An Accessory Spleen Mimics a Left Adrenal Carcinoma

Chieh-Hsiao Chen, MD; Hsi-Chin Wu, MD; Chao-Hsiang Chang, MD

Disclosures

May 05, 2005

Discussions

There are variants of spleen development, such as splenic clefts, notches, lobulations, an accessory spleen, polysplenia, and wandering spleen.[1] When an accessory spleen wanders to another place, it may mimic some tumors. Adnexal tumor, pancreatic tumor, retroperitoneal tumor, and testicular tumor had been reported.[1,2,4,5,6] In this case, it mimics an adrenal carcinoma.

The diagnosis of adrenal carcinoma should always be kept in mind when a solitary adrenal mass is greater than 5 cm in diameter.[8] There is no study mentioned about an accessory spleen greater than 5 cm at the suprarenal area. Typically, an accessory spleen is located at the splenic hilum and is less than 3 cm in diameter.[1,2,3] This patient had a huge suprarenal tumor about 7 x 6 cm in size. We performed laparoscopic resection for this patient due to the initial diagnosis of adrenal carcinoma, not an accessory spleen.

Treatment of an accessory spleen is controversial. It is usually asymptomatic. When an accessory spleen is located in the abdomen without any symptoms, treatment is not necessary. However, torsion of the pedicle of the wandering accessory spleen may happen and can result in rupture and infarction.[3] Laparoscopic resection to treat the wandering accessory spleen is recommended by some investigators when there is a hematologic problem, such as anemia, or symptoms, such as pain or torsion.[3]

We reported this special image of an accessory spleen mimicking the adrenal carcinoma and suggested that for a homogeneous solid adrenal mass, magnetic resonance angiography (MRA) and damaged red blood cell (RBC) scintigraphy may be indicated to rule out the possibility of an accessory spleen from an adrenal tumor.[3,5,6] For an accessory spleen that requires surgical intervention, MRA is indicated due to the more detailed anatomic structure. For a small asymptomatic accessory spleen, damaged RBC scintigraphy is the most specific evaluation technique.[3] For an asymptomatic accessory spleen that is incidentally discovered during laparoscopic surgery, we suggest that splenectomy should be performed if the accessory spleen still has a chance of torsion and the laparoscopic splenectomy is simple and harmless.

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