Endoscopic ultrasound fine-needle aspiration in the diagnosis of intrapancreatic accessory spleen.

摘要

Intrapancreatic accessory spleens represent a potential pitfall in the diagnosis of pancreatic lesions by mimicking pancreatic neoplasms, in particular, neuroendocrine tumors. We report two cases of intrapancreatic accessory spleen discovered in patients with a previous history of neuroendocrine tumors. Case 1. A 39-year-old woman with a history of well-differentiated pancreatic neuroendocrine tumor with liver metastases underwent follow-up endoscopic ultrasound (EUS) (Olympus GF-UCT140AL5; Olympus America, Melville, NY, USA) revealing a well-defined, homogeneous, hypoechoic lesion in the tail (013 mm), suggesting a neuroendocrine localization; echo-Doppler showed arterial and venous supply. EUS-fine-needle aspiration (FNA) was carried out with a 22-G needle (Wilson-Cook, Winston-Salem, NC, USA), (Fig. 1). A dedicated cytopathologist carried out a rapid on-site evaluation (ROSE):1 two slides were smeared and remaining material preserved for cell-block preparation. Smears showed tangles of small blood vessels and a population of heterogeneous lymphocytes, intermixed with neutrophils, histiocytes and plasma cells (Fig. 2). Flow cytometry showed a polyclonal B and T cell population. Immunocytochemistry for cytokeratin AE1/AE3 on cell-block sections was negative. These findings were diagnostic for accessory spleen.