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Saverio Cerasari
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Vittoria Bellato
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Simone Cicconi
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Antonio Ciardi
- Department of Radiological Oncological and Pathological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Edoardo Maria Muttillo
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Tiziana Feola
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Roberto Caronna
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Piero Chirletti
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
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Chavan N, Desai GS, Tampi C, Wagle P. Intrapancreatic accessory spleen: an enigmatic entity. BMJ Case Rep 2019; 12:12/3/e228510. [PMID: 30898942 DOI: 10.1136/bcr-2018-228510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Solitary hypervascular lesion in the distal body/tail of pancreas in a patient with non-specific abdominal symptoms is a diagnostic challenge. Neuroendocrine neoplasm (NEN) and metastasis from renal cell carcinoma are the most common differentials and intrapancreatic accessory spleen (IPAS) is the rarest of its differential diagnosis. We present, here, a case of a 56-year-old man with a space-occupying lesion in body/tail of pancreas that was preoperatively diagnosed as a NEN based on elevated chromogranin levels and hyperenhancing lesion on contrast-enhanced CT scan. He underwent a spleen-preserving distal pancreatectomy. The final histopathology revealed an IPAS.
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Affiliation(s)
- Namita Chavan
- Department of Gastrointestinal Surgery, Lilavati Hospital and Research Centre, Mumbai, India
| | - Gunjan Shailesh Desai
- Department of Gastrointestinal Surgery, Lilavati Hospital and Research Centre, Mumbai, India
| | - Chandralekha Tampi
- Department of Pathology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Prasad Wagle
- Department of Gastrointestinal Surgery, Lilavati Hospital and Research Centre, Mumbai, India
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10
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Kim GE, Morris JD, Anand N, DePalma F, Greenwald BD, Kim RE, Laczek J, Lee WJ, Papadopoulas I, Uradomo L, Young P, Darwin PE. Recognizing intrapancreatic accessory spleen via EUS: Interobserver variability. Endosc Ultrasound 2019; 8:392-397. [PMID: 31417068 PMCID: PMC6927143 DOI: 10.4103/eus.eus_35_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background and Objective: Accessory spleen (AS) may be encountered as an intrapancreatic lesion on EUS. This can look similar to other pancreatic pathologies and may lead to unnecessary interventions. The goal of this study was to evaluate the accuracy of EUS in distinguishing intrapancreatic AS (IPAS) from other pancreatic lesions. Materials and Methods: Twelve sets of endoscopic images of the spleen and various pancreatic lesions confirmed on histology or cytology were gathered. Ten endosonographers were asked to characterize and identify the lesions. The responses were analyzed via Excel and the interobserver agreement was analyzed using Gwet's agreement coefficient statistic via Stata I/C v15. Results: In our sample, the interobserver agreement was 0.37 (−1–1; 0–0.2 poor, 0.2–0.4 fair, 0.4–0.6 moderate, 0.6–0.8 substantial, and 0.8–1.0 almost perfect) for determining whether or not the pancreatic lesion is IPAS. The reviewers were able to correctly determine IPAS endosonographically with a sensitivity of 77%, specificity of 74%, and positive and negative predictive values of 50% and 92%, respectively. Conclusion: There is a moderate-to-substantial interobserver agreement in describing the sonographic characteristics of the pancreatic lesions, such as the shape, echogenicity compared to spleen, echotexture, and border of the lesions. However, the interobserver agreement is only fair when deciding if the pancreatic lesion is an IPAS. The similar profile of IPAS and pancreatic neuroendocrine tumor could confound the diagnosis of IPAS, thus contributing to the decreased interobserver agreement. This study demonstrates that EUS criteria alone are not accurate for IPAS diagnosis. Fine-needle aspiration (FNA) may be required for a confirmatory diagnosis.
