Simultaneous intrathoracic and peritoneal splenosis with spontaneous regression of intrathoracic splenosis.
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Adult↗
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Splenosis is regulated by a circulating factor.
Splenic rupture may result in splenosis, the growth of splenic fragments. We used a parabiotic model to test the hypothesis that splenotic growth is governed by a circulating mediator(s). Pairs of C57B1/6 mice underwent side-to-side anastomosis. After 2 weeks, each of four groups underwent a second operation in which one or both of the partners had a sham operation or a splenectomy, or had splenic fragments transplanted into their peritoneums, or some combination thereof. Six weeks later, splenotic fragments were excised and weighed. Spleen fragments involuted when inserted into the pairs that had two intact spleens. In contrast, in pairs with one intact spleen and one set of fragments, multiple splenules developed, whose aggregate mass was approximately half (ratio, 0.53 +/- 0.04 [mean +/- SE]) that of the original transplanted fragments. Significantly more splenosis (P < .01) developed in pairs with no intact spleens and one set of fragments (0.82 +/- 0.04). The pairs with no intact spleens and twice as many fragments had an intermediate amount of splenosis (0.66 +/- 0.08). The authors conclude that (1) splenosis is inhibited by a factor (or factors) that circulates across the capillary network in a parabiotic pair of mice, and (2) the level of inhibition of splenosis appears to be directly proportional to total splenic mass. The authors speculate that spleen-saving operations, even if partial, may decrease the incidence of splenosis in the patient with a shattered spleen.
Animals↗
A case of splenosis masquerading as endometriosis.
Splenosis represents the autotransplantation of splenic tissue after splenic trauma or surgery. Characterized by bluish implants diffusely scattered throughout the peritoneal cavity, splenosis is frequently mistaken for endometriosis. A 19-year-old woman was referred for "extensive endometriosis" found at diagnostic laparoscopy by her gynecologist. After extensive resection of peritoneal, pelvic, and intestinal implants of typical and "atypical" endometriosis, the "atypical" endometriosis was reported by the pathologist to be splenosis. Because splenosis is not a pathologic process but may actually be beneficial to the patient, it is important to recognize splenosis and not confuse it with endometriosis, malignancy, or hemangioma.
Adult↗
Splenosis. A cause of massive gastrointestinal hemorrhage.
Splenosis is the autotransplantation of splenic tissue following surgery or trauma. While it has been reported to cause a number of complications, splenosis is most commonly an incidental finding at laparotomy or on imaging studies. In our study, a case of massive, acute gastrointestinal hemorrhage occurred secondary to splenosis involving the small bowel. While there are several reports of self-limited gastrointestinal hemorrhage secondary to splenosis involving the gastric fundus, we are aware of no reports of massive, acute intestinal bleeding caused by this condition. Splenosis should be considered in the differential diagnosis of gastrointestinal hemorrhage in patients who have experienced prior splenic trauma or splenectomy.
Adult↗
SPECT demonstration of splenosis.
Splenosis is defined as the heterotopic autotransplantation of splenic tissue. The main cause of splenosis is splenic rupture following abdominal trauma, in which fragments of splenic tissue are seeded throughout the peritoneal cavity. Demonstration of splenosis by scintigraphy or CT imaging has been reported, but there is no previous report of simultaneous demonstration by SPECT and CT imaging. Autotransplantation of splenic tissue in the abdominal cavity forms a solid tumor-like image on CT and is difficult to differentiate from other abdominal masses. In such cases, SPECT demonstration of splenosis is very important for identification of its exact site. A case report of splenosis is presented, in which simultaneous demonstration by SPECT and CT was performed. This was confirmed at laparotomy for gastrectomy.
Abdominal Neoplasms↗
Splenosis: autotransplantation of splenic tissue.
Splenosis is the autotransplantation of splenic tissue that usually follows traumatic rupture of the spleen. Generally, the splenic implants are numerous and are located within the peritoneal cavity; however, extra-abdominal splenosis does occur. The implants are rarely clinically significant and are incidental findings at autopsy or at abdominal operation, unrelated to and distant from the splenic trauma and splenectomy. Splenic implants retain their ability to function, and recurrence of a hematologic disease for which the spleen was previously removed should alter the clinician to the possibility of splenosis. The differential diagnosis includes accessory spleens, endometriosis, hemangiomas and metastatic cancer. We report three cases, two of which represent unusual complications of splenosis: a twisted pedicle of a splenic implant, which apparently caused abdominal pain, and recurrent Felty's syndrome associated with splenosis and an accessory spleen.
