Splenosis Presenting as Pancreatic Neoplasm: Report of Two Cases

Case Report

Austin J Gastroenterol. 2014;1(3): 1015.

Splenosis Presenting as Pancreatic Neoplasm: Report of Two Cases

Beltrame V, Merigliano S and Sperti C*

Department of Surgery, Oncology and Gastroenterology, University of Padua, Italy

*Corresponding author: :Cosimo Sperti, Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, via Giustiniani 2, 35128 Padova, Italy

Received: August 04, 2014; Accepted: August 18, 2014; Published: August 20, 2014


plenosis is the auto transplantation of splenic tissue generally seen after traumatic injury or elective splenectomy. Although this condition affects one to two thirds of patients submitted to splenectomy for trauma, Splenosis is rarely diagnosed preoperatively, and sometimes, it is mistaken for a neoplasm.

We report two consecutive patients, incidentally discovered to have a mass in the tail of the pancreas, during a work-up for other pathology. Both patients had undergone splenectomy, 12 and 14 years before, respectively. Abdominal ultra sonography, computed tomography, and magnetic resonance imaging demonstrated a round, solid mass with low contrast enhancement in the pancreatic tail: both clinical and radiologic findings suggested for the first patient, a solid-cystic or neuroendocrine tumour of the pancreas. After distal pancreatectomy, microscopic examination revealed heterotrophic splenic tissue. The second patient presented with two solid, round masses in the tail, and in the peripancreatic tissue of the head of the pancreas, respectively. Tc-99 sulphur colloid scintigraphic showed intense tracer uptake in both lesions, suggesting the presence of splenic tissue. So, surgical operation was avoided. Splenosis should be considered in the differential diagnosis of incidental pancreatic masses in previously splenectomised patients.

Keywords: Accessory spleen; Pancreas; Pancreatic neoplasm; Splenectomy; Splenosis

Case Presentation

Case 1

A 57-year-old woman was referred to our Department for a 1-year history of a solid mass in the tail of the pancreas. Her medical history included hysterectomy 14 years before, and anterior resection of sigmoid colon cancer with splenectomy for spleen injury, 12 years before. The pancreatic mass was incidentally discovered by abdominal ultra sonography during follow-up evaluation after endoscopic excision of bladder polyps. She had no symptoms or any remarkable physical signs. Routine laboratory tests were within normal range, including carcinoembrionic antigen (CEA) and carbohydrate antigen, CA 19-9. Magnetic resonance imaging (MRI), confirmed the presence of 4 x 3 cm, slightly contrast enhanced mass in the tail of the pancreas. The enhancement pattern was homogeneous, with regular margins. An integrated positron emission tomography with computed tomography (CT) acquisition (PET/CT) using 18-Fluorodeoxyglucose (FDG) revealed a 4-cm, low-density, lesion with low FDG uptake in the tail of the pancreas (SUV=1.5): the mass had some internal septa, but did not show contrast enhancement (Figure 1).