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Affiliation(s)
- Grace E Kim
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - John D Morris
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Naveen Anand
- Division of Gastroenterology and Hepatology, Norwalk Hospital, Norwalk, CT, USA
| | | | - Bruce D Greenwald
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Raymond E Kim
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jeffery Laczek
- Department of Gastroenterology, Walter Reed National Military Medical Center and Uniformed Services University, Bethesda, MD, USA
| | - Woo Jung Lee
- Department of Gastroenterology, Temple University Hospital, Philadelphia, PA, USA
| | | | - Lance Uradomo
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Patrick Young
- Department of Gastroenterology, Walter Reed National Military Medical Center and Uniformed Services University, Bethesda, MD, USA
| | - Peter E Darwin
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
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11
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Li BQ, Xu XQ, Guo JC. Intrapancreatic accessory spleen: a diagnostic dilemma. HPB (Oxford) 2018; 20:1004-1011. [PMID: 29843985 DOI: 10.1016/j.hpb.2018.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/17/2018] [Accepted: 04/29/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND As intrapancreatic accessory spleen (IPAS) is rarely encountered during clinical practice, the aim of this review was to summarize the epidemiologic features, the diagnosis and treatment of IPAS. METHODS MEDLINE and EMBASE were searched for articles reporting on IPAS. Categorical variables were reported as frequency and percentage. Continuous variables were reported as median (range). RESULTS A total of 105 patients were included, of which 73% were detected incidentally. The male/female ratio was 1.23. The size of IPAS in patients who had previously undergone splenectomy was larger than that of patients without prior splenectomy (2.5 cm vs 1.5 cm; p = 0.020). No preoperative examination was able to make a definite diagnosis for all IPASs. More than half of the patients (55%) received surgical treatment, most of which (87%) were suspected as pancreatic neuroendocrine tumors (p-net) preoperatively. CONCLUSIONS Although rare, IPAS should be considered in the differential of patients with suspected incidental p-net, especially if there has been a past history of splenectomy. Preoperative diagnosis is important as unnecessary surgery can be avoided. As it is difficult to make a definite diagnosis of IPAS by one single examination, multiple techniques may be required.
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Affiliation(s)
- Bing-Qi Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Xie-Qun Xu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Jun-Chao Guo
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China.
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12
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Ding Q, Ren Z, Wang J, Ma X, Zhang J, Sun G, Zuo C, Gu H, Jiang H. Intrapancreatic accessory spleen: Evaluation with CT and MRI. Exp Ther Med 2018; 16:3623-3631. [PMID: 30250526 DOI: 10.3892/etm.2018.6613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/23/2018] [Indexed: 01/05/2023] Open
Abstract
The aim of the present study was to evaluate the characteristics of computed tomography (CT) and magnetic resonance imaging (MRI), particularly diffusion-weighted imaging (DWI), in the imaging of intrapancreatic accessory spleen (IPAS). The clinical and pathological records of 9 patients, including 8 patients with IPAS and 1 patient with splenosis, were reviewed. The patients had undergone plain and triple-phase enhanced CT scanning (n=9) and MRI scanning (n=8). The lesions of the 8 IPAS patients were located in the pancreatic tail, and were round (n=3), oval (n=4) or triangular (n=1) in shape. The CT and/or MRI densities, signal intensities and dynamic enhanced patterns of the lesions were similar to those of the orthotopic spleen. In DWI images (n=5), the IPAS regions presented high signal intensity (SI), and no significant difference in the apparent diffusion coefficient determined using a b-value of 600 sec/mm2 was identified between the IPAS and orthotopic spleen (P>0.05). One patient with splenosis complicated with cirrhosis had a nodule located in the pancreatic tail with an unenhanced CT value of 65 HU. In MRI examination, with the exception of the dynamic enhancement pattern, the T1-weighted, T2-weighted and DWI signals of splenosis were inconsistent with those of the normal spleen. In conclusion, in pre-contrast and post-contrast-enhanced CT and MRI images, IPAS exhibits similar characteristics to the orthotopic spleen. CT and MRI used in combination with DWI are important in the diagnosis of IPAS.
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Affiliation(s)
- Qianjiang Ding
- Department of Radiology, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, Zhejiang 315020, P.R. China
| | - Zhihao Ren
- Department of Radiology, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, Zhejiang 315020, P.R. China
| | - Jianhua Wang
- Department of Radiology, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, Zhejiang 315020, P.R. China
| | - Xiaolong Ma
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Jian Zhang
- Department of Nuclear Medicine, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Gaofeng Sun
- Department of Nuclear Medicine, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Changjing Zuo
- Department of Nuclear Medicine, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Hao Gu
- Department of Pathology, Ningbo Second Hospital, Ningbo, Zhejiang 315010, P.R. China
| | - Hui Jiang
- Department of Pathology, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
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13
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Kriger AG, Gorin DS, Kaldarov AR, Berelavichus SV, Akhtanin AE. [Intrapancreatic accessory spleen]. Khirurgiia (Mosk) 2018:68-71. [PMID: 30113596 DOI: 10.17116/hirurgia2018868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Accessory spleen is the human growth anomaly, which appears in embryogenesis and frequently becomes an accidental finding during prophylactic medical examination. Pancreatic tail - the second frequent localization after the splenic hilus. Intrapancreatic accessory spleen can mimic the pancreatic tumor. AIM To demonstrate case series of intrapancreatic accessory spleen in course of differential diagnostic with pancreatic neuroendocrine tumor and metastasis of renal - cell cancer. MATERIAL AND METHODS Three patients with intrapancreatic accessory spleen were observed in abdominal department #1 A.V.Vishnevsky Institute of Surgery, - two females and one male. RESULTS Two patients were surgically treated: in the first case basing on preoperative anamnesis and diagnostic data diagnosis of renal - cell cancer metastasis was established, in the second case - nonfunctional pancreatic neuroendocrine tumor. In both cases robotic distal pancreatectomy was performed. There were no conversions. Postoperative recovery was accompanied by clinicaly not relevant pancreatic fistulas, which didn't increase length of hospitalization. In the third case during CT and MRI diagnosis of intrapancreatic accessory spleen was determined. Surgical treatment wasn't performed. Control examination showed an absence of dynamic of characteristics and growth. CONCLUSION Described cases demonstrate difficulty of differential diagnostics of tumor - like mass. Neuroendocrine tumors, renal - cell cancer metastases, solid pseudopapillary neoplasms and accessory spleen can have similar CT-characteristics. In appearance of differential diagnostic difficulties minimally invasive surgical treatment has to be performed.
