[Ectopic spleen in pelvis minor--a case report]

A case of ectopic spleen diagnosed as a left adnexal tumor in a 19 year old female was presented. Considering the rareness and lack of typical symptoms, diagnosis of this pathology still is very difficult, and establish most often intraoperatively. In every case of ascertainment irregular mass in minor pelvis one should differentiate it among: colonic diverticulosis, wandering kidney, coproliths, colon and mesentery tumors and ectopic spleen. We consider that ultrasonography plays the special role in these cases. In every case of stating the pathologic structure in minor pelvis it seems advisable not to content only with estimation of genital organs, but also locate such as: kidneys, liver, spleen. Such a procedure allows to state preoperative diagnosis more precisely.

Pediatric wandering spleen: case report and review of literature

Wandering spleen is a rare diagnosis, especially in the pediatric population. We reviewed the English literature from 1900 through April 1991 for all cases of wandering spleen in patients from birth through age 10. There are 50 case reports prior to the one presented here. The goals of this article are to summarize the histories, findings, and treatment of the 51 patients, describe diagnostic and treatment modalities, and increase the clinician's suspicion for wandering spleen. This condition is probably underdiagnosed and potentially treatable by splenopexy if suspected and diagnosed early in the course of disease.

Noninvasive imaging of a retrocardiac spleen. Unusual component of paraesophageal diaphragmatic hernia

The findings on chest roentgenograms, cardiac ultrasound, computed tomography (CT), and radionuclide liver-spleen scan are described in a 54-year-old man with a paraesophageal diaphragmatic hernia. The CT revealed the spleen as a solid mass with a notched border adjacent to the intrathoracic retrocardiac stomach. The radionuclide scan showed splenic uptake above the diaphragm. The diagnosis in this case, which, to our knowledge, is the first such reported case, was confirmed at surgery.

Chlorambucil-induced mutations in mice recovered in homozygotes

Chlorambucil induced a number of recessive visible mutations in the mouse. Induction of these mutations was studied in two mating schemes, each designed to recover mutations after two intercrosses. In scheme 1, 10 mutations were detected in 82 mice; in scheme 2, 1 mutation was detected in 19 mice. We have estimated that the proportion of gametes carrying a recessive visible mutation may be as high as 25% after a dose of 10 mg of chlorambucil per kg to early spermatids. Seven of these mutations caused morphologically distinct abnormalities, including (i) a cerebellar abnormality similar to that expressed in homozygotes for the reeler (rl) mutation; (ii) open eyelids at birth; (iii) a rostral head hemangioma; (iv) abnormally small spleens, anemia, and umbilical hemorrhages; (v) immobility at birth; (vi) polycystic kidneys; and (vii) a circling behavior. Four additional mutations resulted in growth retardation and a runting syndrome. Because, in earlier studies, all molecularly characterized mutations induced by chlorambucil in poststem cells have proved to be deletions, these recessive visible mutations are probably deletions as well. These mutations may be useful in isolating and characterizing the genes responsible for the observed phenotypes.

[Accessory spleen: ultrasonographic and tomographic characteristics]

The failure of fusion of splenic tissue results in the formation of accessory spleens. This entity normally appears in post-mortem examinations. The purpose of this work was to determine the incidence of the accessory spleen and to compare the ultrasonographic and tomographic features of the accessory spleen and the main spleen in a group of one thousand patients affected with several abdominal pathologies. Five hundred of these patients were studied by ultrasonography and five hundred patients by computed tomography. The ultrasonographic and tomographic features of the accessory and main spleen were similar. Its diagnosis is specially important in certain groups of patients with hematologic disease or abdominal trauma with splenic tear. This is due to the fact that the hypertrophy of the accessory spleen can produce a relapse of the disease.

[Torsion of wandering spleen. An unusual case of abdominal pain]

Wandering spleen is uncommon and of difficult diagnosis. New Imaging Modalities (Eco; TC), can suggest or confirm the preoperative diagnosis of wandering spleen, permitting conservative surgery, mainly in children. We report two cases of wandering spleen. The first one, with acute surgical abdomen and tumor on left iliac fossa, operated as an ovarian cyst torsion: the laparotomy showed a necrotic spleen in pelvis. The second case presented as intestinal sub-occlusion with recurrent abdominal pain, and a left iliac fossa movable tumor. It was diagnosed by eco and radionuclides before laparotomy. Even diagnosed in different ways, the surgical treatment was the same.

