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A 65-year-old farmer who had used arsenic as a plaguicide for many years developed a hepatosplenic hemangiosarcoma with metastasis in the colonic serosa, mesentery and omental. The tumor was complicated with intraabdominal hemorrhage originated by spontaneous intraperitoneal rupture. The echographic and post-mortem findings are presented. This is the first case of hepatic hemangiosarcoma reported in Uruguay.
We report a patient in whom a solitary splenic lesion detected by computed tomography (CT) was successfully diagnosed by fine-needle aspiration biopsy under CT guidance. The ability to distinguish metastatic carcinoma from lymphoma in the spleen assisted the clinician in making therapeutic decisions. Fine-needle aspiration of spleen is a reasonable diagnostic approach that has been underutilized.
A splenectomy was performed in a 37-year-old woman because of spontaneous rupture of the spleen. Primary angiosarcoma of the spleen was diagnosed postoperatively based on histology. Primary angiosarcoma of the spleen is a very rare neoplasm with disastrous prognosis. Immunohistochemical and ultrastructural examinations are necessary to verify the diagnosis because the histopathological picture of the tumor is variable. Due to the small number of reported cases, there are no guidelines for adjuvant or palliative therapy, and up to today all adjuvant means of radiotherapy and chemotherapy have not improved the prognosis of the patients.
We have reported a case of pseudomyxoma peritonei manifested as a splenic mass in a 38-year-old woman. Upon reviewing previously reported cases of pseudomyxoma peritonei with visceral involvement or extension above the diaphragm, we conclude that such spread of the disease does not significantly alter the prognosis. Furthermore, our findings support the concept that pseudomyxoma peritonei represents the implantation of malignant cells rather than metaplastic transformation of mesothelial cells.
Fifteen dogs with hemangiosarcoma were treated with a combination of vincristine, doxorubicin, and cyclophosphamide after incisional or excisional biopsy. The median survival for all fifteen dogs was 172 days (mean survival = 316 days). The median survival for those dogs with splenic hemangiosarcoma was 145 days (mean survival = 271 days) as compared with previously published median survival times in dogs with splenic hemangiosarcoma treated with surgery alone of 19 to 65 days. Toxicities included neutropenia (11/15), severe gastroenteritis (4/15), cardiotoxicity (3/15), and sepsis (2/15). The authors conclude that vincristine, doxorubicin, and cyclophosphamide chemotherapy may be an efficacious treatment modality in dogs with hemangiosarcoma and is associated with acceptable toxicity.
The ultrasonographical and computed tomography findings of a six-month-old female infant with haemangioendotheliomas of the liver and spleen are described. The splenic lesion had an unusual ultrasonographical appearance of a well-defined isoechoic mass with a hypoechoic rim. Diagnosis was confirmed by histological examination of the hepatic biopsy specimen. Hepatosplenic lesions in the first year of life may be due to a variety of pathological processes. It is important to include haemangioendotheliomas in the differential diagnosis of hepatosplenic masses in an infant.
Laparoscopy permits direct inspection of the peritoneal cavity. Its role is very important in oncology both in the adult and in the pediatric patient. From 1973 to 1985, 147 laparoscopies were performed on 137 patients, aged 2-16; indications were: definition of the nature of neoplastic disease in 8 cases, staging of known neoplasia in 132, restaging in 7. On Hodgkin's disease, splenic involvement in 8/113 cases was revealed by laparoscopy with biopsy. Histological examination was positive in 4 out of 22 cases of ovarian tumors. Morbidity was 1.2%. Although a laparotomy performed after laparoscopy has shown some false negatives, in most cases the clinical and instrumental follow-up has proved reliability of laparoscopic examination.
