Case Report: Challenging diagnostic of an accessory spleen mimicking a retroperitoneal tumor: A case report and review of the literature [version 1; peer review: 1 approved with reservations]

• Published in: F1000 research Vol. 12; p. 491
• Main Authors: Zouaghi, Alia, Miri, Rim, Hadded, Dhafer, Mesbahi, Meryam, Zaafouri, Haithem, Cherif, Mona, Riahi, Wassim, Benzarti, Yazid, Mleyhi, Sobhi, Ghedira, Faker, Souli, Aslam, Chamekhi, Chiraz, Khanchel, Fatma, Ben Maamer, Aniss
• Format: Journal Article
• Language: English
• Published: 2023
• Subjects: retroperitoneal spleen; case report; accessory spleen; retroperitoneal neoplasm; retroperitoneal mass
• DOI: 10.12688/f1000research.73043.1
• EISSN: 2046-1402

Background: The accessory spleen is a congenital defect with an additional splenic tissue to the native spleen due to an incomplete fusion of splenic masses during the embryologic period. The preoperative diagnosis is usually mistaken for a retroperitoneal neoplasm. The aim of the present manuscript is to highlight the diagnostic difficulties of a retroperitoneal spleen.
Case presentation: A 41-year-old woman was admitted to the surgical department of Habib Thameur Hospital, Tunis, for an abdominal mass discovered by auto palpation associated with a left lower quadrant pain. The computed tomographic scan showed a heterogeneous and partially necrotic retroperitoneal mass located along the left primitive iliac vessels . Arterial supply to the mass arose from the aorta and the left iliac vessel. The spleen was normal. MRI examination showed a left retroperitoneal heterogeneous and necrotic mass, surrounding the iliac vessels extended from the aortic to the left iliac bifurcation, hyper vascularized at the arterial time with a peripheral capsule intensely enhanced, and there were two other lateroaortic vascularized masses. The patient had a laparotomy resection of the retroperitoneal mass. The result of the specimen examination was an accessory spleen. The postoperative outcome was uneventful.
Conclusion: An accessory spleen on the retroperitoneal position is extremely uncommon. Preoperative diagnosis is still challenging. The main misdiagnosis was neoplastic disease.