title: Post-splenectomy intrapancreatic accessory spleen mimicking endocrine tumor of the pancreas.
abstract: BACKGROUND
  Intrapancreatic accessory spleen is an uncommon congenital abnormality of the spleen with no indication for surgical intervention. Among the few cases reported, IPAS coexisted with a normal spleen. We here report the first case of IPAS arising a couple years after splenectomy with the appearance of an endocrine tumor of the pancreas.
  
  
  METHODS
  A 62-year-old female presented with a one-week history of left upper quadrant discomfort. She had splenectomy for the treatment of hypersplenism caused by cirrhotic portal hypertension two years before this admission. Her physical examination was unremarkable and laboratory data was within the normal range. Both the ultrasonography and magnetic resonance image revealed a small oval-shaped mass in the tail of her pancreas with the diameter 2cm or less. A distal pancreatectomy was performed for the suspection of malignant neuroendocrine tumor of the pancreas. An intrapancreatic accessory spleen was confirmed by the pathologic examination.
  
  
  CONCLUSIONS
  Intrapancreatic accessory spleen is one kind of congenital ectopic spleen without indication for operative intervention. We present the case to support that intrapancreatic accessory spleen may enlarge through a compensatory mechanism, and raise the awareness of this intrapacreatic entity to avoid unnecessary surgical operation.
  
  
  CONCLUSIONS
  IPAS should be highly considered as a differential diagnosis while the lesion is no more than 2.5cm in diameter and/or other accessory spleens show around the splenic hilum.
authors.affiliation: Department of General Surgery, Zhongshan Hospital Fudan University, Shanghai 200032, China.
authors.forename: Hong-Xu
authors.initials: HX
authors.lastname: Zhu
authors.affiliation: Department of General Surgery, Zhongshan Hospital Fudan University, Shanghai 200032, China.
authors.forename: Wen-Hui
authors.initials: WH
authors.lastname: Lou
authors.affiliation: Department of General Surgery, Zhongshan Hospital Fudan University, Shanghai 200032, China.
authors.forename: Tian-Tao
authors.initials: TT
authors.lastname: Kuang
authors.affiliation: Department of General Surgery, Zhongshan Hospital Fudan University, Shanghai 200032, China. Electronic address: zhuhongxu007@163.com.
authors.forename: Dan-Song
authors.initials: DS
authors.lastname: Wang
keywords: Intrapancreatic accessory spleen; Pancreas; Pancreatic neuroendocrine tumor; Splenectomy