An Accessory Spleen Mimicking Left Adrenal Tumor: Tc 99m Labeled Sulfur Colloid Scintigraphy can Avoid Invasive Investigation

Case Report

Austin J Clin Case Rep. 2016; 3(5): 1104.

An Accessory Spleen Mimicking Left Adrenal Tumor: Tc 99m Labeled Sulfur Colloid Scintigraphy can Avoid Invasive Investigation

Yadav R¹*, Chaudhary S¹, Yadav P² and Kumar A¹

¹Department of Urology, Kidney Transplant & Robotics, Medanta-Medicity, India

²Department of Radiodiagnosis, Medanta-The Medicity, India

*Corresponding author: Yadav Rajiv, Department of Urology, Kidney Transplant and Robotic, Medanta-The Medicity, Gurgaon, India

Received: August 14, 2016; Accepted: October 30, 2016; Published: November 16, 2016

Abstract

We describe a case of accessory spleen mimicking left adrenal tumor. A 48-year-old woman with a history of treatment for locally advanced carcinoma breast was evaluated for left adrenal mass. Due to past history of malignancy, the possibility of solitary metastasis as well as nonfunctional adrenal tumor were considered. Homogenous lesion with the attenuation and enhancement pattern similar to spleen raised the suspicion of an accessory spleen. The finding was confirmed by Sulfur colloid scintigraphy. The article underscores the fact that the urologists should be aware of the possible existence of accessory spleens when left adrenal tumors are suspected on imaging.

Keywords: Adrenal tumor; Accessory spleen; Scintigraphy; Sulfur colloid scan

Introduction

Metastasis to the adrenal is common. Metastatic tumor is the first consideration when a patient with a history of malignancy is found to have adrenal lesion. In the absence of any functional or biochemical abnormalities and equivocal imaging findings, invasive procedures (like biopsy or excision) may be required for characterization of nature of lesion. We present a case of accessory spleen in suprarenal location mimicking adrenal tumor. The presence of accessory spleen was confirmed by Tc 99m labelled Sulfur colloid scintigraphy thus avoiding invasive procedure or surgery.

Case Presentation

A 48 year old female with a history of treatment for locally advanced carcinoma breast was referred to urology services for evaluation of left supra renal mass. She has had modified radical mastectomy two years ago (Stage T1c, N1a, Mx). Following surgery she had received chemotherapy and Radiotherapy to chest wall and axilla. Left suprarenal mass lesion was first detected on Computed Tomography (CT) in the follow up scan. CT showed a well-defined 4.6 X 4.4 X 4.6 cm, homogenously enhancing mass without any necrosis or calcification in left supra renal area (Figures 1a and 2a). The mass seemed to arise from the lateral limb of left adrenal gland. Lesion showed attenuation value of 40 HU on non-contrast CT and failed to demonstrate significant contrast loss on ‘washout’ study. She is non-hypertensive and non-diabetic. No abnormalities were found on functional and biochemical assessment regarding adrenal lesion.

Citation: Yadav R, Chaudhary S, Yadav P and Kumar A. An Accessory Spleen Mimicking Left Adrenal Tumor: Tc 99m Labeled Sulfur Colloid Scintigraphy can Avoid Invasive Investigation. Austin J Clin Case Rep. 2016; 3(5): 1104. ISSN:2381-912X