title: Intrapancreatic accessory spleen: investigative dilemmas and role of EUS-guided FNA for diagnostic confirmation.
abstract: BACKGROUND
  We submit a case of intrapancreatic accessory spleen.
  
  
  METHODS
  A 33-year-old patient with history of dyspepsia underwent imaging studies suggestive of a neuroendocrine tumor. After referral to our institute, endoscopic ultrasound guided fine needle aspiration (EUS-FNA) confirmed diagnosis as intrapancreatic accessory spleen.
  
  
  CONCLUSIONS
  An accessory spleen may develop from estranged mesenchymal cells due to fusion failure of the splenic anlage. The prevalence of an accessory spleen is 10-30% with 80% of them present at the splenic hilum and 17% in the pancreatic tail. Intrapancreatic accessory spleen is commonly misdiagnosed as a pancreatic tumor. Since, the differential diagnosis includes pancreatic neuroendocrine tumors, additional investigation with EUS-FNA should be considered when radiological diagnosis is not definitive.
  
  
  CONCLUSIONS
  For diagnosis of intrapancreatic accessory spleen, radiographic imaging is useful, but lacks specificity without tissue diagnosis. Diagnosis can be safely and reliably established with EUS-FNA, leading to a benign prognosis and avoidance of unnecessary surgical intervention.
authors.affiliation: Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. sgkrishna@gmail.com
authors.forename: Somashekar G
authors.initials: SG
authors.lastname: Krishna
authors.forename: Muhannad M
authors.initials: MM
authors.lastname: Heif
authors.forename: Shree G
authors.initials: SG
authors.lastname: Sharma
authors.forename: Tarun
authors.initials: T
authors.lastname: Pandey
authors.forename: Rayburn F
authors.initials: RF
authors.lastname: Rego
mesh_terms: D000328:Adult; D044963:Biopsy, Fine-Needle / Q000379:methods; D002828:Choristoma / Q000000981:diagnostic imaging* / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging* / Q000473:pathology*; D013154:Spleen / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000473:pathology; D018084:Ultrasonography, Interventional; D054928:Validation Studies as Topic