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  • Case report
  • Open Access

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

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World Journal of Surgical Oncology201917:117

https://doi.org/10.1186/s12957-019-1660-2

  • Received: 25 February 2019
  • Accepted: 28 June 2019
  • Published:

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

  • Intrapancreatic accessory spleen
  • False positive to 68Ga-Dotatoc
  • Neuroendocrine tumor
  • Pancreatic mass

Background

Accessory spleen is a congenital abnormality consisting of normal splenic tissue in ectopic sites. It arises as a failure of fusion between some of the multiple buds of splenic tissue in the dorsal mesogastrium during embryologic life. This ectopic tissue can be found, in order of frequency in the following: splenic hilum (80%), pancreatic tail (20%), stomach, bowel, and genitals [1, 2]. In autoptic studies, the accessory spleen has an incidence of 10% and IPAS of 2% [3], but clinical incidence, despite rare, is growing probably related to the improvement of diagnostic imaging accuracy. Rarely a specific abdominal pain or idiopathic thrombocytopenic purpura (not responsive to splenectomy) could be present in patients with IPAS [4]. Because asymptomatic, IPAS is almost always found incidentally as an undefined pancreatic mass similar to NETs [5]. The frequency of functional pancreatic NETs (F-P-NETs), similar to that of non-functional pancreatic NETs (NF-P-NETs), is probably increasing [5] due to the widespread use of high-quality imaging techniques [6]. Recent studies have shown imaging with 68-Ga-labeled somatostatin analogs with PET/CT to be highly sensitive and specific for P-NETs [7]. We are illustrating a 69-year-old man with a mass in the tail of the pancreas found during his follow-up for previous sigmoid colon adenocarcinoma. Because of a positive result at 68-Ga-Dotatoc PET/CT and volumetric increasing of mass during follow-up, a P-NET was suspected.

Case presentation

A 69-year-old man with a past medical history significant for hypertension and sigmoid adenocarcinoma (UICC 2012: pT4 pN2 M0) underwent sigmoid colectomy and adjuvant chemotherapy (2015). No pancreatic mass was described at the computed tomography (CT) images performed after colectomy. During the follow-up, a magnetic resonance imaging (MRI) showed a 1.5-cm nodule of the pancreatic tail, non-homogeneous, hyperintense on T2-weighted and hypointense on T1-weighted sequence, and a focal lesion inside hyperintense on T1. Endoscopic ultrasonography (EUS) revealed a 1.5-cm anechoic nodule, with two hyperechoic foci ascribable to calcifications. The needle biopsy (EUS-FNA) was not performed due to difficulties of endoscopic examination (the nodule was too far from the duodenal wall). 18-Fluorodeoxyglucose positron emission tomography ([18-F] FDG-PET) did not show FDG uptake.

Follow-up indication was given. After 8 months, this lesion showed a volumetric increase (2 cm) both at computed tomography (CT) and MRI (Fig. 1 and Fig. 2) without pathological uptake at FDG-PET. Tumoral markers (CA 19.9, CEA, alpha-fetoprotein) were negative. A 68-Ga-Dotatoc PET/CT, more sensitive and specific for neuroendocrine tumor (NET), showed a focal area of uptake (Fig. 3), but neuroendocrine markers (gastrin, chromogranin A, calcitonin, 5-hydroxytryptophan) were negative. Given the suspicion of NF-P-NET and close contact to splenic vessels, the patient underwent open distal splenopancreatectomy (Fig. 4) with an unremarkable postoperative course.
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

Definitive histologic examination revealed an intrapancreatic accessory spleen, with multiseptated epidermoid cyst (Fig. 5).
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)

Discussion

In the English literature, there are, up to date, only 144 articles of which 115 are case reports concerning diagnosis and treatment of IPAS. From this data review, it was observed that most patients with IPAS underwent surgery without a preoperative definitive diagnosis and that IPAS was often put in differential diagnosis with NET or rarely with adenocarcinoma or metastatic tumors [8]. In Table 1, we report the literature results of diagnostic procedures performed, when clearly specified, in patients with IPAS [931]. Despite the high diagnostic accuracy of morphological and scintigraphic exams, IPAS was often unidentified and unnecessary surgery was performed in 66.6% of patients. False-negative results have been reported also after endoscopic ultrasonography-guided fine needle aspiration biopsy (EUS-FNA) and after Tc-99m heat-damaged red blood cell (HDRBD) scintigraphy.
Table 1