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Affiliation(s)
- A G Kriger
- A.V. Vishnevsky Institute of Surgery of Healthcare Ministry, Moscow, Russian Federation
| | - D S Gorin
- A.V. Vishnevsky Institute of Surgery of Healthcare Ministry, Moscow, Russian Federation
| | - A R Kaldarov
- A.V. Vishnevsky Institute of Surgery of Healthcare Ministry, Moscow, Russian Federation
| | - S V Berelavichus
- A.V. Vishnevsky Institute of Surgery of Healthcare Ministry, Moscow, Russian Federation
| | - A E Akhtanin
- A.V. Vishnevsky Institute of Surgery of Healthcare Ministry, Moscow, Russian Federation
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14
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Nakagun S, Díaz-Delgado J, Groch KR, Kobayashi Y. Intrapancreatic accessory spleen in a harbor porpoise (Phocoena phocoena). J Vet Med Sci 2018; 80:701-705. [PMID: 29445074 PMCID: PMC5938203 DOI: 10.1292/jvms.17-0691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The occurrence of accessory spleens in cetacean species is high yet confirmed reports of
intrapancreatic accessory spleen, a congenital malformation, remain undescribed. The
current study provides the gross, microscopical, histochemical and immunohistochemical
features of an intrapancreatic accessory spleen in a harbor porpoise (Phocoena
phocoena). Grossly, a 17 × 18 × 9 mm well-demarcated, dark brown to red mass
expanded the left pancreatic lobe. Microscopically, this mass consisted of mature splenic
tissue interspersed with exocrine pancreatic acini. Intrapancreatic accessory spleens
should be considered in the list of differential diagnoses for intrapancreatic nodular
lesions in cetaceans.
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Affiliation(s)
- Shotaro Nakagun
- Laboratory of Veterinary Pathology, Department of Basic Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8555, Japan.,United Graduate School of Veterinary Sciences, Gifu University, Gifu, Gifu 501-1193, Japan
| | - Josué Díaz-Delgado
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, 05508-270, Brazil
| | - Kátia R Groch
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, 05508-270, Brazil
| | - Yoshiyasu Kobayashi
- Laboratory of Veterinary Pathology, Department of Basic Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8555, Japan
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Suriano S, Ceriani L, Gertsch P, Crippa S, Giovanella L. Accessory Spleen Mimicking a Pancreatic Neuroendocrine Tumor. TUMORI JOURNAL 2018; 97:39e-41e. [DOI: 10.1177/030089161109700625] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 60-year-old man underwent computed tomography as part of colorectal cancer follow-up. A hypervascular nodule was found within the pancreatic tail and subsequently proved to be positive on [111In] DTPA-octreotide scan. A neuroendocrine tumor of the pancreas was supposed and a distal pancreatectomy performed. Heterotopic splenic tissue was finally proved by pathological examination. The present case suggests that intrapancreatic accessory spleen be considered in the differential diagnosis of pancreatic lesions positive on [111In] DTPA-octreotide scan.
