Korean J Gastroenterol.  2012 Jun;59(6):433-436. 10.4166/kjg.2012.59.6.433.

Diagnosis of an Accessory Spleen Mimicking a Gastric Submucosal Tumor Using Endoscopic Ultrasonography-guided Fine-needle Aspiration

• Ahn JY
• Jung HY
• Kim DH
• Choi KD
• Song HJ
• Lee GH
• Kim JH
• Hwang HS

• KMID: 1792849
• DOI: http://doi.org/10.4166/kjg.2012.59.6.433

Abstract

Accessory spleen can be mistaken as a gastric subepithelial mass, and may not be differentiated in CT or endoscopic ultrasonography (EUS). A gastric subepithelial mass was detected on routine endoscopy in a 39-year old woman with history of splenectomy. In subsequent CT and EUS, the subepithelial mass was located on the fourth layer of the stomach. To make a definite diagnosis, EUS-guided fine needle aspiration (FNA) was performed, and a splenic tissue was demonstrated in histologic examination. EUS-guided FNA can be beneficial in the diagnosis of accessory spleen which mimics a gastric subepithelial mass.

Keyword

Endoscopy; Spleen; Endosonography; Fine-needle biopsy

MeSH Terms

Adult
Antigens, CD34/metabolism
Biopsy, Fine-Needle
Endosonography
Female
Gastroscopy
Humans
Immunohistochemistry
Splenic Diseases/pathology
Stomach Neoplasms/*diagnosis/pathology
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Upper gastrointestinal endoscopy findings. (A) A gastric SMT-like lesion was approximately 30 mm in diameter. (B) The mass was hard, and had a well-demarcated margin at the gastric fundus.

• 

  Fig. 2 Abdominal contrast-enhanced computed tomography revealed a well-marginated and enhanced ovoid mass close to the gastric fundus (white arrow).

• 

  Fig. 3 Endoscopic ultrasonography showed a hypoechoic mass in the fourth layer.

• 

  Fig. 4 Endoscopic ultrasonography-guided fine needle aspiration findings (white arrow: 25-G needle).

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  Fig. 5 Photomicrographs of biopsied submucosal tissue (×200). (A) Characteristic sinusoidal architectures (white arrows) in splenic red pulp were demonstrated. Transition of capillaries (black arrow) into sheathed capillaries was also present (H&E). (B) The endothelial cells of sinus were positive for anti-CD8 antibody. (C) But, the endothelial cells of sinus were negative for anti-CD34 antibody on immunohistochemical stains. The cells showing positivity for anti-CD34 antibody were endothelial cells of perifollicular sinus.

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