Literature review of 87 cases of IPAS confirmed by postoperative histological examination or by follow-up: diagnostic hypothesis and related surgical treatment [931]. Fifty-eight cases treated with surgery (66.6%)

 

Patients, n

Diagnostic hypothesis

Unnecessary surgery

IPAS

U

NET

Other

Misleading, n (%)

n

%

CT scan

57

13

16

24

4

44

(77.1)

31

54.3

MRI

60

32

10

11

7

28

(46.6)

40

66.6

EUS

30

3

14

12

1

27

(90)

15

50

EUS-FNA

20

15

2

3

0

5

(25)

8

40

Octreoscan

9

0

7

2

0

2

(22.2)

7

77.7

HDRBD

10

6

0

4

0

4

(40)

6

60

U unclear

The context is usually a CT/MRI incidental diagnosis of a nodule localized in the pancreatic tail, between 1 and 3 cm, well-delimited, homogeneous, and hypervascular: IPAS should be suspected and more examinations required.

Tumoral and neuroendocrine markers have a limited role in the differential diagnosis. In pancreatic carcinoma, the most important tumoral markers are CA 19.9, CEA, CA125 (sensitivity of 81.3%, 39%, and 56.4%; specificity of 75.9%, 91.4%, and 77.6% respectively) [32, 33]. Approximately 50% of NET are non-functional tumors; in functional ones, neuroendocrine marker sensitivity is about 80% while specificity is much lower [34]. However, false-positive cases consisting of IPAS with increased tumoral and neuroendocrine markers have been reported [10, 13]. Therefore, serological markers are not useful in the differential diagnosis between IPAS and NET or pancreatic carcinoma, as in our case.

For these reasons, a careful evaluation of the radiological images is very important.

At CT, IPAS shows attenuation and enhancement similar to the spleen in all phases, more than pancreatic parenchyma. Pancreatic tumors, instead, show a greater attenuation in the arterial phase and less in the venous phase [13, 19].

At MRI, IPAS often shows a low signal intensity in T1 and high intensity in T2 if compared to pancreatic parenchyma; moreover, intratumoral hemorrhage and necrosis are absent in IPAS [19]. The key to suspect IPAS at MRI is detecting the signal intensity of the mass similar to the spleen in all sequences [13]. On the other hand, Kim et al. demonstrated that sometimes IPAS signal intensity is slightly brighter than the spleen on the T2-weighted images, and this finding is due to the higher white-to-red pulp ratio of IPAS [13]. Recently, Jang et al. [23], in a retrospective study, have considered diffusion-weighted MRI (RMDW) value in the differential diagnosis between IPAS and solid pancreatic tumors of less than 3 cm showing a 90% sensitivity and specificity. An Italian group in 2005 correctly diagnosed IPAS (without surgery), observing the same pattern of the spleen at CT and at MRI with reticuloendothelial system-specific contrast medium (ferucarbotran), confirmed by mass stability after 16 months of follow-up [25].

Nuclear medicine has surely a role in IPAS diagnosis. Octreoscan and 68-Ga-PET/CT have been considered reliable in case of NET, while Tc-99m heat-damaged red blood cell (HDRBD) is specific for splenic tissue. According to variable expression NET somatostatin receptors (high or low), it is possible unfortunately unidentify these tumors only with radiolabelled somatostatin analog agent [35]. Furthermore, there are non-tumoral processes (autoimmune diseases, pneumonias, etc.) and some tissues (spleen, kidney, thyroid, liver) that can have avidity for scintigraphy contrast, causing false positives. Octreoscan sensitivity and specificity for NET is about 80% while 68-Ga-Dotatoc seems to be superior (sensitivity and specificity range 80–100%) [36]. Therefore, for NET diagnosis, the actual gold standard is 68-Ga-PET-CT. To date, in the English literature, there is only one IPAS case in which a positive 68-Ga-PET/Tc uptake led to a wrong diagnosis of pancreatic NET [1] probably due to physiological radioisotope uptake in splenic tissue (false positive) [30, 37, 38]. We present the second case of IPAS positive at 68-Ga-PET/CT. About 68-Ga-PET-CT sensitivity and specificity, it should be considered that the splenic tissue uptake of 68-Ga-Dotatoc is highly variable [39, 40]. The accuracy seems significantly higher for NET restaging than diagnosis [41] and then a histological confirmation for final diagnosis could be still considered [42]. Therefore, the diagnostic reliability of the 68-Ga-PET/TC in terms of differential diagnosis between NET and IPAS is still debated.