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Affiliation(s)
- Sergio Suriano
- Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona
| | - Luca Ceriani
- Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona
| | - Philippe Gertsch
- Visceral and General Surgery, Regional Hospital San Giovanni, Bellinzona
| | | | - Luca Giovanella
- Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona
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16
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Accuracy of apparent diffusion coefficient in differentiating pancreatic neuroendocrine tumour from intrapancreatic accessory spleen. Eur Radiol 2017; 28:1560-1567. [PMID: 29134352 DOI: 10.1007/s00330-017-5122-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/02/2017] [Accepted: 10/06/2017] [Indexed: 12/26/2022]
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17
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Krishna SG, Modi RM, Kamboj AK, Swanson BJ, Hart PA, Dillhoff ME, Manilchuk A, Schmidt CR, Conwell DL. In vivo and ex vivo confocal endomicroscopy of pancreatic cystic lesions: A prospective study. World J Gastroenterol 2017; 23:3338-3348. [PMID: 28566895 PMCID: PMC5434441 DOI: 10.3748/wjg.v23.i18.3338] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/21/2017] [Accepted: 04/12/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the reproducibility of the in vivo endoscopic ultrasound (EUS) - guided needle based confocal endomicroscopy (nCLE) image patterns in an ex vivo setting and compare these to surgical histopathology for characterizing pancreatic cystic lesions (PCLs). METHODS In a prospective study evaluating EUS-nCLE for evaluation of PCLs, 10 subjects underwent an in vivo nCLE (AQ-Flex nCLE miniprobe; Cellvizio, MaunaKea, Paris, France) during EUS and ex vivo probe based CLE (pCLE) of the PCL (Gastroflex ultrahigh definition probe, Cellvizio) after surgical resection. Biopsies were obtained from ex vivo CLE-imaged areas for comparative histopathology. All subjects received intravenous fluorescein prior to EUS and pancreatic surgery for in vivo and ex vivo CLE imaging respectively. RESULTS A total of 10 subjects (mean age 53 ± 12 years; 5 female) with a mean PCL size of 34.8 ± 14.3 mm were enrolled. Surgical histopathology confirmed 2 intraductal papillary mucinous neoplasms (IPMNs), 3 mucinous cystic neoplasms (MCNs), 2 cystic neuroendocrine tumors (cystic-NETs), 1 serous cystadenoma (SCA), and 2 squamous lined PCLs. Characteristic in vivo nCLE image patterns included papillary projections for IPMNs, horizon-type epithelial bands for MCNs, nests and trabeculae of cells for cystic-NETs, and a "fern pattern" of vascularity for SCA. Identical image patterns were observed during ex vivo pCLE imaging of the surgically resected PCLs. Both in vivo and ex vivo CLE imaging findings correlated with surgical histopathology. CONCLUSION In vivo nCLE patterns are reproducible in ex vivo pCLE for all major neoplastic PCLs. These findings add further support the application of EUS-nCLE as an imaging biomarker in the diagnosis of PCLs.
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18
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Serrano-Vicente J, Infante-Torre J, García-Bernardo L, Moreno-Caballero M, Martínez-Esteve A, Rayo-Madrid J. Pancreatic accessory spleen. False positive with 99mTc-Octreotide. Rev Esp Med Nucl Imagen Mol 2017. [DOI: 10.1016/j.remnie.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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19
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Serrano-Vicente J, Infante-Torre JR, García-Bernardo L, Moreno-Caballero M, Martínez-Esteve A, Rayo-Madrid JI. Pancreatic accessory spleen. False positive with 99mTc-Octreotide. Rev Esp Med Nucl Imagen Mol 2016; 36:53-55. [PMID: 27329561 DOI: 10.1016/j.remn.2016.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/04/2016] [Indexed: 11/28/2022]
Abstract
The case is presented on a patient with abdominal pain and suspicion of neuroendocrine tumor in the tail of the pancreas shown in the abdominal CT and MRI. Whole-body scintigraphy and abdominal SPECT/CT with 99mTc-octreotide were performed that showed a nodular lesion partially on the posterior side of the pancreas tail. This nodule showed faint tracer uptake, and was reported as probable neuroendocrine tumor. Partial pancreatectomy and splenectomy were performed, and the histological study identified the lesion as an ectopic spleen. There are similar cases in the literature that match these findings, but this lesion is still frequently diagnosed after performing unnecessary surgery. When an asymptomatic intrapancreatic mass is detected, an accessory spleen should be considered and specific diagnostic techniques should be performed, such as labeled and denatured red blood cell SPECT/CT.
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Affiliation(s)
- J Serrano-Vicente
- Nuclear Medicine Department, Infanta Cristina Hospital, Badajoz, Spain.
| | - J R Infante-Torre
- Nuclear Medicine Department, Infanta Cristina Hospital, Badajoz, Spain
| | - L García-Bernardo
- Nuclear Medicine Department, Infanta Cristina Hospital, Badajoz, Spain
| | | | - A Martínez-Esteve
- Nuclear Medicine Department, Infanta Cristina Hospital, Badajoz, Spain
| | - J I Rayo-Madrid
- Nuclear Medicine Department, Infanta Cristina Hospital, Badajoz, Spain
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20
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Endoscopic Ultrasound-Guided Needle-Based Probe Confocal Laser Endomicroscopy (nCLE) of Intrapancreatic Ectopic Spleen. ACG Case Rep J 2016; 3:196-8. [PMID: 27144203 PMCID: PMC4843155 DOI: 10.14309/crj.2016.48] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 12/09/2015] [Indexed: 12/11/2022] Open
Abstract
Accessory spleens and splenosis represent the congenital and acquired type of ectopic splenic tissue. Generally, they are asymptomatic entities posing as solid hypervascular masses at the splenic hilum or in other organs, such as the pancreas. Intrapancreatic ectopic spleen mimics pancreatic neoplasms on imaging studies, and due to the lack of radiological diagnostic criteria, patients undergo unnecessary distal pancreatectomy. We present the first case of intrapancreatic ectopic spleen in which the concomitant use of needle-based probe confocal laser endomicroscopy and fine-needle aspiration supported the final diagnosis.
