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PubMed2004

A rare diagnosis for a pancreatic mass: splenosis.

Splenosis, the autotransplantation of splenic tissue, has been designed to preserve organ functions after splenectomy. We present the first case of laparoscopic resection of a pancreatic splenosis, in a patient who had undergone a splenectomy 31 years before, complaining of abdominal pain and diarrhea. Abdominal computed tomography (CT) scan showed an enhancing hypervascular 3-cm solid mass in the body of the pancreas, mimicking a pancreatic cancer or a neuroendocrine tumor. A diagnostic laparoscopy was planned, and a 3-cm peripancreatic nodule with a long pedicle was visualized, with many nodules close to the tail of the pancreas and in the greater omentum. They were all resected, and the specimens obtained were immediately sent for frozen-section examination, which confirmed the diagnosis of heterotopic splenic tissue. Splenosis should be included in the differential diagnosis of the pancreatic masses in patients with previous splenic surgery. A hypervascular mass on CT scan should be regarded as an adenocarcinoma of the pancreas until proven otherwise. The possibility of a neuroendocrine tumor mandates an octreotide scan and gastrointestinal hormones dosage. In the unlikely event that all tests may produce equivocal results, a diagnostic laparoscopy is mandatory, in order to obtain an accurate histopathologic diagnosis.

Diagnosis, Differential↗
PubMed2006

Diagnosis of thoracic splenosis by ferumoxides-enhanced magnetic resonance imaging.

We report on a 56-year-old woman with a history of splenectomy and surgery of the left hemidiaphragm, who presented with multiple pleural and mediastinal mass lesions. On the basis of the patient's history of splenectomy and missing Howell-Jolly bodies in peripheral blood smears, splenosis was suspected. To confirm the presumptive diagnosis, ferumoxides-enhanced magnetic resonance was performed. As all lesions showed a pronounced signal loss on T2* sequences, the diagnosis of splenosis was made and was further confirmed by scintigraphy. The reported case illustrates that ferumoxides-enhanced magnetic resonance imaging may be a helpful tool for the evaluation of suspected splenosis.

Contrast Media↗
PubMed2005

Solitary ovarian splenosis.

This report describes the case of an asymptomatic, solitary splenotic nodule in the right ovary, revealed incidentally at histopathological examination. In gynaecological patients, splenosis most often presents as multiple pelvic nodules mimicking endometriosis. Two cases of ovarian splenosis accompanying pelvic and serosal splenotic nodules have been reported previously. However, this is the first documented case of solitary intraovarian splenosis.

Female↗
PubMed1994

Thoracic splenosis.

BACKGROUND: Thoracic splenosis is an uncommon side effect of thoracoabdominal trauma involving injury to the diaphragm and spleen. Only 20 patients with a similar problem have been reported previously. METHODS: Two patients with thoracic splenosis were studied. RESULTS: One of the patients had undergone thoracotomy for resection of a "pulmonary nodule". The other remains under observation. CONCLUSION: Presence of a pulmonary nodule in a patient with history of injury to the diaphragm and spleen should arouse suspicion of splenosis. Appropriate investigation may prevent an unnecessary and potentially harmful operation.

Adult↗
PubMed2005

[Utility of Tc-99m labeled heat-denatured red blood cell scintigraphy in a case of hepatic splenosis].

The term splenosis, first used in the medical literature in 1939, refers to the autotransplantation of splenic tissue in a heterotopic location. We report the case of a known hepatitis C carrier in whom computed tomography scanning revealed a hepatic lesion suggestive of hepatocarcinoma. Magnetic Resonance imaging was performed for suspected hepatic splenosis, which was confirmed by Tc-99m labeled heat-denatured red blood cell scintigraphy. In addition to confirming the suspected diagnosis, this technique showed several pathological foci in distinct abdominal locations compatible with splenosis that had not previously been identified.

Erythrocytes↗
PubMedDate not supplied

Splenosis. A diagnosis to be considered.

The term splenosis applies to the autotransplanted splenic tissue resulting from seeding in the context of past splenic trauma or surgery. We report a 42-year-old man with a history of splenectomy observed for an incidentally found retrovesical mass thought to be an ectopic testicle. The abdominal laparotomy revealed multiple focuses of pelvic splenosis. As splenosis can be diagnosed through specific imaging studies one should always consider it in differential diagnosis of a mass discovered years after splenic surgery or trauma.

Abdominal Neoplasms↗
PubMed2003

[Intrahepatic splenosis: a case report].

We report a case of intrahepatic splenosis in a 55-year-old man. The lesion in the right lobe of the liver appeared similar to hemangioma on dynamic CT and MRI, but was compatible with normal splenic tissue. On T2WI after the injection of superparamagnetic iron oxide (SPIO), the lesion showed a loss of signal intensity but remained slightly hyperintense relative to the hypointense liver parenchyma. Reports on the radiographic features of intrahepatic splenosis are rare, and a combination of the findings of CT, MRI (including SPIO injection), and angiography might lead to the diagnosis of splenosis.