Technetium 99-m HDRBD scintigraphy is a specific technique for splenic tissue identification because of the physiological radioisotope uptake: focal uptake in the pancreatic tail suggests the presence of splenic intrapancreatic tissue [17]. Method limits are inferior spatial resolution compared to other cross-sectional imaging modalities and need for a certain quantity of spleen functional ectopic tissue to visualize marked cells (cutoff dimension of 1.1 cm according to Kim et al.) [13]. Consequently, Tc-99m HDRBC scintigraphy is an exam that can be used as a confirmatory test for IPAS (positive predictive value) but false-negative results have been reported [19, 23, 31] (Table 1). In our case, it was not performed because 68-Ga-PET/TC positive result was considered conclusive.

EUS-FNA, despite a certain rate of complications and false negatives, gives significant morphological and cytological informations. Schreiner et al. in 2008 first described a series of 3 IPAS identified by EUS, suggesting the need for a histologic diagnosis (FNA biopsy) in case of unconclusive imaging [14]. Cytological features for differential diagnosis of IPAS from other pancreatic nodules were described by Tatsas et al. [22]. In case of IPAS, there is a population of inflammatory cells (principally lymphocytes, but also monocytes, neutrophils, eosinophils) while immunocytochemical staining of CD8 specifically highlights endothelial cells of the thin-walled blood vessels [22]. EUS-FNA biopsy has a high (80–90%) sensitivity and specificity for pancreatic neuroendocrine tumors although its accuracy for such tumors is considered lower than the accuracy for pancreatic adenocarcinoma [21]. Although false-positive results have been reported [11, 16, 31], the rate of unnecessary surgery after EUS-FNA biopsy is lower (40%) compared with other morphological exams (Table 1). There is also the possibility of performing a contrast-enhancement EUS (CEUS) with intravenous contrast (Levovist or Sonazoid) without FNA: it may become the gold standard in IPAS diagnosis [43].

Finally, there is another method proposed for IPAS diagnosis: confocal laser endomicroscopy (CLE) [24]. CLE is an endoscopic technique which allows to obtain the mucosal images with a magnification of about × 1000. This technique allows to identify cellular and subcellular microstructures and an in vivo histological diagnosis (optical virtual biopsy). The use of needle-based probe CLE prior to EUS-FNA in the diagnosis of pancreatic masses may increase diagnostic accuracy [24].

To date, there are no guidelines but recommended diagnostic algorithms to suspect and diagnose IPAS have been proposed by Spencer et al., Li et al., and Baugh et al. [19, 31, 44].

Conclusion

In the differential diagnosis of solid nodules in the pancreatic tail, IPAS should always be considered. Besides increasing clinical incidence due to the improvement of imaging quality, it remains a non-neoplastic lesion with no surgical indication. IPAS should be suspected in the presence of some features: incidentally asymptomatic lesion, localization in the tail of the pancreas, dimension between 1 and 3 cm, well-delimited homogeneous and hypervascular nodule, similar attenuation to the spleen on CT and MRI, negativity of neuroendocrine, and tumoral markers. A combination of CT, MRI, nuclear medicine examinations, and EUS-FNA biopsy could be necessary for a diagnosis of IPAS because none of them are individually conclusive. False positives or false negatives are possible, as in our clinical case with 68-Ga-Dotatoc PET/CT false positive.

Abbreviations

[18-F] FDG-PET: 

18-Fluorodeoxyglucose positron emission tomography

CEUS: 

Contrast-enhancement EUS

CLE: 

Confocal laser endomicroscopy

CT: 

Computed tomography

EUS: 

Endoscopic ultrasonography

EUS-FNA: 

Endoscopic ultrasonography-guided fine needle aspiration biopsy

HDRBD: 

Tc-99m heat-damaged red blood cell

IPAS: 

Intrapancreatic accessory spleen

MRI: 

Magnetic resonance imaging

NF-NET: 

Non-functional neuroendocrine tumor

Declarations

Acknowledgements

Not applicable.

Funding

The design and collection, analysis, interpretation of data, and writing of the manuscript have not been supported by any grant or fund.

Authors’ contributions

All authors provided an intellectual contribution to this manuscript. PC made the conceptualization. FL and LS wrote the manuscript. EMM made the formal analysis. SC, VB, SC, and TF analyzed the literature and interpreted the patient data. AC confirmed the histopathological examination results. RC reviewed the clinical notes and edited the document. All authors read and approved the final manuscript.

Ethics approval and consent to participate

Not applicable

Consent for publication

Informed consent was obtained from the patient.

