A rare case of splenunculus buried within the stomach

Authors

• Mazen Farhat Department of Gastroenterology and Hepatology, St George University of Beirut, Beirut, Lebanon
• Karam Karam Department of Gastroenterology and Hepatology, University of Balamand, Beirut, Lebanon
• Philippe Attieh Department of General Surgery, University of Balamand, Beirut, Lebanon
• Elie Mina Department of Pathology, St George University of Beirut, Beirut, Lebanon
• Zarouhie Meguerian Department of Gastroenterology and Hepatology, St George University of Beirut, Beirut, Lebanon; Department of Pathology, St George University of Beirut, Beirut, Lebanon
• Elias Fiani Department of Gastroenterology and Hepatology, St George University of Beirut, Beirut, Lebanon; Department of Gastroenterology and Hepatology, University of Balamand, Beirut, Lebanon
• Ihab I. El Hajj Department of Gastroenterology and Hepatology, St George University of Beirut, Beirut, Lebanon; Department of Gastroenterology and Hepatology, University of Balamand, Beirut, Lebanon

karamek7@gmail.com

Keywords

Abstract

Background: Accessory spleen, or splenunculus, is a congenital anomaly resulting from failure of splenic anlage fusion during embryonic development. It is most commonly located near the splenic hilum or pancreatic tail and rarely occurs within the stomach wall. Gastric accessory spleen is a rare entity that may mimic submucosal neoplasms such as gastrointestinal stromal tumour, posing a diagnostic challenge.
Case presentation: We report the case of a 37-year-old male presenting with a 3-month history of epigastric pain, dyspepsia, and nausea. Endoscopy revealed a 2.5–3 cm submucosal mass in the gastric fundus with intact mucosa, and erosive antral gastritis. Endoscopic ultrasound demonstrated a 22.6 × 17.2 × 23.3 mm hypoechoic, homogeneous lesion arising from the third layer of the gastric wall. Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) showed lymphoid aggregates with characteristic vascular structures lined by CD8-positive littoral cells and CD68/PGM1-positive macrophages. Immunohistochemistry excluded epithelial, neuroendocrine, and lymphoproliferative neoplasms, confirming the diagnosis of gastric accessory spleen.
Discussion: This case is distinctive because the patient had no prior splenectomy or trauma and was diagnosed preoperatively using EUS-guided biopsy—avoiding unnecessary surgery. Gastric accessory spleen remains a rare but important differential diagnosis for submucosal gastric lesions. Recognition of its imaging and histopathologic features can prevent misdiagnosis and overtreatment.
Conclusion: Gastric accessory spleen is a benign, rare condition that should be considered in patients presenting with gastric submucosal masses. Non-invasive diagnostic modalities such as EUS-FNB and immunohistochemistry are essential to achieve an accurate diagnosis and to avoid unnecessary surgical resection.

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