Accidents, Traffic↗
PubMed2004

[Splenosis and pelvic pain. A report of a case and literature review].

Initially described by Buchbinder and Lipkoff in 1929, esplenosis is the transplant of the splenic heterotopy weave in the abdominal cavity. It is observed after the splenic traumatic rupture and appendectomy. It occurs also during the embryonic development. The most frequent places where it takes place are: the intrathoraxic cavity, intraperitoneal, retroperitoneo, and brain. Although the presence of this ectopic splenic weave is symptomatic, this pathology can be evident by pain in the pelvis or it can be confused with other pathologies such as hemangiomas of intestine, and endometriosis including metastasis carcinoma. It is impossible to predict which patients will develop the splenosis after the splenic trauma. The time of rupture or damage of the splectonomy and the amount of blood in the peritoneal cavity are not related with the number of implants. The symptoms are the clue. When the splenosis is diagnosed incidentally in a symptomatic patient, the complete surgery removal is not indicated. However this surgery is recommended when the abdominal pain or the diagnosis is uncertain. In this paper a case with a secondary pelvic pain, probably due to a tubaric abortion, agreeing with secondary splenosis and a traumatic splenic rupture, is reported.

Adult↗
PubMed2006

Intrathoracic splenosis secondary to previous penetrating thoracoabdominal trauma diagnosed during delayed diaphragmatic hernia repair.

Although intraperitoneal splenosis is a very common disease, intrathoracic splenosis is very rare. It is generally an asymptomatic disease that occurs after thoracoabdominal trauma, and is diagnosed as an intrathoracic mass that leads to unnecessary investigations to be differentiated from other benign or malignant lesions of the chest. We present a patient with an intrathoracic mass which was preoperatively diagnosed as a diaphragmatic hernia on chest X-ray and magnetic resonance imaging. We have intraoperatively recognized that many pieces of splenic tissue have been herniated through a diaphragmatic defect, and formed intrathoracic splenosis. We repaired the diaphragmatic hernia defect after excision of fragments of the spleen.

Abdominal Injuries↗
PubMed2006

Rare cause of pleural nodularity: Splenosis.

Splenosis is a rare condition described as ectopic splenic tissue implantation generally after a splenic rupture. A 35-year-old male patient who had a history of splenectomy operation due to gunshot wound seven years ago was referred to our hospital with complaints, including exhaustion, sweating and shortness of breath. Thoracic computed tomography of the patient showed nodular pleural thickenings at the level of the left lower lobe, which proved to be unrelated with the presenting symptoms. The patient underwent a minithoracotomy for diagnosis and treatment. During the intraoperative observation, dark-colored, soft, multiple nodular lesions with a biggest size of 2 cm inside the visceral pleura over an area of 5 x 10 cm in dimension were observed. Also, a few tiny nodules in the lung parenchyma approximately 1-cm deep to the pleural nodules were palpated. The lesions were excised. The histopathological examination of the specimen showed splenic tissue in the lung parenchyma and pleura, so the lesions were accepted as splenosis. Pleuropulmonary splenosis, which develops generally after simultaneous rupture of the diaphragma and spleen, is a very rare condition. Most of the patients are asymptomatic and the lesions are detected accidentally. If the diagnosis can be made preoperatively, surgical excision is not needed.

Adult↗
PubMed1988

Splenosis: ultrasound and CT findings in a case complicated by an intraperitoneal implant traumatic hematoma.

A case of intraperitoneal splenosis, found incidentally at ultrasound examination in a 35-year-old man, is reported. The diagnosis, suspected on the basis of computed tomographic (CT) and radionuclide studies, was established by surgery. Three years later, after direct trauma, ultrasound and CT studies revealed a surgically proven splenosis implant hematoma. The contribution of radiologic examinations in the diagnosis of splenosis is emphasized.

Adult↗
PubMed1978

Idiopathic thrombocytopenic purpura occurring in a subject previously splenectomized for traumatic splenic rupture. Role of splenosis in the pathogenesis of thrombocytopenia.

