UKINETS2024 22nd Annual Meeting of the UK and Ireland Neuroendocrine Tumour Society 2024 Poster Presentations (33 abstracts)
Challenging diagnosis of intra-pancreatic splenunculus mimicking neuroendocrine tumour
Elspeth Saunders 1 , Aparna Juneja 1 , Bruce Sizer 2 , Robert Skelly 1 , Jennifer Collins 1 , Srinivasan Gopalakrishnan 2 , Manu Noatay 1 , Carroll Petty 1 , Karen Sheen 2 & Mary McStay 1
1East Suffolk North Essex Foundation Trust, Colchester, United Kingdom. 2East Suffolk North Essex Foundation Trust, Ipswich, United Kingdom
Introduction: Many patients who present with symptoms of possible neuroendocrine tumour, start their journey with cross sectional scans to look for malignancy as part of their diagnostic workup. Often, especially with advances in functional imaging, subtle abnormalities are now visible causing diagnostic challenges. Our case details one such potential pitfall and acts as a reminder to consider broad imaging differentials when reviewing patients scans.
Case: Our patient (a 64-year-old Vietnamese gentleman) initially presented as a 2WW via Haematology due to concerns over B symptoms (hot sweats overnight and weight loss). Initial CT scan showed minor inflammatory changes in the lung, with an ‘unusual appearance’ in the tail of the pancreas. He went on to have an MRI abdomen which showed ‘a 2.4cm focal enhancing lesion in the tail of the pancreas, in keeping with possible neuroendocrine tumour’. Due to this finding, he was referred to Gastroenterology who requested an Octreotide scan which showed ‘increased tracer uptake within the pancreatic tail’. The patient went on to have EUS biopsy of the pancreatic tail which a confirmed a lobulated mass in the tail of the pancreas. Fine needle biopsy surprisingly confirmed the lesion as a splenunculus, with no evidence of neuroendocrine tumour.
Discussion: A splenunculus is a relatively common, benign condition where splenic tissue is found outside of the spleen. Congenital cases of accessory splenic tissue are usually solitary nodules and are found in the region of the gastro-splenic or spleno-pancreatic ligaments. Intra-pancreatic splenunculi are not as rare as previously thought and their incidence rate is estimated to 17% of those with accessory spleens in an autopsy series. They can show uptake in octreotide scans as the splenic tissue frequently expresses somatostatin receptors. This case highlights the important of getting a conclusive tissue diagnosis before committing the patients to radical surgery so as to prevent unnecessary surgical risks and morbidity. Additional imaging scans such as Technetium-99m heat damaged RBC or sulphur colloid scans can be helpful to confirm the suspicion of ectopic splenic tissue.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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