[Recurrence in post-splenectomy spherocytosis anemia due to presence of accessory spleens]

A young female patient had a recurrence of severe spherocytic anemia there years after having been submitted to splenectomy. The presence of two accessory spleens with a size of 3.5 cm and 4.0 cm, was demonstrated by technetium scanning and ultrasound images. Surgical removal of these noduli resulted again in prompt recovery. The development of the spleen beings in the fifth week of intrauterine life at the dorsal mesogastrium. The lack of fusion of splenic lobuli is responsible for the occurrence of accessory spleens. A surgeon performing splenectomy for the treatment of hemolytic anemia should always search for possible existences of accessory spleens.

Encephalocele, radial defects, cardiac, gastrointestinal, anal, and renal anomalies: a new multiple congenital anomaly (MCA) syndrome?

We present two unrelated female patients with a complex pattern of congenital malformations including encephalocele, oesophageal atresia, abnormal lung lobation, congenital heart defects, anal anomalies, liver, spleen and radial defects. Clinical variability between the two cases can be seen as a result of variable expression. The pattern of anomalies in these two unrelated patients suggest that they may represent the same, as yet unknown, syndrome.

"Nude rabbit" with aplasia of B-lymphoid structures

An original observation of the randombred nude rabbit with aplasia of B-lymphoid structures (absence of the follicles in lymph nodes and spleen, no Peyer's plaques). The thymus gland and the T-dependent structures in the spleen and lymph nodes were-on the contrary-well preserved. The nude skin of this genetic rabbit mutant contained large numbers of hair follicles showing almost intrafollicular retention of hairs with their subsequent dysplasia at the subepidermal and ostiopilar level.

[Asplenia syndrome with duodenal stenosis]

We report a patient with asplenia syndrome. To our knowledge this is the first case described of asplenia syndrome with duodenal stenosis and no heart anomalies. An other important finding has been the absence of vomiting in her symptomatology.

Frequent occurrence of asplenism and cholelithiasis in patients with autoimmune polyglandular disease type I

PURPOSE

This study assesses the occurrence of asplenism and gallstones in patients with autoimmune polyglandular disease type I (APG I).

PATIENTS AND METHODS

Nine patients with APG I (ages 14 to 48) were studied at the National Institutes of Health. Each patient received endocrine testing, a careful examination of his or her peripheral blood smear, lymphocyte immunophenotyping, a liver-spleen scan, and either an upper abdominal ultrasound or a computer-assisted tomogram to evaluate the spleen and gallbladder.

RESULTS

We documented asplenism in four patients and cholelithiasis in four patients, with two patients having both conditions. The patients with asplenism had Howell-Jolly bodies on peripheral blood smears, lack of splenic uptake by liver-spleen scan, and absent spleens by abdominal computed tomographic scan or ultrasound evaluation. The clinical presentation of the patients with cholelithiasis ranged from acute symptoms requiring surgery to asymptomatic gallstones. Lymphocyte immunophenotyping did not reveal consistent changes in either B- or T-cell subpopulations in the patients studied.

CONCLUSION

Asplenism and gallstones occur frequently in patients with APG I. In addition to careful examination of the peripheral blood smear for Howell-Jolly bodies to screen for asplenism, we recommend an abdominal ultrasound to detect asplenism and/or gallstones in all patients with APG I. Appropriate immunizations and antibiotic coverage may be helpful in those patients with absent spleens.

Congenital structural abnormalities in biliary atresia: evidence for etiopathogenic heterogeneity and therapeutic implications

The clinical, surgical, laboratory and histological data of 237 children with extrahepatic biliary atresia were reviewed. Forty-seven patients (20%) had associated congenital anomalies, and of these, 28 had cardiovascular, 22 digestive and 19 splenic malformations. Of the 19 patients with splenic malformations, 13 showed the polysplenia syndrome and two had asplenia. Chromosome studies were performed in eight children, six having associated anomalies, and two of them showed karyotype abnormalities (46,XX,del 18 p- and 49,XXXXY). These observations indicated that biliary atresia could be subdivided into four distinct etiopathogenic subgroups, three involving a congenital form that could arise through a malformation, a disruption or a chromosome abnormality, and the remaining to agents active in the perinatal period (the acquired form). The surgical outcome in 171 patients operated on by an experienced surgeon was not influenced by the presence of anomalies but by the timing of surgery. Seventy-one percent of 24 patients operated on by 8 weeks of age were jaundice-free as opposed to only 34% of those who had later surgery (p less than 0.01).

