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"autores" => array:3 [ 0 => array:4 [ "nombre" => "Milan" "apellidos" => "Radojkovic" "email" => array:1 [ 0 => "mida71@mts.rs" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Danijela" "apellidos" => "Radojkovic" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Natalija" "apellidos" => "Premovic" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Surgery Department, School of Medicine, University of Nis, Serbia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Endocrinology Department, School of Medicine, University of Nis, Serbia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "School of Medicine, University of Nis, Serbia" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bazo accesorio intrapancreático" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 868 "Ancho" => 3333 "Tamanyo" => 312001 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abdominal computed tomography scan depicting (white arrow) round homogeneous contrast-enhancing lesion in the pancreatic tail well-delineated from the pancreas parenchyma (A) and macroscopic appearance of the intrapancreatic splenule (white arrows) (B and C).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Accessory spleen is a congenital anomaly and occurs as a result of abnormal embryonic development. It is formed from the left part of the dorsal mesogastrium when the fusion of separate splenic masses fails. Ectopic splenic nodules are present in approximately 10% of the population. They can be solitary or multiple and in 80% of the cases are located near the vessel pedicle of the splenic hilum and adjacent to the pancreas.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In the rest of the cases accessory spleens can be found anywhere along the splenic vessels and within the distant organs like the pancreas, liver, jejunum wall, mesentery, greater omentum, pelvis and even scrotum,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> with the pancreatic tail being the second most frequent site of their occurrence in up to 16% of the cases. Accessory spleens are benign lesions and very rarely symptomatic. However, intrapancreatic accessory spleen (IPAS) may present the differential diagnostic challenge to pancreatic neoplasms particularly mimicking neuroendocrine tumors. Herein we present a patient surgically treated for IPAS mistakenly suspected of neuroendocrine pancreatic neoplasm (pNEN).</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 48-year-old male was referred to our department for further investigation and treatment of a nodular lesion in the pancreatic tail found on abdominal ultrasound. Previously, a comprehensive work-up was initiated for several-month history of mild intermittent vague unspecific upper abdominal pain. Otherwise, the patient's medical history was unremarkable except for the light but regular alcohol consumption. Laboratory check-up revealed normal values of CEA, PSA, CA19-9 and chromogranin A. Computed tomography (CT) confirmed a round homogeneous 11<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>mm contrast-enhancing lesion in the pancreatic tail well-delineated from the pancreas parenchyma suggestive of pNEN (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and additional accessory spleen near the caudal pole of the spleen. On endoscopic ultrasound well-defined hyperechogenic nodule in the pancreatic tail was not accessible for fine needle aspiration biopsy. The case was discussed and left-sided splenopancreatectomy was performed for suspected non-functioning but potentially cancerous pNEN. Histopathological analysis revealed it was IPAS without any elements for the diagnosis of pNEN. The postoperative recovery was uneventful and the patient was discharged at postoperative day 9.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In general, IPAS is an asymptomatic, benign lesion incidentally discovered during imaging studies<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> and does not require surgery or follow-up. Nevertheless, in most of the reported cases the definitive diagnosis of IPAS was made after resection on histopathology examination.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> The exact diagnosis that would ensure avoiding the unnecessary surgery is still a challenge due to the lack of reliable biochemical or radiological parameters to confirm or exclude the presence of IPAS.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Differential diagnosis for IPAS includes numerous hypervascular neoplasms of the pancreas such as pNEN, adenocarcinomas, solid pseudopapillary tumors and metastases, but also lymphomas and lymphoepithelial cysts. It therefore seems mandatory to engage all available imaging modalities for noninvasive IPAS diagnosis such as echosonography (gray-scale, color Doppler, contrast-enhanced, endoscopic), cross-sectional CT (contrast-enhanced, single photon emission CT, 68Ga-DOTA-TOC PET/CT) and MRI (contrast-enhanced, superparamagnetic iron oxide-enhanced) imaging or scintigraphy (somatostatin receptor-octreotide scan, 99mTechnetium heat-damaged red blood cells scintigraphy, 99mTechnetium sulphur colloid scan), alone or combined. On radiological examination IPAS presents as well-defined, small, oval, and homogenous mass with imaging features similar to those of the spleen.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Demonstration of specific blood supply entering the mass may provide the diagnosis of IPAS with the sensitivity of 90%. Also, IPAS demonstrates inhomogenous contrast-enhancement in the early vascular phase similar to that of the spleen and prolonged enhancement during the parenchymal phase.</p><p id="par0020" class="elsevierStylePara elsevierViewall">However, although introducing new imaging techniques increases the capacity for accurate diagnosis, distinguishing IPAS from other pancreatic hypervascular lesions remains challenging due to the lack of their specificity or their poor anatomical resolution. As a result, up to 10% of patients are still being mistakenly diagnosed and subjected to unnecessary resection for pancreatic neoplasms.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Moreover, IPAS is most commonly misdiagnosed as pNEN, also well-defined homogeneous and hypervascular lesion. pNEN are rare and account for less than 2% of all pancreatic tumors. They can be functioning (hormone-secreting) or non-functioning. The latter account for 15–41% of all pNEN and the majority of them are malignant (62–92%, depending on the type of tumor). Complete surgical removal of these tumors is the most important predictor of long-term survival of patients with pNEN and resection is mandatory for such tumors larger than 1<span class="elsevierStyleHsp" style=""></span>cm. Since IPAS does not require any therapy, it is therefore of great importance to distinguish this benign lesion from pNEN. Although octreotide scan is highly sensitive for pNEN (70–95%), false-positive findings have been observed in IPAS mimicking a pNEN due to the somatostatin receptors with high affinity to octeotride present in IPAS lymphocytes.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Finally, endoscopic sampling has been demonstrated to be a relatively safe and most reliable tool to provide definitive IPAS diagnosis with 90% efficacy<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> for accessible lesions.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Although rare IPAS should be suspected and ruled out as differential diagnosis in patients with asymptomatic pancreatic masses. Surgeon should engage all available diagnostic tools to ensure the correct diagnosis and avoid unnecessary surgery. Introducing new sophisticated imaging modalities will probably provide the basis for increasing number of successfully discovered IPASs in the future.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">Authors declare that they have no conflict of interest of any kind.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:2 [ "identificador" => "xack575969" "titulo" => "Acknowledgements" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 868 "Ancho" => 3333 "Tamanyo" => 312001 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abdominal computed tomography scan depicting (white arrow) round homogeneous contrast-enhancing lesion in the pancreatic tail well-delineated from the pancreas parenchyma (A) and macroscopic appearance of the intrapancreatic splenule (white arrows) (B and C).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intrapancreatic accessory spleen issues: diagnostic and therapeutic challenges" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Arkadopoulos" 1 => "P. Athanasopoulos" 2 => "V. Stafyla" 3 => "A. Karakatsanis" 4 => "V. Koutoulidis" 5 => "T. Theodosopoulos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JOP J Pancreas" "fecha" => "2009" "volumen" => "10" "paginaInicial" => "400" "paginaFinal" => "405" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A rare case of pancreatic head splenosis diagnosed by contrast-enhanced ultrasound" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. De Robertis" 1 => "M. D’Onofio" 2 => "E. Manfrin" 3 => "C. Dal Bo" 4 => "R. 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