1/66. splenosis presenting as an ulcerated gastric mass: endoscopic and endoscopic ultrasonographic imaging. A case of an ulcerated gastric wall mass ultimately found to be splenosis is presented in which the index patient had endoscopic and endoscopic ultrasonographic evaluation prior to resection. Although no visual features identified this mass as a splenic implant preoperatively, the lesion appeared to be atypical for leiomyoma, which led to surgical intervention. The role of endoscopic ultrasonography in assessing isolated gastric masses is discussed. ( info) |
2/66. Fine needle aspiration of thoracic splenosis. A case report. 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. ( info) |
3/66. Noninvasive methods of diagnosing thoracic splenosis. Thoracic splenosis is a rare condition resulting from concomitant rupture of the spleen and left hemidiaphragm, with autotransplantation of splenic tissue into the left hemithorax. It is usually an incidental finding on chest plain film or computed tomogram and is rarely diagnosed without biopsy or operation. A history of old splenic trauma and findings of left-sided, pleural-based nodules should indicate the diagnosis, which can be confirmed with nuclear medicine studies. ( info) |
4/66. splenosis as a cause of testicular pain: laparoscopic management. This is a case report of a 37-year-old man with severe testicular pain unresolved after conventional investigative and therapeutic methods. On the basis of his history of abdominal trauma followed by emergency splenectomy and evidence of functioning splenic tissue on a radionuclide scan, the diagnosis of splenosis was established. Laparoscopic exploration was done, and the initial diagnosis confirmed. Splenic tissue located at the right inguinal ring was removed. Testicular pain abated after the procedure. ( info) |
| The case history is presented of a patient with breast cancer who was extensively investigated for presumed hepatic metastases, which were finally diagnosed as splenosis, the heterotopic autotransplantation of splenic tissue after traumatic rupture of the spleen. This case history highlights the importance of obtaining a pathological diagnosis prior to labelling a patient as having metastatic disease. This is especially important for patients who have an unusual pattern or appearance of metastases or for whom the risk of metastatic disease is presumed to be minimal. ( info) |
6/66. 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. ( info) |
7/66. Massive and widely distributed splenosis. A 45-year-old man, seropositive for hepatitis c, was examined because his liver was palpable well below the costal margin. A CT examination revealed multiple nodules within the liver and also several sites of ectopic tissue. The patient had a splenectomy 25 years before. A radiocolloid study showed uptake, consistent with splenosis, in the thorax, abdomen, pelvis, and possibly the left arm. The magnitude of the ectopic tissue, and its multiple locations, indicated the ability of splenic cells to grow in a variety of body sites. ( info) |
8/66. Intrahepatic splenosis: imaging features. We report a patient who presented with asymptomatic focal liver lesions and in whom a diagnosis of intrahepatic splenosis was made. This rare condition mostly occurs in patients who previously underwent splenic trauma or surgery. magnetic resonance imaging (MRI) characteristics suggesting this diagnosis are described. The lesions were mainly hypointense on T1- and hyperintense on T2-weighted images. After administration of small iron oxide particles (SPIO-Endorem), the lesions remained slightly hyperintense relative to the hypointense liver parenchyma but showed a 50% loss in signal intensity. knowledge of these MRI characteristics may avoid the use of surgical interventions to arrive at the correct diagnosis of these rare liver lesions. ( info) |
| We describe a unique case of combined thoracic and subcutaneous splenosis. ( info) |
10/66. 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. ( info) |