Adolescent↗
Splenosis mimicking endometriosis.
Splenosis, the autotransplantation of splenic tissue following traumatic rupture of the spleen, can mimic endometriosis when discovered at laparotomy. The splenic implants are usually widespread throughout the peritoneal cavity. The differential diagnosis includes metastatic cancer, hemangiomas, and accessory spleens as well as endometriosis. The authors present a case of splenosis mistaken at laparotomy for endometriosis, and review the literature on splenosis encountered at gynecologic surgery. As splenosis is usually asymptomatic and may partially compensate for the asplenic state, it is recommended that asymptomatic splenosis not be resected when encountered at surgery.
Adult↗
Splenosis presenting as a left renal mass: a report of two cases.
The development of splenosis is a recognized consequence of splenic trauma. We present 2 cases of splenosis that were initially diagnosed as left renal cell carcinomas. The diagnosis of splenosis was made by technetium sulfur colloid scans. The clinical presentation and diagnosis of these 2 cases of splenosis masquerading as renal cell carcinoma are reviewed.
Adult↗
Laparoscopic removal of pelvic splenosis. A case report.
Splenosis is the autotransposition of splenic tissue and is rarely encountered by the gynecologist. Most patients with splenosis are asymptomatic but may present with gynecologic symptoms. There are few reports in the gynecologic literature describing the management of pelvic splenosis. This paper reports the first case of laparoscopic management of pelvic splenosis.
Adult↗
[Post-traumatic asplenia and splenosis].
After splenectomy for traumatic spleen rupture posttraumatic asplenia occurs. In such a state different pathophysiological changes occur in the peripheral blood and in the immunologic response as well as local changes in the form of splenosis, that is, changes due to trauma-induced autotransplantate of the spleen tissue particle. The study discusses as yet obscure pathogenesis, consequences and significance of these changes, including an increased incidence of sepsis (postsplenectomy sepsis, the so-called OPSI syndrome). In a series of eight patients with posttraumatic asplenia, in seven cases splenosis was detected by means of scintigraphy with labeled erythrocytes. Although splenosis is rarely found in general population, and is usually asymptomatic, diagnostic procedures show that it can mimic other pathological processes causing differential diagnostic difficulties. Because of this the authors are of the opinion that the detection of splenosis necessitates a scintigraphic examination of splenectomized patients; if it is confirmed is should be recorded in medical documentation.
Humans↗
Intrathoracic splenosis.
Intrathoracic splenosis is a rare complication of combined diaphragmatic and splenic injury. This is the 79th reported case of splenosis and the seventh case of intrathoracic splenosis. That intrathoracic splenosis can mimic carcinoma of the lung on chest roentgenogram is exemplified by the similarity between the patient's chest film and that of his brother who died of lung cancer during the patient's hospital stay.
Diagnosis, Differential↗
The histological features of splenosis.
This study presents a detailed histological analysis of two cases of splenosis, including one of the largest nodules to be reported. Splenosis may exhibit red and white pulp that appears histologically and immunohistochemically normal by routine methods, and a well-developed capsule and trabeculae may form. The capsule may be thicker than in the normal spleen but is otherwise indistinguishable and may contain fibrous, elastic and smooth muscle elements. These findings are in contrast to previously published works which have described poorly-developed white pulp, capsule and trabeculae in splenosis. The histological pattern may depend on the blood supply to the autotransplanted splenic tissue in the early days after implantation. The close resemblance that splenosis may show to an accessory spleen suggests that histological examination may have a limited role in the distinction between these two conditions.
Adult↗
Thoracic splenosis presenting with hemoptysis.
Thoracic splenosis (post-traumatic autotransplantation of splenic tissue) is rare and generally asymptomatic. We report a patient with thoracic splenosis presenting with repeated hemoptysis. The blood supply of the hypervascular splenic transplants originated from a bronchial and an intercostal artery. Hemoptysis improved after surgical exeresis of splenosis. Recognizing splenosis presenting with hemoptysis is important, since percutaneous embolotherapy could be hazardous because of the risk of ectopic splenic tissue infarction.
Chronic Disease↗
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↗
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↗
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↗
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↗
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↗