Background: Identification of incidental pancreatic lesions is increasing because of advancements in imaging. Diagnosis remains a challenge for clinicians, with intrapancreatic accessory spleens (IPAS) posing a unique dilemma. IPAS are frequently resected because of inability to exclude alternate diagnoses, subjecting patients to unnecessary risk. The purpose of this study was to examine our institutional experience with IPAS and develop a multidisciplinary algorithm to improve preoperative diagnosis. 
Conclusions: Incidental pancreatic lesions like IPAS remain a diagnostic challenge for clinicians. Employing a diagnostic algorithm as proposed may aid in the distinction of malignant and premalignant pathology and prevent unwarranted pancreatic resections. 
Pancreatic Incidentalomas: A Management Algorithm for Identifying Ectopic Spleens 
Baugh KA et al.
J Surg Res. 2019 Apr;236:144-152

“Ten patients of 303 patients who underwent a distal pancreatectomy were identified with a final pathology of IPAS. The average age was 54 y, 80% were white, and 60% were male. Lesions ranged in size from 7 mm to 5.1 cm in largest diameter (mean 2.2 cm). Lesions were described as round, well-marginated, and enhancing masses within the pancreatic tail. Preoperative workup was variable in terms of imaging and laboratory testing. Diagnostic workups were examined and combined with multidisciplinary input to create a diagnostic algorithm.”
Pancreatic Incidentalomas: A Management Algorithm for Identifying Ectopic Spleens 
Baugh KA et al.
J Surg Res. 2019 Apr;236:144-152

Pancreatic Incidentalomas: A Management Algorithm for Identifying Ectopic Spleens 
Baugh KA et al.
J Surg Res. 2019 Apr;236:144-152

“The heterogeneous enhancement on arterial phase is secondary to the differences in rate of blood flow between the red pulp and the white pulp of the spleen. Nonfunctioning PNETs are also hyperenhancing lesions on CT but with uniform or ring-like enhancement and greater enhancement on the venous phase.” 
Pancreatic Incidentalomas: A Management Algorithm for Identifying Ectopic Spleens 
Baugh KA et al.
J Surg Res. 2019 Apr;236:144-152

“Metastatic disease represents 2%-5% of all malignant pancreatic tumors and usually arises from renal cell carcinoma, non-small cell lung cancer, and gastrointestinal carcinoma. Renal cell carcinoma usually presents as an enhancing lesion, whereas the other two are usually hypoattenuating but all typically correlate with the discovery of a primary tumor on CT.”
Pancreatic Incidentalomas: A Management Algorithm for Identifying Ectopic Spleens 
Baugh KA et al.
J Surg Res. 2019 Apr;236:144-152

”The octreoscan is 70%-95% sensitive for detecting PNETs with somatostatin receptors. However, not all PNETs have somatostatin receptors; therefore, a negative octreotide scan does not rule out PNETs. In addition, lymphocytes can also display somatostatin receptors on their surface and cause uptake of the radiolabeled analog creating a false positive. One of the two IPAS patients in our series had a false positive octreotide scan; this displays the challenges that persist in diagnosing incidental pancreatic lesions.”
Pancreatic Incidentalomas: A Management Algorithm for Identifying Ectopic Spleens 
Baugh KA et al.
J Surg Res. 2019 Apr;236:144-152

“Diagnosis of incidental distal pancreatic solid lesions like IPAS creates significant difficulty for pancreas surgeons. Our algorithm provides needed structure to the work up. Although this is designed to rule out IPAS, this algorithm can be used as a starting point for the work up of any incidentally found pancreatic mass. In the past, the work up of incidentally found lesions led to the development of useful guidelines in the adrenal gland. Therefore, establishment of protocols like the one proposed for pancreatic lesions may aid in the development of future guidelines for the pancreas.”
Pancreatic Incidentalomas: A Management Algorithm for Identifying Ectopic Spleens 
Baugh KA et al.
J Surg Res. 2019 Apr;236:144-152

“Work up of an incidental pancreatic solid lesion remains a challenge, especially for the diagnosis of IPAS. Successful diagnosis will require a strong index of suspicion, a multi- disciplinary approach, and the use of the proposed algorithm. In time, this may aid clinicians in the distinction between benign IPAS, which requires no further action and a lesion requiring resection.”
Pancreatic Incidentalomas: A Management Algorithm for Identifying Ectopic Spleens 
Baugh KA et al.
J Surg Res. 2019 Apr;236:144-152

Splenosis

• Ectopic splenic tissue caused by autotransplantation of splenic cells resulting from traumatic disruption of the splenic capsule via trauma or surgery.
• More numerous and widespread than accessory spleens.