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Presented by Peter Illei, M.D. and prepared by Danielle Wehle, M.D.
Case 5: 81 year old woman found to have a mass in the tail of the pancreas.
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1. Question
Week 273: Case 5
81 year old woman found to have a mass in the tail of the pancreas.images/62606ectopicspleenHE SPLEEN 2XA.jpg
images/62606ectopicspleenHE SPLEEN 20X-C.jpg
images/62606ectopicspleenHE CAPS 20XD.jpg
images/62606ectopicspleenHE PANCR 2X-C.jpg
images/62606ectopicspleenHE PANCR 20X-C.jpgCorrect
Answer: Intrapancreatic heterotopic splenic tissue
Histology: Grossly, a 2.2 x 1 x 0.8 cm red-burgundy colored mass was noted within the parenchyma of the distal pancreas. The spleen was also removed and had an intact capsule. The mass had a consistency and texture of spleen. Microscopically, a 2.2 cm well demarcated area of splenic tissue is identified in the tail of the pancreas. Grossly, the splenic tissue appears to be confined to the pancreas. Microscopically, at least a narrow rim of compressed pancreatic tissue is surrounding the histologically unremarkable splenic tissue. The pancreatic parenchyma shows focal chronic pancreatitis in an area adjacent to the splenic tissue. No neoplasm is identified.
Discussion: Accessory splenic tissue can be found in the pancreas and is usually found in the tail, however, rarely it can also be seen in the head. They usually mimick pancreatic neoplasms (islet cell tumor) on imaging, which may result in partial pancreatectomy (as in the case above).
Incorrect
Answer: Intrapancreatic heterotopic splenic tissue
Histology: Grossly, a 2.2 x 1 x 0.8 cm red-burgundy colored mass was noted within the parenchyma of the distal pancreas. The spleen was also removed and had an intact capsule. The mass had a consistency and texture of spleen. Microscopically, a 2.2 cm well demarcated area of splenic tissue is identified in the tail of the pancreas. Grossly, the splenic tissue appears to be confined to the pancreas. Microscopically, at least a narrow rim of compressed pancreatic tissue is surrounding the histologically unremarkable splenic tissue. The pancreatic parenchyma shows focal chronic pancreatitis in an area adjacent to the splenic tissue. No neoplasm is identified.
Discussion: Accessory splenic tissue can be found in the pancreas and is usually found in the tail, however, rarely it can also be seen in the head. They usually mimick pancreatic neoplasms (islet cell tumor) on imaging, which may result in partial pancreatectomy (as in the case above).
