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Differentiating intrapancreatic accessory spleen from a pancreatic neuroendocrine tumor or metastasis by the “bridge sign”


1 Department of Gastroenterology, Hepatology and Nutrition-Unit 1466, UT MD Anderson Cancer Center, Houston, Texas, USA
2 Department of Gastroenterology, Hepatology and Nutrition-Unit 1466, UT MD Anderson Cancer Center, Houston, Texas, USA; Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
3 Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania

Date of Submission05-Dec-2018
Date of Acceptance10-Apr-2019
Date of Web Publication20-Jun-2019

Correspondence Address:
Manoop S Bhutani,
Department of Gastroenterology, Hepatology and Nutrition-Unit 1466, UT MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030-4009
USA
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/eus.eus_29_19

PMID: 31249165



How to cite this URL:
Bhutani MS, Singh BS, Cazacu IM, Saftoiu A. Differentiating intrapancreatic accessory spleen from a pancreatic neuroendocrine tumor or metastasis by the “bridge sign”. Endosc Ultrasound [Epub ahead of print] [cited 2019 Jul 15]. Available from: http://www.eusjournal.com/preprintarticle.asp?id=260856



An accessory spleen (splenule) may be present in 10%–30% of the general population.[1] Majority of these are located around the splenic hilum with a smaller number within the pancreatic tail.[2] The intrapancreatic accessory spleens not infrequently cause diagnostic confusion (especially with neuroendocrine tumors of the pancreas or pancreatic metastases) on imaging modalities such as CT, MR, and US. Even fine-needle aspiration or surgery has been done for patients with intrapancreatic accessory spleens due to continued concern for a pancreatic neoplasm. [Figure 1] shows an intrapancreatic accessory spleen during EUS where a round, homogeneous, well-defined lesion is seen in the pancreas tail that may be indistinguishable from a neuroendocrine tumor or a metastatic lesion. However, on dynamic real-time EUS imaging with careful transducer movement, the lesion is seen to be connected to the spleen with a bridge of splenic tissue. The authors would like to name it “the bridge sign” [Figure 2]. Nothing else is needed at this point. This simple technique saves the patient an EUS-FNA, diagnostic confusion, surgery, anxiety, and health-care dollars. Let's not forget this dynamic EUS imaging aspect before reaching for the biopsy needle!
Figure 1: EUS showing a round, homogeneous, well-defined lesion in the pancreatic tail. Differential diagnosis includes intrapancreatic accessory spleen or a pancreatic neuroendocrine tumor

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Figure 2: Dynamic EUS imaging reveals the “bridge sign” where the lesion is connected to the spleen by a bridge of tissue. Diagnosis: intrapancreatic accessory spleen

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Halpert B, Alden ZA. accessory spleens in or at the tail of the pancreas. A survey of 2,700 additional necropsies. Arch Pathol 1964;77:652-4.  Back to cited text no. 1
    
2.
Chan KJ, Fenton-Lee D. Intrapancreatic accessory spleen masquerading as a pancreatic neuroendocrine tumor. J Gastrointest Surg 2018;22:1799-800.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2]



 

 
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