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Smoot T, Revels J, Soliman M, Liu P, Menias CO, Hussain HH, Savas H, Gaballah AH. Abdominal and pelvic splenosis: atypical findings, pitfalls, and mimics. Abdom Radiol (NY) 2022; 47:923-947. [PMID: 35076742 DOI: 10.1007/s00261-021-03402-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 01/28/2023]
Abstract
Splenosis is an acquired form of ectopic splenic tissue that typically arises after trauma or splenectomy. It is often an incidental image finding in an otherwise asymptomatic patient, but the spectrum of symptoms varies based on the site of implantation. Radiologists should be familiar with the imaging features of splenosis to avoid mistaking it for malignancy. Splenosis has identical imaging features to that of the native spleen on US, CT, MRI, and nuclear medicine examinations. Therefore, when the radiologic findings support the diagnosis of splenosis, the patient can be spared invasive procedures for tissue sampling.
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Affiliation(s)
- Travis Smoot
- Department of Diagnostic Radiology, University of Missouri, One Hospital Dr. Columbia, Columbia, MO, 65212, USA
| | - Jonathan Revels
- Department of Radiology, University of New Mexico, Albuquerque, NM, USA
| | - Moataz Soliman
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, 48109, USA
| | - Peter Liu
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Hero H Hussain
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Hatice Savas
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, 48109, USA
| | - Ayman H Gaballah
- Department of Diagnostic Radiology, University of Missouri, One Hospital Dr. Columbia, Columbia, MO, 65212, USA.
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Vernuccio F, Dimarco M, Porrello G, Cannella R, Cusmà S, Midiri M, Brancatelli G. Abdominal splenosis and its differential diagnoses: What the radiologist needs to know. Curr Probl Diagn Radiol 2020; 50:229-235. [PMID: 32540140 DOI: 10.1067/j.cpradiol.2020.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/25/2020] [Accepted: 04/14/2020] [Indexed: 12/13/2022]
Abstract
Splenosis is a benign acquired condition characterized by the presence of heterotopic viable splenic tissue in other organs or within cavities such as peritoneum, retroperitoneum, or thorax after splenic trauma or surgery. Abdominal splenosis is often an incidental finding and computed tomography and magnetic resonance usually allow a confident diagnosis. The typical enhancement that parallels the spleen is a useful hallmark of splenosis. Splenic implants lack contrast uptake in the hepatobiliary phase and show high signal at high b-values on diffusion-weighted images. In some cases splenosis may mimic malignant and benign conditions in the peritoneum as well as in hollow and parenchymal abdominal organs and further investigations - including scintigraphy with Tc99m-labelled heat-denatured red blood cells or biopsy - are sometimes required in challenging cases. This pictorial essay reviews the imaging presentation and potential differential diagnosis of splenosis according to the site of implantation. A prompt and accurate radiological diagnosis of splenosis can avoid unnecessary biopsy or surgery.
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Affiliation(s)
- Federica Vernuccio
- Dipartimento Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza G. D'Alessandro, University of Palermo, Palermo, Italy; I.R.C.C.S, Centro Neurolesi Bonino Pulejo, Messina, Italy; Hôpitaux Universitaires Beaujon, Radiology, Université Paris VII, Clichy, France.
| | - Mariangela Dimarco
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University of Palermo, Palermo, Italy
| | - Giorgia Porrello
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University of Palermo, Palermo, Italy
| | - Roberto Cannella
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University of Palermo, Palermo, Italy
| | - Silvestro Cusmà
- Radiology department, Oncologic Hospital "La Maddalena", Palermo, Italy
| | - Massimo Midiri
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University of Palermo, Palermo, Italy
| | - Giuseppe Brancatelli
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University of Palermo, