SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Splenosis, an auto-transplantation of splenic tissue after splenic trauma, is an uncommon condition of which there are relatively few published cases in the literature. We report a case of abdominal splenosis found at autopsy, briefly review the literature, and discuss some of the clinico-pathologic events which may occur in such conditions. Splenosis is an entity of which physicians and surgeons alike should be aware.
The authors report an exceptional case of intrathoracic splenosis in a 34 year old woman suffering from a circulation injury with rupture of the spleen and left diaphragm and hemothorax. She had been splenectomized. Eleven years later, a systematic thoracic X-ray examination revealed a rounded opacity of the left extremity. Exeresis of a lump the size of a nut located in the pleural space without individualized vascular pedicle was performed. The lesion showed macroscopic and microscopic characteristics of splenic tissue. If peritoneal splenosis is more frequent, intrathoracic splenosis is exceptional (only 7 observations known). Every time, a traumatic splenic antecedent has been noted. The etiopathogeny consists of an autograft of splenic tissue most often in the pleural cavity, when a diaphragmatic lesion has been associated to the injury. The lesion is asymptomatic and does not provoke complication in that area. Histologically, the splenic parenchyma can be normal or limited to the red pulp with a more or less important degree of white pulp. The histological differences with the normal or accessory spleen are the non contractile collagenous texture of the capsular and the septa and the absence of hila. One should consider this etiology when antecedents of splenic and diaphragmatic traumatism are noted. Hepato-splenic scintigraphy can be useful in the diagnosis and help to avoid thoracotomy.
A case of an unusual location of splenosis is reported in a 30-year-old man who underwent autopsy after committing suicide. Twelve years before he was splenectomized after traumatic rupture of the spleen. At the postmortem examination splenosis was found on the right kidney and the diaphragmatic surface resembling hemangiomas. It is noteworthy that the patient had never experienced any severe infection after splenectomy, and the possible protective influence of splenosis is discussed in the light of our present knowledge of spleen function.
Report on 4 cases of traumatic splenosis (autotransplantation of splenic tissues) which were diagnosed 1 to 15 years after traumatic spleen rupture in childhood or adolescence. In 3 of the 4 cases traumatic splenosis was detected casually, the other case was misinterpreted during laparoscopy as endometriosis. Histologically the autotransplants reveal functional red and white splenic pulp. This may be significant for hematologic diseases. Although clinical signs are often lacking or noncharacteristic, knowledge of traumatic splenosis is important for surgeons, internists (laparoscopy!), gynecologists, and pathologists, because splenic autotransplantants are often misinterpreted as accessory spleens, hemangiomas, endometriosis or peritoneal metastases of melanoma.
We report one case of splenosis. A 43-year-old male patient was referred to our hospital because of a hepatic mass. The hepatic lesion was incidentally found during an annual ultrasonographic follow-up since the patient was a known chronic hepatitis B carrier for the previous 10 years. Surgical records revealed a history of splenectomy in conjunction with a blunt abdominal trauma, which the patient had sustained 20 years prior to this admission. On abdominal computed tomography scanning, a 3.5-cm sized focal bulging mass was noted in segment 6 of the liver. An inferior phrenic artery angiogram showed a hepatic tumor and the patient was treated by chemoembolization for hepatocellular carcinoma. A partial resection of the liver with a portion of the diaphragm was done after the transcatheter arterial chemoembolization procedure. A pathologic examination revealed splenosis within the hepatic parenchyme.
Splenosis is usually a sequel of splenic rupture from abdominal trauma but can be associated with elective splenectomy. Recurrence of the hematological disorder for which the patient underwent splenectomy may occur, and splenic nodules can be found anywhere in the thoracic or abdominal cavity, as well as subcutaneously. We are presenting intramural colonic splenosis, a large inoculum of the splenic tissue that has been found to have the capacity to maintain anemia and thrombocytopenia, in a child previously splenectomized because of a hematological problem.
