Intrapancreatic Accessory Spleen Diagnosed by Size Reduction after Immunosuppressive Therapy: A Case Report

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

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.

Cite this article as:

Tursem Tokmak Turgut*, Burak Lacin Mahmut and Gencer Humeyra, Intrapancreatic Accessory Spleen Diagnosed by Size Reduction after Immunosuppressive Therapy: A Case Report, Current Medical Imaging 2024; 20 : e150823219727 . https://dx.doi.org/10.2174/1573405620666230815142649

DOI https://dx.doi.org/10.2174/1573405620666230815142649	Print ISSN 1573-4056
Publisher Name Bentham Science Publisher	Online ISSN 1875-6603