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21
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Lü YF, Han BB, Yu HL, Cui ZH, Li ZW, Wang JX. Accessory spleen appearing as an intrasplenic pseudo-tumoral mass: A rare case report. Oncol Lett 2015; 10:982-984. [PMID: 26622609 DOI: 10.3892/ol.2015.3331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 04/14/2015] [Indexed: 11/06/2022] Open
Abstract
The current study presents a rare case of an accessory spleen that manifested as a solid intrasplenic pseudotumor. The affected patient was previously healthy. Upon examination with computed tomography (CT), an ovoid, soft-tissue mass of ~4.1 cm in diameter was found on the upper pole of the spleen. Biochemical indices, such as blood routine and coagulation tests, and tumor marker analysis, revealed no abnormalities. Another CT scan was performed, but this failed to indicate whether the mass was benign or malignant. Therefore, the lesion was resected along with the spleen by laparoscopic surgery. The resected sample was subject to pathological examinations for final validation, and was finally diagnosed as an accessory spleen. The patient was followed up for six months with no signs of recurrence.
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Affiliation(s)
- Yan-Feng Lü
- Department of Anoproctology, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Bing-Bing Han
- Microcirculation Laboratory, Shangdong University of Traditional Chinese Medicine, Jinan, Shandong 250014, P.R. China
| | - Hua-Long Yu
- Department of Anoproctology, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Zhen-Hua Cui
- Department of Anoproctology, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Zhi-Wen Li
- Department of Anoproctology, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Jian-Xin Wang
- Department of Anoproctology, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
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22
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Intrapancreatic accessory spleen: possibilities of computed tomography in differentiation from nonfunctioning pancreatic neuroendocrine tumor. J Comput Assist Tomogr 2015; 38:874-8. [PMID: 24979264 DOI: 10.1097/rct.0000000000000127] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the ability of computed tomography (CT) in differentiating between intrapancreatic accessory spleen (IPAS) from pancreatic neuroendocrine tumor (PanNET). METHODS Eight IPASs and 12 PanNETs in the pancreatic tail were retrospectively evaluated by 2 radiologists. Readers assigned a diagnosis to each examination and evaluated for the presence or absence of 9 CT findings that may aid in the diagnosis. RESULTS Reader 1 had a sensitivity of 0.83 and a specificity of 1; reader 2 had a sensitivity of 0.78 and a specificity of 0.86. Three of the 9 CT findings were found to be statistically significant in IPASs: the lesion present along the pancreatic dorsal surface, the lesion demonstrating the same enhancement as the spleen on venous phase, and heterogeneous enhancement during arterial phase. CONCLUSIONS CT can be used to differentiate between IPAS and PanNET with good specificity and sensitivity. The IPAS mirrors the spleen's enhancement and is usually located along the dorsal surface of the pancreas.
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23
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Kang BK, Kim JH, Byun JH, Lee SS, Kim HJ, Kim SY, Lee MG. Diffusion-weighted MRI: usefulness for differentiating intrapancreatic accessory spleen and small hypervascular neuroendocrine tumor of the pancreas. Acta Radiol 2014; 55:1157-65. [PMID: 24259300 DOI: 10.1177/0284185113513760] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Image findings of intrapancreatic accessory spleen (IPAS) can closely resemble those of neuroendocrine tumor (NET) of the pancreas. PURPOSE To investigate the usefulness of diffusion-weighted imaging (DWI) for differentiating IPAS from small (≤3 cm) hypervascular NET of the pancreas. MATERIAL AND METHODS The visually assessed signal intensity of pancreatic lesions compared with the spleen on DWI (b value of 1000 s/mm(2)) and the apparent diffusion coefficient (ADC) values were compared in 25 patients with IPAS and 31 patients with small hypervascular NET. Two blinded radiologists independently rated their confidence in differentiating the two conditions and compared the diagnostic performance of contrast-enhanced magnetic resonance imaging (CE-MRI) alone with that of combined CE-MRI and DWI. RESULTS The isointensity of the pancreatic lesions compared with the spleen on DWI was more frequently observed in IPAS than in NET (92% vs. 12.9%, P < 0.001). The mean ADC value was significantly lower in IPAS than in NET (0.90 × 10(-3) mm(2)/s vs. 1.44 × 10(-3) mm(2)/s, P < 0.001). The sensitivity and specificity of ADC quantification for differentiating the two conditions when using 1.07 × 10(-3) mm(2)/s as the cut-off value were 96% and 93.5%, respectively. For both readers, the area under the receiver operating characteristic curve and accuracy in differentiating the two conditions of combined CE-MRI and DWI were significantly greater than those of CE-MRI alone (P ≤ 0.039). CONCLUSION Visual assessment of DWI and ADC quantification were useful in differentiating IPAS from small hypervascular NET of the pancreas.
