MetroHealth Medical Center Cleveland, OH, United States
Sophie Trujillo, DO, Fahmi Shibli, MD, Bhavesh Shah, MD MetroHealth Medical Center, Cleveland, OH
Introduction: An accessory spleen (AS) is splenic tissue located in a separate region of the abdomen. AS are rare and usually benign. AS are commonly incidentally visualized during endoscopy or on cross-sectional imaging. We describe a rare presentation of an AS presenting as a gastric mass.
Case Description/Methods: Our patient is a 54-year-old female with a medical history significant for stage 2 breast cancer (treated with mastectomy, chemotherapy, and tamoxifen), splenectomy in her 30s for a large vascular mass, and total hysterectomy for menorrhagia. She presented to her physician with fatigue and found to have iron deficiency anemia. Labs were significant for a hemoglobin of 10 g/dL (12-15g/dL), MCV 73fL (80-100fL), iron 14µg/dL (45-160µg/dL), iron saturation 3% (20-55%), TIBC 535µg/mL (250-410µg/mL), and ferritin 4µg/mL (10-219µg/mL). Her family history was notable for death of her sister due to splenic rupture of a vascular mass and was otherwise noncontributory.
As part of her anemia work up, EGD was performed and significant for a 2cm submucosal gastric fundic lesion with normal overlying mucosa. Follow up radial endoscopic ultrasound (EUS) for this lesion revealed a uniform, oval-like lesion, measuring 1.5cmx2cm. Full thickness resection with the gastroduodenal FTRD® System was performed on the mass without complication. Pathology was significant for submucosal accessory spleen extending into the deep tissue end.
Discussion: Patients with gastric AS are usually asymptomatic but may present with abdominal pain. Rare complications include rupture, embolization, hemorrhage, and torsion. AS are usually discovered incidentally and can be mistaken for malignant tumors. EUS is the best modality for viewing submucosal tumors. On EUS, AS are oval with a sharp outer margin and echogenicity identical to that of the spleen. EUS guided fine needle aspiration may be beneficial for diagnosis in cases of uncertainty to avoid invasive resections. Full thickness resection was utilized to obtain a diagnosis for our patient.
Resection of AS is not regularly recommended as they often are of no clinical significance. In cases where splenectomy has been performed due to refractory immune thrombocytopenia, resection may be indicated to prevent relapse. Resection may also be indicated if the tumor is indistinguishable from other tumors or if the patient becomes symptomatic. The etiology of the accessory spleen in this patient is unknown, but likely due to autologous transplantation of tissue from her previous splenectomy.
Figure: Gastric Accessory Spleen
Disclosures: Sophie Trujillo indicated no relevant financial relationships. Fahmi Shibli indicated no relevant financial relationships. Bhavesh Shah indicated no relevant financial relationships.
Sophie Trujillo, DO, Fahmi Shibli, MD, Bhavesh Shah, MD. P1737 - Accessory Spleen – a Rare and Incidental Finding, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.