Competing interests

The authors declare that they have no competing interests.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
(2)
Department of Radiological Oncological and Pathological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
(3)
Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy

References

  1. Bostanci EB, Oter V, Okten S, Küçük NO, Soydal C, Turhan N, et al. Intra-pancreatic accessory spleen mimicking pancreatic neuroendocrine tumor on 68-ga-dotatate PET/CT. Arch Iran Med. 2016;19:816–9.PubMedGoogle Scholar
  2. Kawamoto S, Johnson PT, Hall H, Cameron JL, Hruban RH, Fishman EK. Intrapancreatic accessory spleen: CT appearance and differential diagnosis. Abdom Imaging. 2012;37(5):812–27.PubMedView ArticleGoogle Scholar
  3. Halpert B, Gyorkey F. Lesions observed in accessory spleens of 311 patients. Am J Clin Pathol. 1959;32(2):165–8.PubMedView ArticleGoogle Scholar
  4. Bhutiani N, Egger ME, Doughtie CA, Burkardt ES, Scoggins CR, Martin RC 2nd, et al. Intrapancreatic accessory spleen (IPAS): a single-institution experience and review of the literature. Am J Surg. 2017;213(4):816–20.PubMedView ArticleGoogle Scholar
  5. Gastrointestinal Pathology Study Group of Korean Society of Pathologists, Cho MY, Kim JM, Sohn JH, Kim MJ, Kim KM, Kim WH, et al. Current trends of the incidence and pathological diagnosis of gastroenteropancreatic neuroendocrine tumors ( GEP-NETs ) in Korea 2000-2009: Multicenter Study. Cancer Res Treat. 2012;44(3):157–65.View ArticleGoogle Scholar
  6. Halfdanarson TR, Rabe KG, Rubin J, Petersen GM. Pancreatic neuroendocrine tumors (PNETs): incidence, prognosis and recent trend toward improved survival. Ann Oncol. 2008;19(10):1727–33.PubMedPubMed CentralView ArticleGoogle Scholar
  7. Falconi M, Eriksson B, Kaltsas G, Bartsch DK, Capdevila J, Caplin M, et al. ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors. Neuroendocrinology. 2016;103(2):153–71.PubMedPubMed CentralView ArticleGoogle Scholar
  8. Uchiyama S, Chijiiwa K, Hiyoshi M, Ohuchida J, Imamura N, Nagano M, et al. Intrapancreatic accessory spleen mimicking endocrine tumor of the pancreas: case report and review of the literature. J Gastrointest Surg. 2008;12(8):1471–3.PubMedView ArticleGoogle Scholar
  9. Ota T, Tei M, Yoshioka A, Mizuno M, Watanabe S, Seki M, et al. Intrapancreatic accessory spleen diagnosed by Technetium-99m heat damage red blood cell SPECT. J Nucl Med. 1997;38(3):494–5.PubMedGoogle Scholar
  10. Läuffer JM, Baer HU, Maurer CA, Wagner M, Zimmermann A, Büchler MW. Intrapancreatic accessory spleen. A rare cause of a pancreatic mass. Int J Pancreatol. 1999;25(1):65–8.PubMedView ArticleGoogle Scholar
  11. Ardengh JC, de Paulo GA, Ferrari AP. EUS-guided FNA in the diagnosis of pancreatic neuroendocrine tumors before surgery. Gastrointest Endosc. 2004;60(3):378–84.PubMedView ArticleGoogle Scholar
  12. Brasca LE, Zanello A, De Gaspari A, De Cobelli F, Zerbi A, Fazio F, et al. Intrapancreatic accessory spleen mimicking a neuroendocrine tumor: magnetic resonance findings and possible diagnostic role of different nuclear medicine tests. Eur Radiol. 2004;14(7):1322–3.PubMedView ArticleGoogle Scholar
  13. Kim SH, Lee JM, Han JK, Lee JY, Kim KW, Cho KC, et al. Intrapancreatic accessory spleen: findings on MR imaging, CT, US and scintigraphy, and the pathologic analysis. Korean J Radiol. 2008;9(2):162–74.PubMedPubMed CentralView ArticleGoogle Scholar
  14. Schreiner AM, Mansoor A, Faigel DO, Morgan TK. Intrapancreatic accessory spleen: mimic of pancreatic endocrine tumor diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy. Diagnostic Cytopathology. 2018;36(4):262–5.View ArticleGoogle Scholar