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Affiliation(s)
- Bo-Kyeong Kang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jin Hee Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jae Ho Byun
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hyoung Jung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Moon-Gyu Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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24
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Ardengh JC, Lopes CV, Kemp R, Lima-Filho ER, Venco F, Santos JSD. Pancreatic splenosis mimicking neuroendocrine tumors: microhistological diagnosis by endoscopic ultrasound guided fine needle aspiration. ARQUIVOS DE GASTROENTEROLOGIA 2013; 50:10-14. [PMID: 23657300 DOI: 10.1590/s0004-28032013000100003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Accepted: 10/02/2012] [Indexed: 11/22/2022]
Abstract
CONTEXT Pancreatic splenosis is a benign condition which can mimic a pancreatic neoplasm. OBJECTIVE To describe the role of the endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic nodules suspicious for pancreatic splenosis. METHOD From 1997 to 2011, patients with pancreatic solid tumors suspicious for splenosis by computed tomography and/or magnetic resonance imaging were referred to EUS-FNA. Those cases with pancreatic splenosis confirmed by EUS-FNA or surgery were included. Endosonographic findings and clinicopathologic features were also analysed. RESULTS A total of 2,060 patients with pancreatic solid tumors underwent EUS-FNA. Fourteen (0.6%) cases with pancreatic splenosis were found. After applying exclusion criteria, 11 patients were selected. Most patients were male (7), young (mean age: 42 years) and asymptomatic (8). Endoscopic ultrasound imaging alone suspected pancreatic splenosis in 6 cases, and neuroendocrine tumors in 5 cases. Pancreatic splenosis was found most commonly in the tail, was round, hypoechoic, with homogeneous pattern, regular borders, and with scintigraphy negative for somatostatin receptors. The average diameter of these nodules identified by endoscopic ultrasound was 2.15 cm. Microhistology obtained by EUS-FNA confirmed the diagnosis in 9/10 patients. CONCLUSION Pancreatic splenosis can be diagnosed by EUS-FNA. Microhistology prevents unnecessary surgeries, and reassures asymptomatic patients with hypoechoic, homogeneous, and well circumscribed pancreatic nodules.
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25
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Kawamoto S, Johnson PT, Hall H, Cameron JL, Hruban RH, Fishman EK. Intrapancreatic accessory spleen: CT appearance and differential diagnosis. Abdom Radiol (NY) 2012; 37:812-27. [PMID: 22160284 DOI: 10.1007/s00261-011-9830-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Although autopsy studies report that the second most common site of the accessory spleen is in the tail of the pancreas, intrapancreatic accessory spleens (IPASs) are rarely recognized radiologically. With recent improvements in imaging techniques, IPASs are more commonly detected on imaging studies. IPAS can be mistaken for other type of mass-forming lesions in the tail of the pancreas, particularly an asymptomatic small neuroendocrine neoplasm. Rarely, an epidermoid cyst originating from IPAS may simulate other cystic pancreatic lesion. Accurate preoperative diagnosis would obviate unnecessary surgery. IPAS should be considered when a hypervascular mass is seen in the tail of the pancreas on CT. Typical location, similar attenuation of the lesion to the spleen on noncontrast, and postcontrast CT at different phases are helpful to make diagnosis of IPAS. In particular, characteristic heterogeneous contrast enhancement of IPAS on the arterial phase may be helpful for correct diagnosis. However, when it remains difficult to exclude the other diagnosis, (99m)Tc labeled heat-damaged red blood cell scintigraphy or superparamagnetic iron oxide-enhanced MRI can be used to confirm the diagnosis of IPAS.