Intrahepatic splenosis is a rare disorder of ectopic erythropoiesis in the liver. Although traumatic splenic rupture is the common factor in public cases, the mechanism of long latency is still unknown. The correlation between aging and hepatitis virus infection with the diagnosed occurrence was reported in a limited number of cases; nevertheless, it suggested that ectopic erythropoiesis in the liver could be induced by the hepatic disorder. Based on the susceptibility of the splenic erythropoiesis response to hypoxia and the inevitability of hypoxia caused by aging or pathological changes, we hypothesized that the two events caused the occurrence of the intrahepatic splenosis, the migration of the erythrocytic progenitor cells via the portal vein following traumatic splenic rupture, and the local induction of erythropoiesis by hypoxia.
Splenosis results from autotransplantation of splenic tissue, usually after traumatic splenic rupture. The diagnosis is suggested by the history and the presence of multiple nodules on computed tomography. Selective splenic scintigraphy utilising heat denatured red blood cells confirm the diagnosis. Treatment is usually conservative with surgical excision reserved for complicated cases. We report a case of splenosis associated with phlegmon and infectious process, requiring surgical intervention.
Thoracic splenosis is a rare pathologic entity resulting from seeding of splenic tissue in the pleural cavity after thoracoabdominal trauma. A 45-year-old man with a history of splenectomy secondary to abdominal trauma presented with a left lung mass and an inconclusive tissue diagnosis after needle biopsy. Thoracic splenosis was not suspected preoperatively, considered on an intraoperative frozen section, and established on permanent pathologic biopsy specimens obtained during thoracotomy. A history of thoracoabdominal trauma, combined with radiologic and radionuclide imaging studies, may establish the diagnosis without thoracotomy.
We used scintigraphy with sulphur colloid and heat-damaged red cells to detect splenosis after splenectomy in 19 patients 7 to 69 months after injury. We compared planar and tomographic selective spleen scintigraphy using heat-damaged red cells with subtracted planar colloid scintigraphy, and showed that the most sensitive method was tomographic selective splenic scintigraphy. The incidence of splenosis was 58% with this method, the other techniques detecting abnormalities in 21% and 26% of the patients.
Thoraic splenosis is a rare entity after splenic and diaphragmatic injury. We report on a patient who had left pulmonary masses on a routine chest roentgenogram. It was impossible to rule out the possibility of other tumors or malignancies from past history, radiographic findings and needle biopsy. The patient underwent a video-assisted thoracoscopic surgery. The resected tumor was diagnosed as the splenic tissue. This represents the first reported case, that diagnosed by video-assisted thoracoscopic resection, of thoracic splenosis. The course of dissemination of the splenic tissue to chest is considered to be the costophregmatic recessus by the intrathoracic findings thoracoscopically.
A 2-year-old boy had been operated on for a giant renal cell carcinoma including splenectomy because of disrupture of the splenic capsule. During a follow-up examination, 3 nodules were detected by ultrasound in the splenorenal area. This gave reason to suspect tumor recurrence. Considering the possibility of splenosis, a selective spleen scan using denatured red blood cells was performed as a final diagnostic step. This method confirmed the nodules as representing splenic tissue. Splenosis should be included in the differential diagnosis of solid masses in the postsplenectomy patient.
A 40-year-old female patient was admitted for work-up of multiple abdominal masses. The lymphoma-mimicking tumors were detected accidentally during an ultrasound course. The past medical history was unremarkable besides a status post-traumatic splenic rupture and splenectomy. The patient was asymptomatic, especially there were no complaints of fever, night sweats or weight loss. Laboratory tests did not show pathological results. Ultrasound of the abdomen revealed multiple hypoechoic mesenterial and peritoneal enlarged tumors as well as a subhepatic mass (30 x 20 mm). Transmission computed tomography (CT) showed a normal chest, excluded abnormal thoracal masses and confirmed the multiple abdominal nodules. Microparticles were trapped only by tissue with phagocytosis function as cells of the reticulohistiocytary system in liver and spleen. Uptake of (99 m)Tc-labeled microparticles is specific for splenic tissue. All abdominal masses were detectable by single photon emission computed tomography (SPECT) after intravenous administration of this radiotracer. Ultrasound-guided biopsy proved the presence of spleen tissue with follicular hyperplasia. In conclusion, we report a case of post-traumatic splenosis. In 16 - 67 % of patients who experienced traumatic splenic rupture autotransplanted spleen tissue can be detected. Splenosis therefore is an important differential diagnosis of abdominal masses in splenectomized patients.