  15. Belkhir SM, Archambaud F, Prigent A, Chaumet-Riffaud P. Intrapancreatic accessory spleen diagnosed on radionuclide imaging. Clin Nucl Med. 2009;34(9):642–4.PubMedView ArticleGoogle Scholar
  16. Arkadopoulos N, Athanasopoulos P, Stafyla V, Karakatsanis A, Koutoulidis V, Theodosopoulos T, Karvouni E, Smyrniotis V. Intrapancreatic accessory spleen issues: diagnostic and therapeutic challenges. J Pancreas. 2009;10(4):400–5.Google Scholar
  17. Lin J, Jing X. Fine-needle aspiration of intrapancreatic accessory spleen, mimic of pancreatic neoplasms. Arch Pathol Lab Med. 2010;134(10):1474–8.PubMedGoogle Scholar
  18. Kurmann A, Michel JM, Stauffer E, Egger B. Intrapancreatic accessory spleen misdiagnosed as a nonsecreting endocrine tumor: case report and review of the literature. Case Rep Gastroenterol. 2010;4(2):210–4.PubMedPubMed CentralView ArticleGoogle Scholar
  19. Spencer LA, Spizarny DL, Williams TR. Imaging features of intrapancreatic accessory spleen. Br J Radiol. 2010;83(992):668–73.PubMedPubMed CentralView ArticleGoogle Scholar
  20. Krishna SG, Heif MH, Sharma SG, Pandey T, Rego RF. Intrapancreatic accessory spleen: investigative dilemmas and role of EUS-guided FNA for diagnostic confirmation. J Pancreas. 2011;12(6):603–6.Google Scholar
  21. Toussaint E, Flamen P, Demetter P, Matos C, Van Gossum M, Delhaye M et al. A rare case of a pancreatic mass due to accessory spleen; when EUS-FNA is not enough. Endoscopy. 2011;43 Suppl 2 UCTN:E221-2.PubMedView ArticleGoogle Scholar
  22. Tatsas AD, Owens CL, Siddiqui MT, Hruban RH, Ali SZ. Fine-needle aspiration of intrapancreatic accessory spleen: cytomorphologic features and differential diagnosis. Cancer Cytopathol. 2012;120(4):261–8.PubMedView ArticleGoogle Scholar
  23. Jang KM, Kim SH, Lee SJ, Park MJ, Lee MH, Choi D. Differentiation of an intrapancreatic accessory spleen from a small (< 3 cm) solid pancreatic tumor: value of diffusion-weighted MR imaging. Radiology. 2013;266(1):159–67.PubMedView ArticleGoogle Scholar
  24. Bastidas AB, Holloman D, Lankarani A, Nieto JM. Endoscopic ultrasound-guided needle-based probe confocal laser endomicroscopy (nCLE) of intrapancreatic ectopic spleen. ACG Case Rep J. 2016;3(3):196–8.PubMedPubMed CentralView ArticleGoogle Scholar
  25. Boraschi P, Donati F, Volpi A, Campori G. On the AJR viewbox. Intrapancreatic accessory spleen: diagnosis with RES-specific contrast-enhanced MRI. AJR Am J Roentgenol. 2005;184(5):1712–3.PubMedView ArticleGoogle Scholar
  26. Yang B, Valluru B, Guo YR, Cui C, Zhang P, Duan W. Significance of imaging findings in the diagnosis of heterotopic spleen-an intrapancreatic accessory spleen (IPAS): case report. Medicine (Baltimore). 2017;96(52):e9040.PubMedPubMed CentralView ArticleGoogle Scholar
  27. Matsumoto K, Kato H, Okada H. Epidermoid cyst in an intrapancreatic accessory spleen diagnosed by typical radiographic images and endoscopic ultrasound fine-needle aspiration findings with contrast agent. Clin Gastroenterol Hepatol. 2018;16(2):e13–4.PubMedView ArticleGoogle Scholar
  28. Uchida D, Tsutsumi K, Kato H, Okada H. An intrapancreatic accessory spleen that was difficult to diagnose due to temporal changes after splenectomy. Intern Med. 2018;57:681–5.PubMedView ArticleGoogle Scholar
  29. Val-Bernal JF, Martino M, Yllera-Contreras E, Castro-Senosiain B, Bueno-Ortiz P. Intrapancreatic accessory spleen. Report of four cases diagnosed by ultrasound-guided fine-needle aspiration biopsy. Rom J Morphol Embryol. 2018;59(2):619–24.PubMedGoogle Scholar
