In Palermo, street vendors take a page from nonna’s waste-not-want-not cookbook by using an often unwanted part of the cow to make a succulent sandwich. Pane con la milza, or pani câ mèusa in its native Sicilian, literally translates to “bread with spleen,” which is exactly what this sandwich is.

Vendors make the messy sandwich by boiling the cow’s spleen and lungs (and sometimes trachea), then frying everything in lard. When it’s ready to serve, the moist, rich meat is piled on a sesame-topped sandwich bread known as vastedda. Though the sandwich has a resemblance to the United States classic known as “Italian Beef,” the texture is said to be “springier on the teeth,” as entrails often are.

Perhaps the greatest joy of a spleen sandwich is deciding whether you want it “single,” which means spritzed with a fresh squeeze of lemon, or “married,” which involves sprinkling it with local ricotta or caciocavallo (a provolone-like cheese). But take note, no matter how you decide to enjoy your spleen treat, locals advise that pani câ mèusa must be eaten hot, or else your filling will congeal.