Radiologic findings of intrapancreatic accessory spleen

Öz

Introduction: Accessory spleen is an anomaly that observed in about 10% of individuals by the autopsy study,and the most of the accessory spleens are located close to the splenic hilum. Although the accessory spleen is a frequently encountered entity, intrapancreatic accessory spleen (IPAS) is rarely recognized radiologically and which is sometimes misdiagnosed pancreatic neoplasms. We present a case of IPAS which radiologically mimicking a pancreatic tumor in the tail of the pancreas.

Case report: A 45 year-old man who presented with abdominal pain scanned with abdominal US, CT and MRI. On US a well defined hypoechoic mass, measuring 10x12 mm in diameter that was located in the tail of the pancreas. Enhanced CT showed a well-defined and homogeneously enhanced tumor, about 10 mm in size in the tail of the pancreas. A well-defined 10 mm,solid, enhancing mass was identified on MR images, and for all sequences, was of similar signal intensity as that of the spleen.

Discussion: Accessory spleen is a congenital abnormality consisting of normal splenic tissue in ectopic sites. They are found most commonly near the splenic hilum. One in every six accessory spleens is located in the tail of the pancreas. The diagnosis of an IPAS should be considered when a pancreatic mass has the CT densities and/or MRI signal intensities similar to those of the spleen, with and without contrast medium.

 

Anahtar Kelimeler

• accessory spleen, pancreas, ultrasound(US), computed tomography(CT), magnetic resonance imaging (MRI)

Kaynakça

1. Dodds WJ, Taylor AJ, Erickson SJ, Stewart ET, Lawson TL. Radiologic imaging of splenic anomalies. AJR Am J Roentgenol. 1990;155(4):805-10.
2. Choi SK, Ahn SI, Hong KC, Kim TS, Woo ZH, Shin SH. A case of epidermoid cyst of the intrapancreatic accessory spleen..J Korean Med Sci.2000;15(5):589-92.
3. Guo W, Han W, Liu J, Jin L, Li JS, Zhang ZT, WangY. Intrapancreatic accessory spleen:a case report and review of the literature..World J Gastroenterol.2009 7;15(9):1141-3.
4. Uchiyama S, Chijiiwa K, Hiyoshi M, Ohuchida J, Imamura N, Nagano M, et al. Intrapancreatic accessory spleen mimicking endocrine tumor of the pancreas:case report and review of the literature. J Gastrointest Surg. 2008;12(8):1471-3.
5. Sonomura T, Kataoka S, Chikugo T, Hirooka T, Makimoto S, Nakamoto T, et al. Epidermoid cyst originating from an intrapancreatic accessory spleen. Abdom Imaging. 2002;27(5):560-2.
6. Furukawa H, Kosuge T, Kanai Y, Mukai K. Epidermoid cyst in an intrapancreatic accessory spleen: CT and pathologic findings. AJR Am J Roentgenol. 1998;171(1):271.
7. Kanazawa H, Kamiya J, Nagino M, Uesaka K, Yuasa N, Oda K, Arai T, Nishio H, Nimura Y. Epidermoid cyst in an intrapancreatic accessory spleen: a case report. J. Hepatobiliary Pancreatic Surg. 2004;11(1):61-3.
8. Kim SH, Lee JM, Han JK, Lee JY, Kim KW, Cho KC, et al. Intrapancreatic accessory spleen: findings on MR Imaging, CT, US and scintigraphy, and the pathologic analysis. Korean J Radiol. 2008;9(2):162-74.

9. Guo W, Han W, Liu J, Jin L, Li JS, Zhang ZT, WangY. Intrapancreatic accessory spleen:a case report and review of the literature..World J Gastroenterol.2009 7;15(9):1141-3.
10. Churei H, Inoue H, Nakajo M. Intrapancreatic accessory spleen:case report.
11. Abdom Imaging. 1998;23(2):191-3.
12. Ota T, Tei M, Yoshioka A, Mizuno M, Watanabe S, Seki M, et al. Intrapancreatic accessory spleen diagnosed by technetium-99m heat-damaged red blood cell SPECT. J Nucl Med. 1997;38(3):494-5.
13. Kim SH, Lee JM, Han JK, Lee JY, Kang WJ, Jang JY, et al. MDCT and superparamagnetic iron oxide (SPIO)-enhanced MR findings of intrapancreatic accessory spleen in seven patients. Eur Radiol. 2006;16(9):1887-97.