Abstract
Splenules can be found in the adrenals and should be considered in the differential diagnosis of adrenal incidentalomas.
Keywords: accessory spleen, adrenal incidentaloma, adrenal mass, splenosis, splenule
Splenules can be found in the adrenals and should be considered in the differential diagnosis of adrenal incidentalomas.
Adrenal incidentalomas are asymptomatic adrenal masses discovered incidentally on imaging for unrelated reasons. Splenules, as developmental anomalies, have not been previously reported in the adrenal glands. Here, we report a case of an incidental intra‐adrenal splenule suggesting that splenules should be considered in the differential diagnosis of adrenal incidentalomas.
A 51‐year‐old man, status postsplenectomy 9 years prior to the current presentation for hereditary spherocytosis, presented with new‐onset hypertension and found to have hypokalemia and elevated aldosterone in the serum and left adrenal vein. On CT scan, a 7 mm nodule in the left adrenal gland with indeterminate enhancement characteristics was detected. Given the high clinical suspicion for primary aldosteronism secondary to adrenocortical adenoma, a retroperitoneoscopic adrenalectomy was performed and histology revealed an adrenocortical adenoma. In addition, in the grossly uninvolved adrenal tissue, a well‐circumscribed, 6‐mm‐nodule was also found, which was surrounded by a fibrous capsule and comprised of splenic red pulp (Figure 1A–E). The findings were diagnostic of intra‐adrenal splenule.
FIGURE 1.
On H&E morphology, the nodule is well‐circumscribed, surrounded by a capsule, and consisted of splenic red pulp with scattered megakaryocytes and erythroid precursors (panel A; whole slide image ×1.5, panel B; ×20 objective; H&E stain). CD8 highlights the sinusoids (panel C; ×20 objective). CD34 highlights a large feeding vessel adjacent to the nodule (panel D; ×4 objective). Smooth muscle bundles are seen in the capsule of the nodule on SMA (panel E; ×10 objective)
A splenule, or accessory spleen, is a developmental anomaly where splenic tissue is found outside the normal spleen. Splenules are different from splenosis, which is a consequence of embedding of broken splenic tissue in the peritoneal cavity. Unlike splenosis, splenules have thick capsules with smooth muscle elements and blood supply arising from arteries. Splenules are most commonly found in the splenic hilum (75%) and the tail of the pancreas (20%), and rarely in the wall of the stomach or intestine, ligaments, and omentum. 1 Adrenal incidentalomas are asymptomatic masses discovered incidentally on imaging studies performed for unrelated reasons. 2 Our case suggests that splenules should be considered in the differential diagnosis of adrenal incidentalomas.
CONFLICTS OF INTERESTS
None declared.
AUTHOR CONTRIBUTION
WWL and BA: involved in conception and design, and manuscript preparation; JPC: involved in conception and manuscript review.
ETHICAL APPROVAL
The authors confirmed that we have followed the high standards as set out by Commission on Publication Ethics (COPE) and International Committee of Medical Journal Editors (IJCME). Ethics approval was not required for this study.
ACKNOWLEDGEMENTS
Published with written consent of the patient.
Lin W‐HW, Crapanzano JP, Alobeid B. Incidental intra‐adrenal splenule. Clin Case Rep. 2021;9:e04469. 10.1002/ccr3.4469
DATA AVAILABILITY STATEMENT
Data sharing not applicable—no new data generated.
REFERENCES
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data sharing not applicable—no new data generated.