Title:Intrapancreatic Accessory Spleen Diagnosed by Size Reduction after
Immunosuppressive Therapy: A Case Report
Volume: 20
Author(s): Turgut Tursem Tokmak*, Mahmut Burak Lacin and Humeyra Gencer
Affiliation:
- Department of Radiology, Kayseri City Training and Research Hospital, Seker Mah. Muhsin YAZICIOĞLU Bulvarı No:77 Kocasinan / KAYSERİ
38080, Turkey
Keywords:
Intrapancreatic spleen, Lupus erythematosus, Magnetic resonance imaging, Pancreatic neoplasms, Case report, Immunosuppressive therapy.
Abstract:
Background:
Intrapancreatic accessory spleen (IPAS) is a congenital entity that can be confused with malignant distal pancreatic masses. Radiologic imaging
and radionuclide imaging have an important place in the diagnosis of IPAS.
Case Report:
Blood tests were performed on a 36-year-old female patient who presented with tachypnea, tachycardia, pain in the joints, and pain in the left
abdominal quadrant. Laboratory test results were as follows: hemoglobin value 6.0 mg/dl, sedimentation 120, aspartate transaminase (AST)
150U/L, and alanine transaminase level (ALT) 110U/ L. Additional laboratory tests and ultrasonography were performed. The anti-doublestranded
DNA (dsDNA) level was 800 IU/ml. C3 and C4 values were both 0.64 IU/ml, with anti-Ro-52 +++(three positive) and anti-Ro-60 ++
(two positive). A clinical diagnosis of systemic lupus erythematosus (SLE) was made. Ultrasonography and dynamic contrast-enhanced upper
abdominal MRI showed lesions suggestive of multiple hemangiomas in the liver and a 29x18 mm lesion in the tail of the pancreas with a similar
appearance as the spleen. SLE treatment was started. Scintigraphy was recommended for the diagnosis of IPAS. Scintigraphy was performed in the
third week of the treatment. Uptake was not observed. In the second month of the treatment, a control upper abdominal MRI was performed, and a
decrease in the size of the lesion was observed.
Conclusion:
IPAS can be confused with pancreatic masses. Lack of uptake in scintigraphy may be due to treatment protocols that produce low phagocytic
activity. If radiological imaging findings are compatible, a reduction in lesion size after immunosuppressive therapy can be accepted as evidence
for the diagnosis of IPAS.