A 25 year old woman presented with idiopathic thrombocytopenic purpura. She had undergon splenectomy 12 years previously for traumatic splenic rupture. Thrombocytopenia was ultimately resistant to steroid therapy. Howell-Jolly bodies were absent from the peripheral smear and 99mTC-spleen scan demonstrated foci of increased uptake thought consistent with accessory spleens. However, splenosis alone was demonstrated at laparotomy, and all visible splenotic tissue was surgically removed. The patient responded and adequate platelet counts were maintained after discontinuation of steroid therapy. The functional capacity of splenic implants has been previously demonstrated both in animal and man. However, reports linking splenosis to hematologic disease are rare. In the present case, characteristic splenic function was demonstrated by both the the -9mTc-spleen scan and the absence of the typical peripheral blood findings of asplenia. The hematologic response to the removal of the splenotic tissue attests to its importance in maintaining the thrombocytopenic state. In the setting of prior splenectomy for splenic trauma, splenosis may contribute to hematologic disease. Removal of this splenotic tissue may result in hematologic remission.

Adult↗
PubMedDate not supplied

Splenosis: an unusual cause of intraabdominal hemorrhage.

A 31-year-old female presented to the emergency department with an acute onset of severe abdominal pain. She developed hypovolemic shock from an intra-abdominal bleed. At laparotomy she was found to be bleeding from two areas of splenosis on the uterine ligament. The patient had sustained a ruptured spleen 22 years prior and had no symptomatology from her areas of splenosis. A short review of splenosis is presented.

Abdomen, Acute↗
PubMed1978

Splenosis simulating an intramural gastric mass.

A case of splenosis simulating a fundal intramural gastric mass in a patient with leiomyoblastoma is presented. Splenosis should be included in the list of differential possibilities of intramural or exogastric lesions when previous splenectomy has been performed, either secondary to trauma or surgical laceration of the splenic capsule. The absence of the spleen makes splenosis a diagnostic consideration.

Diagnosis, Differential↗
PubMed1986

Diagnosis of thoracic splenosis by tru-cut needle biopsy.

We present a case of thoracic splenosis diagnosed by tru-cut needle biopsy, which yielded histologically normal splenic tissue. This is the first report of a diagnosis of thoracic splenosis by needle biopsy. The patient had a history characteristic of thoracic splenosis. Autotransplanted splenic tissue functions and may provide some defense against serious infections. A conservative approach to diagnosis offers the advantages of preserving splenic tissue and avoiding thoracotomy.

Biopsy, Needle↗
PubMed1987

Detection of splenosis by radionuclide scanning.

Splenosis is the autotransplantation of splenic tissue following trauma. The presence of residual nodules following splenectomy has been investigated by a sensitive scanning method employing reinjection of 99Tcm-labelled, heat-damaged autologous erythrocytes. Splenosis was detected in 11 of 19 patients who had had splenectomy for traumatic rupture of spleen. Four of them had multiple nodules, the others a single nodule. In one case, the splenic nodule did not take up the sulphur colloid, although it could be visualised on selective splenic scan. We found no splenic nodules in 23 patients who had splenectomy for non-traumatic reasons. It is concluded that the key factor in splenosis is trauma.

Adolescent↗
PubMed2001

Autotransplant of spleen tissue in children with schistosomiasis: evaluation of splenic function after splenosis.

Autotransplantation of spleen tissue has been done, in the past ten years, in children with schistosomiasis mansoni with bleeding varices. The purposes of this investigation were: (1) to study the morphology and function of the remnant spleen tissue; (2) to quantify the production of tuftsin; and (3) to assess the immune response to pneumococcal vaccine of these patients. Twenty three children, who underwent splenectomy and autologous implantation of spleen tissue into the greater omentum were included in this investigation. The average postoperative follow-up is five years. Splenosis was proved by colloid liver-spleen scans. Search for Howell-Jolly bodies assessed the filtration function. Tuftsin and the titer of pneumococcal antibodies were quantified by ELISA. Splenosis was evident in all children; however, it was insufficient in two. Howell-Jolly bodies were found only in these two patients. The mean tuftsin serum concentration (335.0 +/- 29.8 ng/ml) was inside the normal range. The immune response to pneumococcal vaccination was adequate in 15 patients; intermediate in four; and inadequate in four. From the results the following conclusions can be drawn: splenosis was efficient in maintaining the filtration splenic function in more than 90% and produced tuftsin inside the range of normality. It also provided the immunologic splenic response to pneumococcal vaccination in 65% of the patients of this series.

Adolescent↗
PubMed1989

[Thoracic splenosis. Review of the literature apropos of a case].

Thoracic splenosis consists of autotransplantation of splenic tissue in the thorax following thoraco-abdominal trauma. The authors report a case of thoracic splenosis in a 35 year old woman who suffered a thoraco-abdominal gunshot wound 12 years previously. Sixteen cases of thoracic splenosis have been reported in the literature. Always asymptomatic, the thoracic lesions were discovered by chance on chest x-rays performed for various reasons 9 to 32 years after the initial trauma. Surgery was required in 13 patients in order to establish the diagnosis. In 2 cases Tc99 and Indium 111 isotope scans revealed the diagnosis, avoiding the need for surgery.

Adult↗