An extremely rare case of an oversized accessory spleen: case report and review of the literature

An unusual presentation of accessory spleen mimicking a pancreatic neoplastic lesion in a splenectomized patient: A case report

Accessory spleen is a relatively common occurrence. However, an intrapancreatic accessory spleen can get hypertrophied following splenectomy and rarely mimic a pancreatic neoplasm leading to misdiagnosis. Here we present a 64-year-old male who had undergone left radical nephrectomy and splenectomy for renal cell carcinoma 14 years back, presenting with upper abdominal discomfort. He was found to have a mass in the pancreatic tail on imaging, suggesting an intrapancreatic neoplastic lesion. After a multidisciplinary team decision based on contrast-enhanced computed tomography and magnetic resonance imaging, he underwent an uncomplicated distal pancreatectomy, and the histology revealed an intrapancreatic accessory spleen. Contrast-enhanced computed tomography, magnetic resonance imaging, and positron emission tomography alone is not specific enough to confidently differentiate an accessory spleen preoperatively. Nuclear scintigraphy fused with contrast-enhanced computed tomography provides more specific and better anatomically localized evidence. Ultrasound-guided fine needle sampling showing lymphocytes with subsets of histiocytes, plasma cells, and immunohistochemistry showing CD8 positivity can be used to guide the definitive diagnosis. Differentiating an accessory spleen from a pancreatic neoplasm may be challenging preoperatively. Accessory spleen needs to be considered in the differential diagnosis of upper abdominal masses especially in patients who have undergone splenectomy.

Posttraumatic thoracic splenosis in a 77-year-old patient after a motor vehicle accident

We present a rare case of autotransplantation of splenic tissue to the thoracic cavity, concerning for lung tumor, after splenic and diaphragmatic injury following a severe motor vehicle accident 27 years previous.

Case report: Misdiagnosis of accessory spleen in the left adrenal region as an adrenal tumour after splenectomy

Background

Adrenal tumours are common in urology and endocrinology, and the diagnosis of adrenal tumours were mainly depends on imaging diagnosis. Howerver, misdiagnosis can still occur for some adrenal space-occupying lesions without specific manifestations or abnormal biochemical indexes.

Methods

We report the case of a 55-year-old patient with a soft-tissue mass in the left adrenal region, and have no specific manifestations or abnormalities in biochemical indexes. The patient had undergone open splenectomy 20 years ago for splenic rupture caused by traffic-accident trauma, and had a 10-year special history of hypertension. Because of the uncertain nature of the mass, surgical treatment was recommended.

Results

The surgeon managed to remove the left adrenal region mass. During the surgery, the adrenal source was excluded. In the histological examination, the splenic corpuscle and splenic medullary structure were seen under the microscope, and an accessory spleen was diagnosed.

Conclusions

The accessory spleen was located in the adrenal region rarely, and can easily be misdiagnosed as an adrenal tumour. When the cases show abnormal adrenal space-occupying lesions in imaging examinations, non-adrenal diseases should be considered. we need to combine different imaging techniques for analysis, and think more about it, avoid misdiagnosis leading to unnecessary surgery.

Rare case of upper gastrointestinal hemorrhage due to accessory spleen: A case report

RATIONALE

Upper gastrointestinal hemorrhage (UGIH) is defined as hemorrhage originating from the gastrointestinal tract proximal to the ligament of Treitz. The causes of UGIH include esophagitis, gastritis, peptic ulcers, Mallory-Weiss syndrome, and cancer. However, a rare cause of UGIH, such as an accessory spleen, may lead to serious complications if left untreated and can sometimes be very difficult to diagnose preoperatively.

PATIENT CONCERNS

An 18-year-old man was admitted to the Department of Gastroenterology of our hospital due to "repeated black stool for 2 months with aggravation, accompanied by hematemesis for 9 days." He denied any history of hepatitis, trauma, or surgery.

DIAGNOSIS

Laboratory evaluation revealed severe anemia (hemoglobin, 6.4 g/dL). Computed tomography revealed a mass measuring 127 mm in its largest dimension, located in the upper left abdomen, with varicose veins in the gastric fundus. Moreover, distended blue-purple tortuous veins were observed by gastroscopy in the gastric fundus. We believed the mass was likely an abnormally proliferating accessory spleen; however, the causes of severe anemia and gastrointestinal hemorrhage were unknown.

INTERVENTIONS

After discussion in a multidisciplinary conference, the mass was completely resected laparoscopically, and the subserosal veins in the gastric fundus were sutured using absorbable threads.

