Val-Bernal José Fernando, Martino María, Yllera-Contreras Elena, Castro-Senosiain Beatriz, Bueno-Ortiz Pablo
Pathology Unit, Department of Medical and Surgical Sciences, University of Cantabria and IDIVAL Research Institute, Santander, Spain;
Rom J Morphol Embryol. 2018;59(2):619-624.
Intrapancreatic accessory spleen (IPAS) is a congenital anomaly usually misdiagnosed as a pancreatic neoplasm. For five years and four months, we collected seven IPASs located in the tail of the pancreas in four patients diagnosed by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). All cases had associated cell block preparations. Each patient underwent endoscopic ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) studies. The patients ranged in age from 57 to 73 years (mean age 65.7 years old). All lesions were well-defined, 1-1.9 cm in size (mean 1.5 cm). To our knowledge, a case with four IPASs in the tail of the gland has not been previously reported. Cytological features of IPAS included a polymorphous population of hematopoietic cells admixed with occasional blood vessels. Cell blocks comprised spleen red pulp. CD8 immunostaining of cell blocks highlighted splenic endothelial cells and confirmed the diagnosis. IPAS presented as an asymptomatic lesion detected on imaging studies. It may mimic a pancreatic neoplasm, mainly a neuroendocrine tumor. The use of EUS-FNA is an essential tool in the diagnosis of the lesion. The endothelial cells of the splenic sinuses characterized by their positivity for CD8 are evident in the sections of the cell blocks. This staining is considered specific and can be used as a confirmatory marker. EUS-FNA biopsy provides a reliable diagnosis that prevents unnecessary surgery.
胰腺内副脾（IPAS）是一种先天性异常，通常被误诊为胰腺肿瘤。在五年零四个月的时间里，我们收集了4例经内镜超声引导下细针穿刺活检（EUS-FNA）诊断为胰腺尾部的7个IPAS病例。所有病例均制作了细胞块标本。每位患者均接受了内镜超声、计算机断层扫描（CT）和磁共振成像（MRI）检查。患者年龄在57至73岁之间（平均年龄65.7岁）。所有病变边界清晰，大小为1-1.9厘米（平均1.5厘米）。据我们所知，此前尚未报道过胰腺尾部有4个IPAS的病例。IPAS的细胞学特征包括多形性造血细胞群，并伴有少量血管。细胞块由脾红髓组成。细胞块的CD8免疫染色突出了脾内皮细胞，从而确诊。IPAS在影像学检查中表现为无症状性病变。它可能酷似胰腺肿瘤，主要是神经内分泌肿瘤。EUS-FNA的应用是诊断该病变的重要工具。脾窦内皮细胞在细胞块切片中表现为CD8阳性，很明显。这种染色被认为具有特异性，可作为确诊标志物。EUS-FNA活检可提供可靠的诊断，避免不必要的手术。