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26
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Tatsas AD, Owens CL, Siddiqui MT, Hruban RH, Ali SZ. Fine-needle aspiration of intrapancreatic accessory spleen: Cytomorphologic features and differential diagnosis. Cancer Cytopathol 2012; 120:261-8. [DOI: 10.1002/cncy.21185] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 11/16/2011] [Accepted: 11/23/2011] [Indexed: 11/09/2022]
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27
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Conway AB, Cook SM, Samad A, Attam R, Pambuccian SE. Large platelet aggregates in endoscopic ultrasound-guided fine-needle aspiration of the pancreas and peripancreatic region: a clue for the diagnosis of intrapancreatic or accessory spleen. Diagn Cytopathol 2011; 41:661-72. [PMID: 22045629 DOI: 10.1002/dc.21832] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 08/09/2011] [Indexed: 11/06/2022]
Abstract
Intrapancreatic and intraabdominal accessory spleens (IPIASs) are rarely encountered in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsies. However, as incidentally discovered IPIAS can mimic a benign or malignant pancreatic neoplasm on imaging studies, a definitive diagnosis made by EUS-FNA can avert an unnecessary surgical intervention or additional radiologic follow-up. We report five cases of intrapancreatic splenules and one case of accessory spleen (AS) in which a definitive diagnosis was made on EUS-FNA. Previously recognized FNA cytomorphologic features of splenic tissue, including ASs and splenosis, are endothelial cells and polymorphous lymphocytes admixed with neutrophils, eosinophils, plasma cells, histiocytes, and lymphoglandular bodies. We describe the additional finding of abundant large platelet aggregates as another distinguishing feature of splenic tissue on FNA. In all six cases, large platelet aggregates were identified along with polymorphous lymphoid cells, lymphoglandular bodies, loose aggregates of endothelial cells and scattered or aggregated bland spindle cells. A review of 10 consecutive cases of EUS-FNA-sampled benign intraabdominal lymph nodes showed that the presence of large platelet aggregates, three-dimensional aggregates of lymphoid cells and of bland slender spindle cells and the absence of follicular germinal cell components (tingible body macrophages and lymphohistiocytic aggregates) are useful in differentiating IPIASs from reactive lymph nodes. Immunoperoxidase stains were useful to confirm a suspected IPIASs by showing CD31-positive acellular flocculent material, consistent with large platelet aggregates and a rich CD8-positive endothelial cell network between CD45-positive lymphoid cells and CD68-positive histiocytes in all six cases.
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Affiliation(s)
- Andrea B Conway
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Abstract
OBJECTIVES Intrapancreatic accessory spleen is a benign lesion that mimics hypervascular or cystic pancreatic neoplasm. A comprehensive clinicopathologic analysis has not yet been reported. METHODS We described the clinicopathologic characteristics of 12 cases of pathologically proven intrapancreatic accessory spleen, among which 6 had internal epidermoid cysts. Immunohistochemistry was done to clarify the origin of epidermoid cysts. RESULTS Most cases were incidentally detected in young adults. Two-thirds of cases with intra-lesional cysts showed elevated serum carbohydrate antigen 19-9 levels. Radiologically, heterogeneously enhancing a solid portion similar to the spleen was a helpful, but not convincing, feature. Grossly, a well-circumscribed dark red mass with or without cysts in the pancreatic tail was characteristic. Microscopically, small foci of pancreatic tissue were embedded within the splenic tissue. Epidermoid cysts consisted of modified squamous epithelium, some of which had intracellular mucin. Cytologic smears showed large aggregates of benign spindle cells that were reactive against CD8. Immunohistochemical staining of the cystic epithelium suggested its pancreatic ductal origin. CONCLUSIONS Intrapancreatic accessory spleen with or without epidermoid cyst should be considered as differential diagnoses when well-enhanced solid or cystic tumors are found in the pancreatic tail. Radiologic suspicion and preoperative aspiration or biopsy might minimize the need for unnecessary surgery.
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29
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Zhang C, Zhang XF. Accessory spleen in the greater omentum. Am J Surg 2011; 202:e28-30. [PMID: 21784408 DOI: 10.1016/j.amjsurg.2010.06.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 06/29/2010] [Accepted: 06/29/2010] [Indexed: 11/24/2022]
Abstract
Although accessory spleen is a frequently encountered entity, accessory spleen in the greater omentum is rare. A 22-year-old woman presented with dull pain in the left upper abdomen. Cross-sectional imaging studies with 3-dimensional reconstruction suggested the presence of a huge tumor in the greater omentum that was associated with the spleen. At laparotomy, the diagnosis of accessory spleen was made. This accessory spleen was unusual in its size and location. Awareness of this entity and familiarity with typical imaging findings is mandatory for preoperative diagnosis. The importance of recognition and appropriate confirmatory diagnosis of an accessory spleen is discussed.
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Affiliation(s)
- Cheng Zhang
- Department of General Surgery, The General Hospital of ShenYang Military Command, Number 83 Wenhua Rd., Shenhe District, ShenTang, Liaoning, 110016 People’s Republic of China.