We analyzed the files of all autopsies performed at the Institute of Pathology of the Philipps-University Marburg between 1980 and 1999 with respect to the presence of splenic metastasis. The total number of autopsies within the study period was 8,563. In 1,898 cases, a solid malignant tumor (1,774 carcinomas, 36 sarcomas, 27 malignant melanomas) was diagnosed. Metastasis to the spleen occurred in 57 cases (3.0%). Compared to the whole study population, patients with splenic metastasis were significantly younger (59 years vs. 67 years, p<0.05) and had significantly more metastastic sites (median: 6 vs. median:1, p<0.05). This underlines the assumption that splenic metastasis is associated with a worse prognosis. Lung cancer, cutaneous malignant melanoma, and breast cancer were the most frequent primary tumors, accounting for 24.6%, 15.8%, and 12.3% of all spleen metastases, respectively. Patients with testicular germ cell tumors (patients: 9, spleen metastasis: 4), malignant melanoma (patients: 27, spleen metastasis: 9, 33%), and small cell lung cancer (patients: 106, spleen metastasis: 8, 7.5%) had the highest frequency of splenic involvement. Most (n=48) metastases were detected macroscopically, the remaining ones were micrometastases (n=2), small tumor cell clusters, and single tumor cells within sinusoids (n=7). The present study underlines the importance of spleen metastasis as an indicator of poor prognosis. There are, however, various aspects as to the detection and morphology of spleen metastasism, which merit further scrutiny.
The development of malignancies after solid organ transplantation represents an increasing clinical problem complicating the long-term follow-up of transplant recipients. In this case report the authors describe the rare triple combination of a simultaneous hepatocellular carcinoma with a glucagonoma and a splenic hamartoma in a renal allograft recipient. It is not only the first published report of a glucagonoma occurring after renal transplantation but serves also as an illustration of the therapeutic decision making in the setting of the immune-compromised host. This case report also illustrates the different imaging modalities that can be used for the diagnosis of neuroendocrine tumors.
AIMS AND BACKGROUND: Littoral cell angioma (LCA) is an uncommon vascular tumor of the spleen recently described and interpreted as the tumoral counterpart of the normally present littoral cells lining the splenic sinus channels of red pulp. The diagnosis of LCA is suggested by a quite characteristic morphology and confirmed by the demonstration of a hybrid endothelial/histiocytic phenotype. METHODS: Four original and previously unreported cases of LCA are presented. All four splenic vascular tumors were investigated by light microscopy and immunohistochemistry for endothelial and histiocytic markers. RESULTS: All four cases were associated with visceral epithelial malignancies (colorectal adenocarcinoma in two cases, renal and pancreatic adenocarcinoma in one case each). One case was also associated with an intracranial tentorial meningioma. CONCLUSIONS: We consider our findings as a novelty and signal the possible existence of a clinical syndrome. Five of a total of 21 previously reported cases in the literature were also described as being associated with other cancers (non-Hodgkin's lymphoma in two cases, two not further specified tumors of the liver and brain, an epithelial ovarian cancer, and a non-small cell lung cancer in one case each). Close follow-up and careful investigation in search of a second visceral neoplasm are strongly recommended in cases of LCA, but further clinical observations and more in-depth genetic and molecular studies are needed before any valid conclusions can be drawn.
A case of an inflammatory pseudotumor arising in the spleen of a 60-year-old Japanese male is described herein. This benign lesion is extremely rare, with only 12 cases, including our own, having been reported in the world literature. We preoperatively diagnosed the splenic tumor as a metastasis, due to the coexistance of advanced stage carcinoma in the sigmoid colon. However, after splenectomy, histopathological examination of the mass revealed an inflammatory process. Inflammatory pseudotumors often pose diagnostic difficulties because the clinical and radiologic findings are suggestive of malignancy. The clinical and pathological features of cases previously reported are reviewed following the presentation of this case.
The authors present a case history of a patient whose most recent relapse occurred 7 years after the initial laparotomy carried out for bilateral ovarian stage III cystadenocarcinoma diagnosed by biological follow-up (CA 125) which occurred because of isolated splenic metastases which were identified thanks to ultrasound examination. The literature, which has been searched fails to show a clinical description of a case with metastases localised just to this site. We propose an explanation of the mechanism and an analysis of the methods of follow-up that can be carried out showing that it is useful to use CA 125 as a checK on epithelial tumours of the ovary.
