Pancreatic Incidentaloma: Differentiating Nonfunctioning Pancreatic Neuroendocrine Tumors from Intrapancreatic Accessory Spleen |
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| Institution: | 1. Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.;2. Department of Gastroenterology, Tel Aviv-Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.;3. Department of Surgery, Tel Aviv-Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.;4. Department of Oncology; Tel Aviv-Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.;5. Department of Radiology; Tel Aviv-Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel. |
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| Abstract: | Objective: To improve the preoperative assessment of pancreatic incidentalomas (PIs) by analysis of 1 index case and characterization of the published features of intrapancreatic accessory spleen (IPAS) compared to pancreatic neuroendocrine tumor (PNET).Methods: A search of the literature using the online database MEDLINE.Results: In all, 46 cases of IPAS have been described to date: 17 were “presumed” as IPAS based on technetium-99m (Tc-99m) scanning, fine-needle aspiration (FNA) stain for CD8, or contrast-enhanced sonography; 29 were misdiagnosed as PNET and underwent surgery. The pancreatic lesions were 1) mostly solitary; 2) solid on imaging; 3) well defined; 4) located predominantly at the pancreatic tail; 5) not exceeding 3 cm in the largest diameter; 5) all detected in adults (22–81 years); 6) not related to sex. In subjects referred for surgery, standard imaging studies/imaging protocols did not differentiate between IPAS and PNET. FNA was performed in 5/46 cases, all of which were false-positive for PNET. Immunohistochemical staining for T-cells on FNA material and specific imaging features (characteristic arciform splenic enhancement pattern on dynamic computed tomography CT]; nuclear scintigraphies with radioisotope specifically trapped by splenic tissue Tc-99m]) or contrast-enhanced sonography offered valuable clues. Still, distal pancreatectomy and splenectomy was carried out in 72%, and the rest had distal pancreatectomies.Conclusion: IPAS should be considered before surgery in patients with PIs. A new practical algorithm is presented for better preoperative evaluation of such lesions; it combines the recognition of early indicators and sequential consideration of cytologic and imaging features to decrease the hazards of unnecessary major surgery.Abbreviations:CT = computed tomographyEUS = endoscopic ultrasoundFNA = fine-needle aspirationHDRBC = heat-damaged red blood cellsIPAS = intrapancreatic accessory spleenMRI = magnetic resonance tomographyNF-PNET = nonfunctioning pancreatic neuroendocrine tumorPET = positron emission tomographyPNET = pancreatic neuroendocrine tumorPI = pancreatic incidentalomasSPIO = superparamagnetic iron oxideTc-99m = technetium-99m |
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