University of Minnesota Medical Center Minneapolis, MN, United States
Nicholas M. McDonald, MD1, Ahmed Dirweesh, MD1, Echko Holman, MD1, Mohammad Bilal, MD2 1University of Minnesota Medical Center, Minneapolis, MN; 2Minneapolis VA Health Care System, Minneapolis, MN
Introduction: Incidental pancreatic masses are a common reason for gastroenterology referral. Evaluation often includes endoscopic ultrasound (EUS) and fine needle biopsy to make a diagnosis and exclude malignancy. While these lesions are often concerning for malignancy, it is critically important to differentiate malignant from benign pancreatic masses. Here, we present a case of an incidental pancreatic tail lesion, ultimately found to be an intra-pancreatic splenule after evaluation.
Case Description/Methods: A 72-year-old man was referred for EUS evaluation for an incidental 2 cm mass in tail of pancreas seen on a computer tomography (CT) scan at an outside hospital. On EUS, a 22 mm by 13 mm hypoechoic lesion with well-defined borders was identified within the pancreatic tail and fine needle biopsy was performed (a). Histopathology revealed benign pancreatic parenchyma and the presence of lymphocytes (b, c).Testing for IgG4 was negative. Given that EUS appearance was suspicious for a neuroendocrine tumor, and the case was discussed in multidisciplinary conference. Subsequently, decision was made to obtain a technetium-99m sulfur colloid scan which demonstrated uptake in the pancreatic tail lesion, consistent with an intra-pancreatic splenule (d). Given the benign nature of splenules and lack of any symptoms, no further evaluation was pursued.
Discussion: A splenule is a benign ectopic focus of splenic tissue and is commonly found incidentally. Splenules usually near the pancreatic tail, however, they can rarely be intra-pancreatic and can be confused for malignancy on cross-sectional imaging. Intra-pancreatic splenules are usually smaller in size (less than 1 cm) but can also be larger as was the case in our patient. It is important for endosonographers to recognize the EUS appearance of an intra-pancreatic splenule so unnecessary work up can be avoided. A technetium-99m sulfur colloid scan can confirm the presence of a splenule when there is clinical suspicion.
Figure: A) 22 mm by 13 mm hypoechoic lesion with well-defined borders within pancreatic tail. B, C) Histopathology revealing benign pancreatic parenchyma and the presence of lymphocytes. D) Sulfur colloid scan demonstrating uptake in the pancreatic tail lesion, consistent with an intra-pancreatic splenule.
Disclosures: Nicholas McDonald indicated no relevant financial relationships. Ahmed Dirweesh indicated no relevant financial relationships. Echko Holman indicated no relevant financial relationships. Mohammad Bilal indicated no relevant financial relationships.
Nicholas M. McDonald, MD1, Ahmed Dirweesh, MD1, Echko Holman, MD1, Mohammad Bilal, MD2. P0110 - Endoscopic Ultrasound Appearance of a Large Intra-Pancreatic Splenule, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.