Subcutaneous splenosis: a clue to diagnosis of thoracic splenosis.
We describe a unique case of combined thoracic and subcutaneous splenosis.
Diagnosis, Differential↗
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Simultaneous intrathoracic and peritoneal splenosis with spontaneous regression of intrathoracic splenosis.
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Adult↗
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↗
[The liver splenosis in a patient following a procedure for the malignant seminoma].
Splenosis is characterized by a presence of islets of the splenic tissue in the abdominal and, rarely, also in the thoracic cavity, most frequently as a consequence of the splenic injury. The authors describe a case of splenosis in a patient followed-up after surgery and radiotherapy for the testicular seminoma and who, 42 years ago, had splenectomy for polytrauma. With respect to the location of the splenosis in the hepatic region, the differential diagnosis was difficult, bearing in mind a possibility of the malignancy relaps. Although splenosis was highly suspected, based on the results of the examinations conducted, with respect to the preexisting malignancy, the tumor was excised. The histopathologist confirmed the diagnosis of splenosis. This case is rare in the literature, considering the time gap between the diagnosis of splenosis and the trauma.
Diagnosis, Differential↗
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↗
Laparoscopic management of abdominal pelvic splenosis.
BACKGROUND: Splenosis is an unusual cause of pelvic pain. CASE: A 37-year-old nulligravida presented with a 10-year history of chronic pelvic and abdominal pain that was diagnosed as splenosis via laparoscopy. The patient was previously advised against surgical intervention. We report our experience with laparoscopic excision of the above splenosis. CONCLUSION: Splenosis should be considered in patients with a history of splenic injury and abdominal pain. Laparoscopic excision of splenic nodules with the argon beam coagulator is a well-suited method of treatment for symptomatic splenosis.
Abdominal Pain↗
Radionuclide imaging in thoracic splenosis and a review of the literature.
Splenosis is defined as the autotransplantation of splenic tissue to abnormal locations after splenic injury. Although abdominal splenosis is the most common form and is usually discovered at laparotomy, thoracic splenosis is less common and occurs as an asymptomatic peripheral pulmonary nodule, incidentally discovered on a routine chest radiograph. Given the long interval between the initial trauma and its discovery, thoracic splenosis is rarely considered in the differential diagnosis of left-sided, pleural-based pulmonary nodules or masses. The diagnosis is often a result of surgery. The authors report an additional case of thoracic splenosis, review the literature, and discuss nonsurgical diagnostic methods.
Abdominal Injuries↗
Thoracic splenosis twenty-nine years after traumatic splenectomy mimicking intrathoracic neoplasm.
Thoracic splenosis refers to a condition of ectopic splenic tissue in the thoracic cavity. It is usually a consequence of splenic tissue seeding in the pleural cavity after thoracoabdominal trauma. A rare case of thoracic splenosis, in a 62-year-old man who had had a traumatic splenectomy due to thoracoabdominal trauma 29 years earlier, is reported. The patient, a heavy smoker, was admitted for evaluation of a left-side thoracic lesion discovered on a plain chest film. Bronchoscopy, CT scan and needle biopsy proved inconclusive for the diagnosis. Exploratory thoracotomy was necessary to establish the diagnosis. During the operation, a thoracic splenosis was confirmed. To date, only 28 cases of thoracic splenosis have been reported in the literature. The purpose of this report is to present a new case of splenosis of the thoracic cavity simulating intrathoracic neoplasm.
Diagnosis, Differential↗
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 occult gastrointestinal bleeding.
A 48-year-old man presented with recurrent gastrointestinal bleeding and anemia. Routine endoscopic evaluation was nondiagnostic. Angiography demonstrated multiple apparent arteriovenous malformations. Exploratory laparotomy revealed numerous splenic implants along the small and large bowels, some of which had apparently eroded through the bowel mucosa and bled. Excision of these penetrating lesions prevented further bleeding. An incidentally noted renal cell cancer was also resected. The patient's splenosis was the result of childhood trauma that caused splenic rupture and precipitated splenectomy. Splenosis develops frequently following traumatic splenic rupture. Experimental evidence suggests that the presence of an intact spleen suppresses the growth and development of splenic implants. Following splenectomy, splenules may replace some of the "housekeeping" and immunologic functions of the spleen, but even patients with documented splenosis should be considered functionally hyposplenic. While in most cases splenules cause no symptoms, splenosis must be considered in the differential diagnosis of previously splenectomized patients who present with unexplained masses or occult bleeding.