Four-hundred-eighty Mongolian gerbils, Meriones unguiculatus [Uclp:(MON)], most of which were experimentally infected with filarial worms, were examined for spontaneous lesions. Previously unrecognized lesions included cutaneous squamous cell carcinoma, duodenal adenocarcinoma, malignant blue nevus, hepatic choleangiocarcinoma, malignant hemangiopericytoma of the uterus, ovarian teratoma, chronic interstitial nephritis, renal cortical retention cysts, splenic hemangiomas, and various histologic abnormalities of the lung. Previously reported lesions also seen in the present study were a malignant melanoma, adrenal cortical adenoma or carcinoma, uterine leiomyoma, sebaceous gland adenoma, hepatic lymphangioma, and renal hemangioma. Hymenolepis diminuta (Cestoda) and Tyrophagus castellani (Acarina) were accidentally recovered from experimental animals. Tritichomonas caviae and a species of Entamoeba were the most common intestinal protozoa. Tyzzer's disease, however, was clearly the most significant infectious disease of gerbils in the UCLA School of Public Health colony.
We report a case of an adult-type granulosa cell tumor of the ovary which was diagnosed in a 20-yr-old woman. After a 21-yr disease-free interval, she developed a pelvic recurrence, followed by a splenic metastasis and, more recently, omental masses. This report is concerned with the fine-needle aspiration (FNA) diagnosis of the granulosa cell tumor in the latter site and corroboration of the interpretation by immunocytochemistry. Only one previous case is similar to the present one documenting the role of immunocytochemistry in the evaluation of suspected metastatic granulosa cell tumor. The cytopathologic features of metastatic granular cell tumor have been described in a limited number of previous reports.
Disseminated hemangiosarcoma was encountered in a 12-year-old female Maltese dog. Tumor tissues were dispersed on the serosal surface of the liver, kidney, digestive tract, omentum and diaphragm. Metastatic lesions were not observed in the parenchyma of the lung and heart. The spleen was enlarged with rupture at the anterior region of the hilus. The disseminated protruding tumor masses could be easily peeled off from the organ surfaces. The tumor cells were round or spindle in shape, with hyperchromatic nuclei containing prominent nucleoli. Various-sized vascular spaces containing erythrocytes and serum could be identified in this tumor. This case was diagnosed as hemangiosarcoma originating from the spleen with abdominal dissemination.
A case of Kaposi sarcoma (KS) with cutaneous and splenic involvement is reported. Carcinoma of the left colon and basal cell epithelioma arose eleven years after KS. Genetic, viral, and immunologic factors which may promote initiation and development of Kaposi sarcoma are reviewed. The responsibility of immunodeficiency, whether resulting from therapy or from other causes, in carcinogenesis is discussed. Prolonged survival may be seen after KS. Another primary malignant disease (lymphoma or solid tumor) may arise. The authors suggest that the risk of immunologic disorders, occurring spontaneously or induced by therapy, should be considered specifically for each patient with KS.
Abdominal computed tomography (CT) revealed an asymptomatic, solitary splenic mass in a woman who had undergone hysterectomy and bilateral salpingo-oophorectomy for papillary serous ovarian adenocarcinoma four years previously. CT-guided fine needle aspiration (FNA) biopsy of the mass demonstrated the presence of nests of malignant epithelial cells in papillary structures. The FNA diagnosis of metastatic ovarian adenocarcinoma was confirmed by histologic study of the splenectomy specimen. Five years later, following several courses of chemotherapy, the patient was in apparent good health. This case again illustrates the value of FNA biopsy in diagnosing lesions in deeply situated organs, such as the spleen.
The metastatic properties of the M5076 tumor, a reticulum cell sarcoma of ovarian origin, were examined. This tumor metastasizes preferentially to the peritoneal viscera (liver, ovaries, spleen, and kidneys) regardless of the site or route of tumor cell injection. Subcutaneous tumor growth followed by direct invasion into the peritoneum resulted in extensive generalized peritoneal involvement. However, when tumor cells were injected in the dorsum, external ear, or footpad, fewer and primarily hepatic metastases developed. Hepatic, splenic, ovarian, and renal tumor colonies were formed after i.v. injection of tumor cells. Radiolabeled tumor cells were used to study the arrest, distribution, and survival of tumor cells injected i.v. These tumor cells were rapidly arrested in the lungs and were retained there for 3 to 4 days. They then slowly detached, recirculated, and were arrested in the liver, where they subsequently developed into tumor nodules. These results strongly support the "soil-seed" hypothesis of metastatic growth and demonstrate that long-term retention of tumor cells in an organ need not result in the formation of a clinically obvious tumor nodule.