PMC4872470_01
Ultrasound showing mass adjacent to gallbladder, arising from the liver.
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The patient subsequently had an abdominal ultrasound scan which showed multiple sub-centimeter gallstones, and a mass arising from the liver (Fig. 1).
CT scan showing mass separate from right kidney laying retro-duodenal.
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This was followed by a CT scan of the abdomen with IV contrast which showed a large mass, approximately 11 x 8 cm in diameter, arising retro-duodenal, lying just anterior to the right kidney (Fig. 2).
Accessory spleen in-situ post kocherization of the duodenum.
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Omental adhesions to the gallbladder and liver were dissected and the duodenum kocherized, to reveal the mass, with no attachment to the duodenum (Fig. 3).
Post removal of mass, showing inferior vena cava (IVC) and right renal vein.
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There were large veins inserting into the inferior vena cava and the mass was resected en bloc by dissection with the ultrasonic dissector (Fig. 4, Fig. 5).
Microscopic images of accessory spleen. A. H&E. There is an outer fibrous capsule (arrow) surrounding typical-appearing splenic parenchyma. B. H&E. Higher magnification highlights a focus of white pulp (arrow) in a background of red pulp (cords and sinuses). Immunohistochemical stains highlight the native population of CD20-positive B-lymphocytes (C.) and CD3-positive T-lymphocytes.
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Immunohistological examination of the specimen revealed a benign spleen (Fig. 6).