Diagnosis, Differential↗
Improved detection of splenosis in patients with haematological disorders: the role of combined transmission-emission tomography.
The purpose of this study was to evaluate the use of combined transmission and emission tomography (TET) for correct localisation of heterotopic splenic tissue and differentiation of splenosis from other masses. The TET technique comprises the fusion of SPET and CT data obtained using the same imaging device to allow perfect overlap of anatomical and functional images. TET was performed in seven patients who either had haematological disorders and relapsing anaemia or thrombocytopenia after splenectomy or were under immunosuppression for different reasons. These patients presented 20 equivocal lesions on CT or MRI. Presence of splenic tissue was investigated using technetium-99m labelled colloids or heat-damaged red blood cells. Findings of spleen scintigraphy, TET and CT or MRI were compared with respect to localisation of splenosis and correct classification of lesions by CT or MRI. Histological validation was achieved by surgery or biopsy in all cases. All 20 lesions demonstrated by CT or MRI were correctly classified by TET as splenosis. Three additional lesions initially overlooked by CT or MRI could be detected. Diagnostic relevance was highest for intrahepatic, intrapulmonary or pleural splenic implants. It is concluded that TET allows exact localisation of heterotopic splenic tissue in patients with suspected splenosis.
Adult↗
Thoracic splenosis mimicking thoracic schwannoma: case report and review of the literature.
BACKGROUND: Thoracic splenosis is a rare entity. It occurs sometime after splenic and diaphragmatic injury, and it is rarely symptomatic. CASE DESCRIPTION: We report a case of left upper thoracic paraspinal splenosis 25 years after a thoracoabdominal penetrating trauma that required a splenectomy. The pathology was suspected on a routine chest x-ray and it mimicked a schwannoma on magnetic resonance imaging. Less than 40 cases of thoracic splenosis were described in the literature, but few were misinterpreted as schwannoma. CONCLUSION: Alertness to the possibility of thoracic splenosis can lead to confirmation of the diagnosis with technetium Tc 99m-tagged red blood cell radionuclide scanning based on a previous history of traumatic splenectomy.
Adult↗
Posttraumatic thoracic splenosis and chronic aortic pseudoaneurysm.
Thoracic splenosis is the autotransplantation of splenic tissue into the pleural cavity, usually following traumatic injury that simultaneously involves the spleen and diaphragm. Intrathoracic splenosis is an uncommonly reported phenomenon. We present a case of intrathoracic splenosis in a patient with a chronic aortic pseudoaneurysm, both detected, incidentally, three decades after the traumatic event. The diagnosis of thoracic splenosis can be confirmed noninvasively, using 99mTc sulfur colloid nuclear scintigraphy.
Aneurysm, False↗
Minimally invasive surgery in the treatment of splenosis.
Splenosis has been serious etiologic reason in the recurrence of benign hematologic diseases after elective open or laparoscopic splenectomy. Although, the incidence of splenosis in patients splenectomized for trauma is high, as long as they are asymptomatic, they do not require surgical treatment. Herein, we report a case of idiopathic thrombocytopenic purpura recurrence due to splenosis 5 years after the initial laparoscopic splenectomy. Laparoscopic treatment of splenosis was performed successfully.
Adult↗
Unusual subcutaneous splenosis occurring in a gunshot wound scar: pathology and immunohistochemical identification.
Splenosis usually occurs after traumatic rupture of the spleen with autotransplantation of splenic tissue to ectopic sites. Most commonly, it occurs as intraperitoneal nodules, which are found either incidentally or after symptomatic complications. Subcutaneous splenosis is a rare condition mostly observed in abdominal surgical scars. Reported herein is a case of subcutaneous splenosis developed in an exit gunshot wound scar on the left lower chest wall 9 years after splenectomy. The lesion presented as an asymptomatic subcutaneous nodule, which was excised under the impression of a skin tumor. Microscopically, there were multiple subcutaneous nodules resembling splenic tissue with red and white pulp. They were confirmed to be ectopic splenic tissue by immunohistochemical staining of the vascular lining cells (CD8+, CD31+, and CD34-). Only 11 cases of subcutaneous splenosis have been reported before. The present case was the third case occurring in an exit gunshot wound scar, and the diagnosis was confirmed by immunohistochemical study.
Adult↗