![]() Given the overall findings, the accessory spleen was the final diagnosis for the pancreatic tail mass. With a high pre-test probability of NET, a repeat EUS with FNA was performed and cytology findings showed benign splenic tissue and pancreatic acinar cells without evidence of malignancy (Figure (Figure3). This showed radiotracer accumulation in the pancreatic tail mass, compatible with somatostatin receptor (SSTR) avid tumor suggestive of a NET without evidence of metastatic disease. In an attempt for further characterization of the mass, a positron emission tomography (PET)-CT NETSPOT was performed (Figure (Figure2). The cytology specimen was non-diagnostic it comprised of benign pancreatic parenchyma, lymphocytes, eosinophils, fibrous tissue, and degenerated cells. Subsequently, an upper endoscopy ultrasound (EUS) with fine needle aspiration (FNA) was performed, revealing a poorly defined irregular mass. Chromogranin A level was 249.6 (normal 0-101.8 ng/mL). Imaging revealed a 1.7 cm x 1.2 cm pancreatic tail mass which was isointense to the spleen and pancreas with prominent solid arterial phase enhancement and moderate diffusion restriction suggestive of an NET without any evidence of abdominal metastatic spread. A concurrent colonoscopy showed multiple adenomatous polyps and diverticulosis. Despite proton pump inhibitor therapy, his symptoms persisted, and an MRI abdomen/pelvis was obtained (Figure (Figure1). He underwent an upper GI endoscopy that revealed mild chronic inactive gastritis without Helicobacter pylori (H. pylori) organisms. ![]() ![]() Physical exam showed a non-distended abdomen with diffuse tenderness and normal bowel sounds. He also endorsed weight loss due to poor oral intake associated with an increase in abdominal girth. Ī 70-year-old male with a past medical history of melanoma, skin squamous cell carcinoma of the scalp, and gastroesophageal reflux disease presented for chronic vague epigastric discomfort and bloating associated with intermittent bilateral flank pain which was present intermittently since his cholecystectomy 12 years ago. In order to avoid unnecessary pancreatic resections and invasive procedures, it is important to correctly diagnose and manage pathologies involving the pancreas. Intrapancreatic location of ectopic splenic tissue may mimic primary and secondary pancreatic malignant neoplasms such as pancreatic neuroendocrine tumor (NET), acinar cell carcinoma, ductal adenocarcinoma, and metastatic carcinoma. While the etiologies of both anomalies are distinct, their presentations are often mistaken for neoplasms of the primary organ they are found in. It has an incidence of 10-30% in the population and the most common sites include splenic hilum (~80%) and pancreatic tail (~20%). The accessory spleen is a congenital anomaly of the spleen which results from the imperfect fusion of separate splenic masses during embryonic development. Splenosis or autotransplantation of splenic tissue occurs after trauma or surgery in locations outside of the spleen, most commonly in the abdominal and pelvic cavity. Splenosis and accessory spleen are both ectopic splenic anomalies.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |