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Julian K, Vasekar M. Thoracic splenosis: an important consideration in oncology patients. BMJ Case Rep 2023; 16:e257091. [PMID: 37940196 PMCID: PMC10632802 DOI: 10.1136/bcr-2023-257091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Abstract
SummarySplenosis is the implantation of ectopic splenic tissue after splenic injury or splenectomy. Signs and symptoms of splenosis vary based on anatomic location; however, it remains asymptomatic in many cases. On radiographic imaging, splenosis often appears as a soft tissue mass and can be diagnosed using heat-damaged red blood cell scintigraphy, a non-invasive imaging modality. Radiographic findings of splenosis on imaging may be suspicious for metastatic disease in patients with known solid organ tumours. It is important to have a high degree of suspicion for splenosis with known history of splenic trauma or splenectomy in order to avoid invasive procedures and guide appropriate management.
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Affiliation(s)
- Katherine Julian
- Internal Medicine, University of Colorado, Aurora, Colorado, USA
| | - Monali Vasekar
- Hematology/Oncology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
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Gelsomino F, Castellani MR, Marchianò A, Duca M, Mariani P, Aliberti G, Maccauro M, Duranti L, Capri G, de Braud FG, Bianchi GV. Pitfalls in oncology: a unique case of thoracic splenosis mimicking malignancy in a patient with resected breast cancer. J Thorac Dis 2016; 8:E403-7. [PMID: 27293867 DOI: 10.21037/jtd.2016.04.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Thoracic splenosis (TS) is a condition of autotransplantation of splenic tissue into the pleural cavity after thoraco-abdominal trauma, with diaphragmatic and spleen injury. It is usually asymptomatic and discovered as an incidental finding at imaging performed for other reasons. Its differential diagnosis regards different benign and malignant conditions and should be discerned avoiding invasive procedures. We report a case of thoracic mass associated with pleural nodules mimicking malignancy in a patient with resected breast cancer for whom a diagnosis of TS was made early by using non-invasive methods. Briefly, we review the literature data on TS, comment concisely the possible implications of using invasive procedures and describe the current non-invasive techniques available. Furthermore, we highlight the importance of an accurate medical history collection, the role of the multidisciplinary board and their impact on treatment decision making. Finally, we conclude that clinical information and imaging would be the discriminating factors to avoid unnecessary invasive procedures.
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Affiliation(s)
- Francesco Gelsomino
- 1 Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 2 Nuclear Medicina Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 3 Radiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 4 Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Maria Rita Castellani
- 1 Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 2 Nuclear Medicina Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 3 Radiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 4 Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Alfonso Marchianò
- 1 Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 2 Nuclear Medicina Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 3 Radiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 4 Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Matteo Duca
- 1 Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 2 Nuclear Medicina Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 3 Radiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 4 Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Paola Mariani
- 1 Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 2 Nuclear Medicina Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 3 Radiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 4 Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Gianluca Aliberti
- 1 Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 2 Nuclear Medicina Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 3 Radiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 4 Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Marco Maccauro
- 1 Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 2 Nuclear Medicina Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 3 Radiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 4 Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Leonardo Duranti
- 1 Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 2 Nuclear Medicina Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 3 Radiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 4 Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Giuseppe Capri
- 1 Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 2 Nuclear Medicina Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 3 Radiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 4 Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Filippo Guglielmo de Braud
- 1 Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 2 Nuclear Medicina Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 3 Radiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 4 Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Giulia Valeria Bianchi
- 1 Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 2 Nuclear Medicina Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 3 Radiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy ; 4 Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
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Abstract
CONTEXT A diverse and complex variety of lymphoproliferative diseases may involve the serosa, with widely differing clinical outcomes encompassing a spectrum of benign and malignant conditions. OBJECTIVE To review lymphoproliferative disease involving the serosa and to provide a practical approach to the evaluation of lymphoid and plasma cell infiltrates in the serosa, together with a review of various tumors and tumorlike conditions that may mimic lymphoproliferative disease. DATA SOURCES Analysis of published literature. CONCLUSIONS All forms of hematologic malignancy may involve the various serosal sites, although this is usually observed as secondary involvement in persons with known lymph nodal, marrow-based, or extranodal disease. Primary pericardial, pleural, and peritoneal lymphomas are rare; many nonneoplastic conditions may mimic lymphoma and a variety of nonhematolymphoid tumors may simulate hematologic malignancies. An understanding of the role of ancillary tests, together with an appreciation of their limitations, will prevent misdiagnosis.
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Affiliation(s)
- Richard Attanoos
- Department of Histopathology, University Hospital Llandough, Cardiff, United Kingdom.
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