Hepatobiliary anomalies associated with polysplenia syndrome

The report of a 29-year-old woman with polysplenia syndrome, Crohn's disease, and bilateral cataracts is presented. The patient was noted to have a right-sided stomach and small bowel, Crohn's ileitis, and a left-sided colon. Results of roentgenography of the chest and echocardiography were consistent with a diagnosis of hypoplasia of the inferior vena cava with azygos continuation. The patient underwent laparotomy with cholecystectomy, exploration of the common bile duct, and choledochoscopy for cholelithiasis, choledocholithiasis, and chronic cholecystitis. Laparotomy revealed a liver that had two lobes, each with the morphologic appearance of the left lobe. The gallbladder was centrally located. T-tube cholangiography revealed a quadruplication of the intrahepatic biliary ducts. To our knowledge, this patient is the only known adult with this syndrome in whom cholangiography demonstrated isomerism of the biliary tree. A review of the literature on this subject is given with emphasis on biliary anomalies.

Immunologic study of the asplenia syndrome

Asplenia syndrome is usually associated with complex congenital cardiovascular defects. These patients often succumb to overwhelming infections. A complete immunological evaluation was therefore conducted on 13 consecutive patients with asplenia syndrome and 12 age-matched patients with congenital heart disease but without evident splenic problems. IgG, IgA, IgM and C3 and C4 values were normal for age in all subjects studied. T cell subsets, including the percentage of CD3, and CD4 cells and the CD4/CD8 ratio were significantly different in patients and controls (P less than 0.01, respectively). Lymphoproliferative responses to mitogens (ConA, concanavalin A, phytohemagglutinin and pokeweed mitogen) were also decreased in patients. Fc-mediated clearance of sensitized autologous erythrocytes was significantly impaired in patients (n = 13) when compared with age-matched controls (n = 5) (clearance t1/2 59.0 +/- 9.6 minutes vs. 12.5 +/- 1.6 minutes, P less than 0.001). Thus profoundly impaired reticuloendothelial clearance and decreased T cell function might account for the life-threatening infections frequently seen in patients with congenital asplenia syndrome.

[Accessory spleen causing recurrent idiopathic thrombocytopenic purpura (case report)]

Idiopathic thrombocytopenic purpura is an autoimmune disease in which macrophages of reticuloendothelial system, mainly in the spleen, remove platelets covered by autoantibodies from circulation. By removing the spleen 60-80% of patients are cured. Partial remission is achieved in 10-20% of cases. Recurrence of idiopathic thrombocytopenic purpura in a splenectomized patient achieving complete remission, may be caused by hypertrophy of one or more of the retained accessory spleens. We describe a 41-year-old wonam in whom splenectomy for idiopathic thrombocytopenic purpura was performed 10 years ago. After quick and full remission which lasted almost 10 years, a full reccurrence of the disease with severe thrombocytopenia and haemorhagic syndrome appeared. With ultrasonography, computed tomography and scintigraphy accessory spleens in the splenic fossa were found. Removal of 3 accessory spleens, 21 gram of weight, led to quick and full remission of the disease. A number of platelets stayed over 200 x 10(9)/l with no additional treatment.

Unusual variation of asplenia syndrome

The case of a 1-year-old cyanotic boy diagnosed with asplenia syndrome has been reported. By physical and laboratory examinations, levocardia, atrial inversion, primum ASD, single atrioventricular valve, single ventricle (left-hand morphology), rudimentary right ventricle (anterior, left-sided), pulmonary stenosis, left-sided vena cava, single vena cava superior were established and the case was diagnosed with asplenia syndrome. The patient has concordance between tracheo-bronchial situs and lung anatomy and inverted atrial and visceral situs, but without atrial isomerism that makes his case an unusual variation of asplenia syndrome.

Smith-Fineman-Myers syndrome in two brothers

We report on 2 brothers with a distinctive facial appearance, severe mental retardation, short stature, cryptorchidism, asplenia in one, dramatic failure to thrive, early hypotonia, and later hypertonia all suggestive of the Smith-Fineman-Myers syndrome. All 5 of the reported cases have been males, suggesting X-linked inheritance.