OUTCOMES

After the surgery, the patient recovered uneventfully without any complications. Clinicopathological examination showed that the mass was chronic congestive splenomegaly. Gastrointestinal hemorrhage secondary to an abnormally proliferating accessory spleen was confirmed as the diagnosis. Laboratory evaluation revealed hemoglobin at 12.1 g/dL 2 months after surgery. At the 12-month follow-up, the patient showed no recurrence of gastrointestinal hemorrhage.

LESSONS

UGIH caused by accessory spleen is extremely rare. This entity should be considered in differential diagnosis of gastrointestinal hemorrhage. Surgical intervention is necessary for timely diagnosis and treatment in case of gastrointestinal hemorrhage in critical clinical situations.

Preoperative angioembolisation of a mediastinal accessory ectopic spleen: A case report and review of the literature

A 50-year-old male presented to our institution for embolization of an incidentally detected mediastinal mass prior to surgical resection. The patient had undergone extensive pre-procedural imaging as well as bronchoscopy and mediastinoscopy. Ultimately, resection was required for a definitive diagnosis of congenital ectopic mediastinal accessory spleen. This case represents the first reported incidence of ectopic splenic tissue in this location and illustrates the difficulties in establishing a pre-operative diagnosis with often confounding imaging findings.

An extremely rare case of a gastric accessory spleen: case report and review of the literature

BACKGROUND

The accessory spleen has no anatomical or vascular relationship with the normal spleen, The tissue structure and physiological function of the accessory spleen are the same as those of the normal spleen, which usually locate in the splenic hilum and the tail of the pancreas. The aims of this manuscript are to present a rare case of the gastric accessory spleen and a review of the literature.

CASE PRESENTATION

A 19-year-old male patient was sent to the emergency department with stomach bleeding after drinking alcohol. The computed tomographic scan showed a 1.2 cm × 1.7 cm mass at the lesser curvature of the gastric fundus. Gastrointestinal endoscopy displayed a submucosal elevated lesion on the gastric fundus, and gastrectomy was performed. Postoperative pathological examination proved an accessory spleen in the stomach. The postoperative course was uneventful, and the patient was discharged on the 6th day after the surgery.

CONCLUSIONS

The accessory spleen at the fundus of stomach is extremely rare, especially in this case, which is accompanied by acute gastric bleeding, and it is difficult to diagnosis before operation. Many literatures reported that it was misdiagnosis as tumor, so it is necessary to diagnose accessory spleen correctly.

Enlarged accessory spleen after splenectomy mimicking a pancreas tumor

INTRODUCTION

An accessory spleen (AS), a common condition, is usually located in the hilar region of the spleen. ASs are not often large; however, after splenectomy, the initially inactive AS may become reactive and hypertrophic. Therefore, an AS can be misdiagnosed as a neoplastic tumor and removed unnecessarily. An undiagnosed abdominal mass located in the spleen site in a patient who has had a splenectomy must be managed carefully. Computed tomography (CT) scanning and magnetic resonance imaging (MRI) may provide useful information for the diagnosis, preventing unnecessary surgery.

CASE PRESENTATION

Herein, we report the case of a 38-year-old female with an enlargement of AS after splenectomy that was misdiagnosed as a primary tumor of the pancreas and managed by a nonessential surgery.

CONCLUSION

An AS should be added to the differential diagnosis of a pancreatic tail tumor for patients with prior splenectomy in order to avoid nonessential surgery to ensure the patient's safety.

Heterotopic accessory spleen with squamous epithelial cyst in pancreas mimicking other pancreatic tumor: a case report

A 49-year-old female undergoing a periodic health examination at other hospital revealed a mass in the tail of pancreas. The patient denied any personal history of surgery except subtotal hysterectomy because of multiple myomas in uterus 7 years ago, family history of abdominal cancer and trauma. Physical examination and laboratory finding (including tumor marker) were unremarkable. Chest X-ray result was normal. Contrast enhanced ultrasound (CEUS) examination showed a well-defined hypoechoic pancreatic mass which was suggestive of solid pseudopapillary tumor. Contrast enhanced computed tomography (CE-CT) of the abdomen revealed a mass of hypodensity suggestive of intraductal papillary mucinous neoplasm. Because of the risk of bleeding and exclusion of surgical contraindications, patient underwent laparoscopic surgery. Intraoperatively, a solid mass was identified in the tail of pancreas, the intraoperative frozen pathological examination suggested a heterotopic accessary spleen (HAS) with squamous epithelial cyst. Partial pancreatectomy was performed. The uniqueness of this case is that the spleen can be ectopic to the pancreas, what is even more unexpected is that the HAS undergone cystic change. When encountering a pancreatic mass, we need to think about the possibility of HAS. In conclusion, it is important to diagnose HAS with squamous cyst in the pancreatic tail presenting as other pancreatic masses.