Save or Remove the Accessory Spleen in Patient Candidates to Splenectomy for Lymphoproliferative Disorders: Rational and Literature Review

Sparing or removing the accessory spleen (AS) in patients undergoing diagnostic splenectomy for lymphoproliferative disorders (LPD) is an unsolved issue rarely considered. Usually, a healthy AS can be preserved. Reporting a case of our own, this paper aims to review existing literature and propose a tailored approach. A 59-year-old woman presented with unexplained anemia. A FDG-PET-CT scan revealed splenomegaly and two hypermetabolic splenic nodules, pathological upper and lower diaphragmatic lymph nodes, and a non-FDG-avid AS around splenic hilum. The patient underwent diagnostic splenectomy and AS removal. The histopathological examination of the spleen disclosed a diffuse large B-cell lymphoma (DLBCL), whereas the AS was uninvolved, consistent with the preoperative FDG-PET-CT findings. The post-operative course was uneventful. The patient was discharged on the 5th post-operative day. Asplenia following splenectomy increases the risk of severe infections. It is hypothesized that sparing a healthy AS could help maintain immune competence. However, there is currently insufficient evidence to guide the decision on whether to remove or spare an AS during splenectomy for diagnostic purposes in suspected LPD cases, and to understand the potential prognostic impact (both oncological and infectious) of this strategy. The preoperative finding of a non-FDG-avid AS may recommend surgical sparing.