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30
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Lin J, Jing X. Fine-needle aspiration of intrapancreatic accessory spleen, mimic of pancreatic neoplasms. Arch Pathol Lab Med 2010; 134:1474-8. [PMID: 20923303 DOI: 10.5858/2010-0238-cr.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intrapancreatic accessory spleen (IPAS) is a congenital abnormality, which mimics neoplasm. Distinguishing IPAS from pancreatic neoplasm/malignancy is extremely important from a treatment perspective. We report the case of a 67-year-old asymptomatic man who had a 1.3-cm, incidentally detected, pancreatic tail mass. The mass was round, well-circumscribed, and hypervascular with uniform enhancement. The image findings were highly suggestive of a pancreatic endocrine neoplasm. An endoscopic ultrasound-guided fine-needle aspiration was performed. Conventional smears revealed a polymorphous population of lymphocytes admixed with a subset of other inflammatory cells. Hematoxylin-eosin–stained cell block sections showed conspicuous thin-walled blood vessels in addition to inflammatory cells. Immunostaining for CD8 demonstrated strong positivity in endothelial cells of the thin-walled vessels. By correlating the cytologic findings with the result of immunostaining, we rendered the diagnosis of IPAS. Our experience supports the view that endoscopic ultrasound-guided fine-needle aspiration may enable a reliable, preoperative diagnosis of IPAS and thus prevent unnecessary surgery.
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Affiliation(s)
- Jingmei Lin
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI 48109, USA.
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Kurmann A, Michel JM, Stauffer E, Egger B. Intrapancreatic Accessory Spleen Misdiagnosed as a Nonsecreting Endocrine Tumor: Case Report and Review of the Literature. Case Rep Gastroenterol 2010; 4:210-214. [PMID: 20805946 PMCID: PMC2929417 DOI: 10.1159/000318857] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In a large series of nonselected autopsy investigations an accessory spleen was found in 10–30%. The second most common site is the pancreatic tail (17%). We report a case of intrapancreatic accessory spleen misdiagnosed as a nonsecreting neuroendocrine tumor of the pancreas. Nuclear scintigraphy may provide the definitive diagnosis of an intrapancreatic spleen and therefore prevent patients from unnecessary major surgery.
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Affiliation(s)
- Anita Kurmann
- Department of Surgery, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
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32
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Accesory Spleen - Incidence, Localization and Clinical Significance. POLISH JOURNAL OF SURGERY 2010. [DOI: 10.2478/v10035-010-0074-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Spencer LA, Spizarny DL, Williams TR. Imaging features of intrapancreatic accessory spleen. Br J Radiol 2009; 83:668-73. [PMID: 19690077 DOI: 10.1259/bjr/20308976] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Although accessory spleens are commonly identified on CT, intrapancreatic accessory spleen (IPAS) is often not recognised or is mistaken for other pancreatic lesions. Currently, with improved cross-sectional techniques and spatial resolution, IPAS is more detectable. We report the imaging features and work-up for the differentiation between IPAS and other pancreatic lesions. An index case of a suspected pancreatic tail islet cell tumour, subsequently confirmed as IPAS, led to inquiries into the incidence of IPAS and the means of preventing unnecessary surgery. For 2 years, we searched for IPAS during our daily interpretations and compared these cases with those taken from our institution's database to determine the distinguishing characteristics. Three proven cases of IPAS, which mimicked pancreatic tail lesions on CT, are presented. Nine patients with suspected IPAS, based on imaging characteristics and stability, are also described. All cases of IPAS are well defined, 1-3 cm in size, follow the density and intensity of the spleen on CT and MRI, and accumulate technetium-99m ((99)Tc(m)) sulphur colloid and (99)Tc(m) heat damaged red blood cell scintigraphy (in contrast to other lesions). In conclusion, radiologists should be aware that a subtle pancreatic tail lesion could be an IPAS. A high index of suspicion will lead to correlative imaging. A combination of CT, MRI and nuclear medicine examinations can confirm the diagnosis and prevent unnecessary surgery.
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34
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Kavic SM, Park A. Intrapancreatic accessory spleen: deficiency in diagnosis or therapeutic success? J Gastrointest Surg 2009; 13:396; author reply 397. [PMID: 19057966 DOI: 10.1007/s11605-008-0764-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Accepted: 11/12/2008] [Indexed: 01/31/2023]
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Happel B, Niederle B, Puespoek A, Ba-Ssalamah A, Schima W. Benigne neuroendokrine und andere seltene benigne Tumoren des Pankreas. Radiologe 2008; 48:752-63. [DOI: 10.1007/s00117-008-1672-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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