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Splenules Presenting as Incidental Gastric Fundic Masses on Endoscopy

Khayat, Ammar; Martinez, Alfonso M.

Journal of Pediatric Gastroenterology and Nutrition: October 2017 - Volume 65 - Issue 4 - p e78–e79
doi: 10.1097/MPG.0000000000001706
Short Communication: Gastroenterology

Medical College of Wisconsin, Milwaukee, WI.

Address correspondence and reprint requests to Ammar Khayat, MD, Department of Pediatrics, GI Division, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226 (e-mail:

Received 27 January, 2017

Accepted 25 July, 2017

The authors report no conflicts of interest.

We would like to alert the reader to an unusual presentation of splenosis as a gastric subepithelial mass found on endoscopy. We performed an upper endoscopy to evaluate vomiting and dysphagia, in an 18-month-old girl, who was post repair of cleft lip and palate and G-tube dependent. She had no history of splenic trauma or splenectomy. Two distinct fundic masses were found (Fig. 1A) that appeared to be due to extrinsic compression, as their appearance was unchanged with gastric distension. Histology of the overlying mucosa was normal. Abdominal ultrasound revealed a round 3 × 2 cm mass between the stomach and the spleen that was isoechoic with the spleen with similar Doppler flow characteristics compatible with a splenule (Fig. 1B and C).



Splenules and splenosis presenting as gastrointestinal subepithelial masses have been reported in adults. (1–4). They have been mistaken for gastrointestinal stromal tumors (1,3). Patients may present with abdominal discomfort or gastrointestinal bleeding (1,2,4). Classically, patients have a history of a splenectomy or splenic injury, subsequently resulting in hypertrophy of previously undetected splenules or fragment autotransplantation (splenosis) into gastric or intestinal submucosa (1–4).

Generally, gastrointestinal subepithelial masses can be due to intramural lesions or extrinsic compression by intra-abdominal organs, for example, the left lobe of the liver, gallbladder, spleen, colon, or pancreas, or by an abnormal structure such as a pancreatic pseudocyst, renal cysts, enlarged lymph nodes, or an abscess (5,6). Intramural lesions can be benign or malignant. Benign lesions include lipomas, leiomyomas, varices, pancreatic rest, duplication cysts, and inflammatory polyps. Malignant lesions or lesions with malignant potential include gastrointestinal stromal tumors, carcinoid, lymphoma, and metastases (5,6). Overall, subepithelial masses are very rare in children, with the exception of lipomas, pancreatic rest, and duplication cysts.

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auto-transplantation; fundic mass; GIST; splenectomy; splenosis; splenule; stromal tumor; subepithelial mass

© 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,