  30. Barber TW, Dixon A, Smith M, Yap KS, Kalff V. Ga-68 octreotate PET/CT and Tc-99m heat-denatured red blood cell SPECT/CT imaging of an intrapancreatic accessory spleen. Med Imaging Radiat Oncol. 2016;60(2):227–9.View ArticleGoogle Scholar
  31. Baugh KA, Villafane N, Farinas C, Dhingra S, Silberfein EJ, Massarweh NN, Cao HT, Fisher WE, Van Buren G. Pancreatic incidentalomas: a management algorithm for identifying ectopic spleens. J Surg Res. 2019;236:144–52.PubMedView ArticleGoogle Scholar
  32. Setoyama T, Natsugoe S, Okumura H, Matsumoto M, Uchikado Y, Yokomakura N, et al. Alpha-catenin is a significant prognostic factor than E-cadherin in esophogeal squamous cell carcinoma. J Surg Oncol. 2007;95(2):148–55.PubMedView ArticleGoogle Scholar
  33. Huang Z, Liu F. Diagnostic value of serum carbohydrate antigen 19-9 in pancreatic cancer: a meta-analysis. Tumour Biol. 2014;35(8):7459–65.PubMedView ArticleGoogle Scholar
  34. Modlin IM, Oberg K, Taylor A, Drozdov I, Bodei L, Kidd M. Neuroendocrine tumor biomarkers: current status and perspectives. Neuroendocrinology. 2014;100(4):265–77.PubMedView ArticleGoogle Scholar
  35. Balon HR, Brown TL, Goldsmith SJ, Silberstein EB, Krenning EP, Lang O, et al. The SNM Practice Guideline for Somatostatin Receptor Scintigraphy 2.0. J Nucl Med Technol. 2011;39(4):317–24.PubMedView ArticleGoogle Scholar
  36. Mojtahedi A, Thamake S, Tworowska I, Ranganathan D, Delpassand ES. The value of (68)Ga-DOTATATE PET/CT in diagnosis and management of neuroendocrine tumors compared to current FDA approved imaging modalities: a review of literature. Am J Nucl Med Mol Imaging. 2014;4(5):426–34.PubMedPubMed CentralGoogle Scholar
  37. Suriano S, Ceriani L, Gertsch P, Crippa S, Giovanella L. Accessory spleen mimicking a pancreatic neuroendocrine tumor. Tumori. 2011;97(6):39e–41e.PubMedView ArticleGoogle Scholar
  38. García Angarita F, Sanjuanbenito DA. Intrapancreatic accessory spleen: a rare cause of recurrence of immune thrombocytopenic purpura. Clin Case Rep. 2016;4(10):979–81.PubMedPubMed CentralView ArticleGoogle Scholar
  39. Prasad V, Baum RP. Biodistribution of the Ga-68 labeled somatostatin analogue DOTA-NOC in patients with neuroendocrine tumors: characterization of uptake in normal organs and tumor lesions. Q J Nucl Med Mol Imaging. 2010;54(1):61–7.PubMedGoogle Scholar
  40. Kagna O, Pirmisashvili N, Tshori S, Freedman N, Israel O, Krausz Y. Neuroendocrine tumor imaging with 68Ga-DOTA-NOC: physiologic and benign variants. AJR. 2014;203:1317–23.PubMedView ArticleGoogle Scholar
  41. Sharma P, Arora S, Dhull VS, Naswa N, Kumar R, Ammini AC, Bal C. Evaluation of 68Ga-DOTANOC PET/CT imaging in a large exclusive population of pancreatic neuroendocrine tumors. Abdom Imaging. 2015;40(2):299–309.PubMedView ArticleGoogle Scholar
  42. Mapelli P, Tam H, Sharma R, Aboagye E, Al-Nahhas A. Frequency and significance of physiological versus pathological uptake of 68Ga-DOTATATE in the pancreas: validation with morphological imaging. Nucl Med Commun. 2014;35(6):613–9.PubMedView ArticleGoogle Scholar
  43. Makino Y, Imai Y, Fukuda K, Seki Y, Kogita S, Sawai Y, et al. Sonazoid-enhanced ultrasonography for the diagnosis of an intrapancreatic accessory spleen: a case report. J Clin Ultrasound. 2011;39(6):344–7.PubMedView ArticleGoogle Scholar
  44. Li BQ, Xu XQ, Guo JC. Intrapancreatic accessory spleen: a diagnostic dilemma. HPB. 2018;20(11):1004–11.PubMedView ArticleGoogle Scholar

Copyright

© The Author(s). 2019

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