Ectopic spleen and liver hemangioma mimicking metastatic pancreatic neuroendocrine tumor

Endoscopic ultrasonography elastography in the diagnosis of intrapancreatic ectopic spleen: A case report

BACKGROUND

Intrapancreatic accessory spleen (IPAS) mimics a pancreatic neoplasm on imaging studies, and due to the lack of radiological diagnostic criteria, patients undergo unnecessary distal pancreatectomies. Endoscopic ultrasonography (EUS) is a reliable and efficient diagnostic modality for pancreatic diseases. However, no EUS criteria have been established for IPAS. We present the EUS-elastography image of IPAS, which may minimize the chance of misdiagnosis in the future.

CASE SUMMARY

A 50-year-old man was referred for an EUS evaluation after computed tomography showed a hypervascular enhanced mass in the tail of the pancreas, which indicated a neuroendocrine neoplasm. EUS elastography demonstrated that the lesion of interest covered no more than 25% of the region of interest. The patient underwent distal pancreatectomy. However, the resected tissue was evaluated, and the patient was finally diagnosed with IPAS.

CONCLUSION

IPAS should be considered in patients with suspected pancreatic neuroendocrine tumors of the pancreatic tail before surgery is performed. The differentiation between IPAS and pancreatic neuroendocrine tumors can be demonstrated using EUS-elastography.

68Ga-Prostate-Specific Membrane Antigen Uptake in a Pancreatic Neuroendocrine Tumor

We present a 60-year-old man with known prostate cancer treated with robot-assisted radical prostatectomy. Prostate-specific antigen levels did not decline accordingly, and a second Ga-PSMA PET/CT demonstrated a new focus with high Ga-PSMA uptake in the pancreatic tail. A subsequent CT scan did not display the lesion as a typical pancreatic tumor, and a spleen scintigraphy was also negative excluding an ectopic intrapancreatic accessory spleen. Ga-DOTATOC PET/CT showed uptake in the same area of the pancreatic tail consistent with a neuroendocrine tumor. This case illustrates that neuroendocrine tumors can be important pitfalls in Ga-PSMA PET/CT performed in prostate cancer patients.