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A 63-year old male underwent a distal pancreatectomy and splenectomy for a solid, slowly enlarging pancreatic nodule. Associated with the pancreatic tail but separate to the spleen several lymph nodes were also sampled. The pancreatic lesion was confirmed to be a completely excised serous cystadenoma. The spleen was normal and one of the sampled “lymph nodes” was in fact, an accessory spleen or splenunculus. The splenunculus measured 0.8 x 0.5 x 0.3 cm and grossly appeared uniformly tan in colour. Microscopic evaluation of the splenunculus revealed a 0.4 x 0.3 cm well circumscribed nodule that was clearly demarcated from the rest of the accessory splenic parenchyma. It consisted of a myriad of blood-filled slit-like vascular channels. Within the centre of the lesion a sclerotic, fibrous focus containing similar blood vessels was also noted. The cellular component of ovoid and spindle cells lining the vascular spaces were positive for CD31, CD34 (highlighting a reticular vascular network) and negative for CD8, CD21 and CD68. These features were in keeping with a microscopic sclerosing angiomatoid nodular transformation occurring within an accessory spleen or splenunculus.

Two cases of intussusception or inversion of the appendix are highlighted. One patient presented with chronic right iliac fossa pain and at laparoscopic surgery was noted to have a polypoid lesion at the appendiceal orifice opening into the caecum. The second Case was discovered at routine colonoscopy and thought to be a polypoid caecal tumour. In both cases the appendix had inverted and masqueraded as caecal lesions. Histological evaluation showed the entire circumference of the appendix inside of the appendix lumen simulating a telescoping phenomenon. In the second case the appendix had prolapsed through the orifice and composed of normal appendix with a luminal faecolith. Inverted appendices often show pathology in their walls such as endometriosis or polyps but a significant proportion are "normal". They tend to occur in females and range from being asymptomatic to having acute and/or chronic abdominal pain.