HISTORY AND REASON FOR ADMISSION: A 53-year-old man, who had undergone a splenectomy for a traumatic splenic tear 20 years previously, was admitted because an acute myocardial infarction was suspected. 20 years ago, a splenectomy had been performed because of traumatic rupture. INVESTIGATIONS: Laboratory values were normal except for a microcytic anaemia, thrombocytopenia (109,000/microliter) and a raised ferritin level (547 ng/ml). Coronary heart disease as well as other cardiac and upper gastrointestinal abnormalities were excluded. Computed tomography revealed a space-occupying mass in the left lower lobe of the lung near the heart. This filled with contrast medium on coelangiography at the same time as the liver and a subphrenic mass thought to be an accessory spleen. TREATMENT AND COURSE: At thoracotomy numerous splenic masses, maximally 7 cm in diameter, were removed from near the heart, the costal pleura and the lung margin. There were haematological changes similar to those after splenectomy: leucocytosis (32,400/microliter) and thrombocytosis (637,000/microliter) on the 11th postoperative day and Howell-Jolly bodies noted on the 16th day. CONCLUSION: In splenosis the disseminated pieces of splenic tissue can partly substitute for the normal spleen's functions. Splenosis tissue should, therefore, not be removed in every case, especially, if it does not cause symptoms.
The authors present a case that demonstrates the continued high sensitivity of Tc-99m SC liver-spleen imaging for thoracic splenosis. A patient with profound weight loss, positive PPD and left upper lobe lung density on a chest radiograph was felt to have a strong clinical suspicion of a malignant pulmonary lesion. Two needle biopsies of the lesion were consistent with splenic tissue. Transbronchial biopsy of the right lower lobe lung revealed metastatic adenocarcinoma of an unknown origin. A Tc-99m SC liver-spleen scan of the abdomen and thorax indicated the lung density was consistent with thoracic splenosis.
Splenosis is the ectopic implantation of splenic tissue, usually as the result of trauma. Intraperitoneal, intrathoracic, and retroperitoneal sites of implantation have been reported. The authors report a case of subcutaneous splenosis involving the abdominal wall that was imaged with CT and scintigraphy.
BACKGROUND: Thoracic splenosis is a rare event, and fine needle aspiration (FNA) of a pleural implant of splenic tissue can be a pitfall when previous anamnestic data are ignored. CASE: A 53-year-old male underwent FNA of a left thoracic subpleural nodule highly suggestive of a metastatic lesion. The presence of a population of small and medium-sized lymphocytes suggested the possibility of lymphoproliferative disease; frozen sections confirmed this possibility. The final diagnosis was normal splenic tissue. Twenty-five years earlier the patient sustained a gunshot wound in the left side of the upper abdomen followed by splenectomy and drainage of the left pleural cavity because of mild, concomitant hemothorax. CONCLUSION: A left pleural thoracic nodule in subjects with a previous history of traumatic rupture of the spleen must be considered highly suggestive of thoracic splenosis. Scintigraphy with Tc 99 m and magnetic resonance imaging are diagnostic, while FNA, especially in the absence of anamnestic data, can create a pitfall that can induce inappropriate removal of ectopic, normally functioning splenic tissue.
Intrathoracic splenosis is a rare diagnosis that is usually made following an invasive procedure. Although radiographic and CT findings are nonspecific, these findings combined with a history of splenic injury should suggest the possibility of this diagnosis. We present a patient with intrathoracic splenosis diagnosed on the basis of a technetium Tc 99m heat-damaged RBC scan following false-negative technetium Tc 99m sulfur colloid scan results.