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Review
. 2019 Jul 9;17(1):117.
doi: 10.1186/s12957-019-1660-2.

Intrapancreatic accessory spleen false positive to 68Ga-Dotatoc: case report and literature review

Francesco Lancellotti  1 , Luca Sacco  1 , Saverio Cerasari  1 , Vittoria Bellato  1 , Simone Cicconi  1 , Antonio Ciardi  2 , Edoardo Maria Muttillo  1 , Tiziana Feola  3 , Roberto Caronna  4 , Piero Chirletti  1
Affiliations
Review

Intrapancreatic accessory spleen false positive to 68Ga-Dotatoc: case report and literature review

Francesco Lancellotti et al. World J Surg Oncol. .

Abstract

Background: Intrapancreatic accessory spleen (IPAS) is an uncommon finding of pancreatic mass. Differential diagnosis with pancreatic tumor, especially with non-functional neuroendocrine tumor (NF-NET), may be very hard and sometimes it entails unnecessary surgery. A combination of CT scan, MRI, and nuclear medicine can confirm the diagnosis of IPAS. 68-Ga-Dotatoc PET/CT is the gold standard in NET diagnosis and it can allow to distinguish between IPAS and NET.

Case presentation: A 69-year-old man was admitted to our hospital for an incidental nodule in the tail of the pancreas with focal uptake of 68-Ga-dotatate at PET/CT. NET was suspected and open distal splenopancreatectomy was performed. Pathologic examination revealed an IPAS.

Conclusion: This is the second IPAS case in which a positive 68Ga-Dotatoc uptake led to a false diagnosis of pancreatic NET. Here is a proposal of a literature review.

Keywords: False positive to 68Ga-Dotatoc; Intrapancreatic accessory spleen; Neuroendocrine tumor; Pancreatic mass.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Incidental mass in the tail of the pancreas (arrow). CT revealed a mass well delimited with homogeneous contrast enhancement. a Venous and b arterial phase axial CT images
Fig. 2
Fig. 2
MRI confirmed a 2-cm nodule of the tail of the pancreas hypointense on T1 (a) and hyperintense on T2 (b)-weighted sequence with a focal lesion inside hyperintense on T1. Diffusion-weighted MR imaging shows a high restriction (c) and hypointense in T1 fat sat sequence (d)
Fig. 3
Fig. 3
The PET image shows an indeterminate pancreatic tail nodule with enhanced uptake of 68-Ga-dotatate at PET-CT fusion image (false positive)
Fig. 4
Fig. 4
Gross pathologic findings of IPAS: S the main spleen; P the tail of the pancreas. The arrow shows a reddish nodule with epidermoid cyst surrounded by pancreatic parenchyma
Fig. 5
Fig. 5
Microscopic findings (hematoxylin and eosin staining). a, b It is possible to observe the interface between pancreatic parenchyma (red arrow) and accessory spleen with epidermoid cyst (yellow arrow) (H&E, × 4). c Histological picture of intrapancreatic splenic parenchyma with adjacent normal pancreas (H&E, × 40). d Multiseptated intrasplenic epithelial cyst, with multilayered squamous epithelium (H&E, × 40)
See this image and copyright information in PMC

References

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