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Reporting a case of our own, this paper aims to review existing literature and propose a tailored approach. A 59\u2010year\u2010old woman presented with unexplained anemia. A FDG\u2010PET\u2010CT scan revealed splenomegaly and two hypermetabolic splenic nodules, pathological upper and lower diaphragmatic lymph nodes, and a non\u2010FDG\u2010avid AS around splenic hilum. The patient underwent diagnostic splenectomy and AS removal. The histopathological examination of the spleen disclosed a diffuse large B\u2010cell lymphoma (DLBCL), whereas the AS was uninvolved, consistent with the preoperative FDG\u2010PET\u2010CT findings. The post\u2010operative course was uneventful. The patient was discharged on the 5th post\u2010operative 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\u2010FDG\u2010avid AS may recommend surgical sparing.<\/jats:p>","DOI":"10.1002\/ccr3.70735","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T03:40:47Z","timestamp":1758598847000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Save or Remove the Accessory Spleen in Patient Candidates to Splenectomy for Lymphoproliferative Disorders: Rational and Literature Review"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1778-9399","authenticated-orcid":false,"given":"Valerio","family":"Rinaldi","sequence":"first","affiliation":[{"name":"Department of Surgery Sapienza University of Rome  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michela","family":"Ribersani","sequence":"additional","affiliation":[{"name":"Department of Traslational and Precision Medicine Sapienza University of Rome  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla","family":"Giordano","sequence":"additional","affiliation":[{"name":"Department of Radiological, Oncological and Pathological Sciences Sapienza University of Rome  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Maccioni","sequence":"additional","affiliation":[{"name":"Department of Radiological, Oncological and Pathological Sciences Sapienza University of Rome  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iulia Catalina","family":"Ferent","sequence":"additional","affiliation":[{"name":"Department of Surgery Sapienza University of Rome  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priscilla","family":"Nardi","sequence":"additional","affiliation":[{"name":"Department of Surgery Sapienza University of Rome  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4683-2756","authenticated-orcid":false,"given":"Roberto","family":"Caronna","sequence":"additional","affiliation":[{"name":"Department of Surgery Sapienza University of Rome  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolina","family":"Saullo","sequence":"additional","affiliation":[{"name":"Department of Surgery Sapienza University of Rome  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,9,22]]},"reference":[{"volume-title":"Anatomy, Abdomen and Pelvis, Accessory Spleen","year":"2020","author":"Bajwa S. 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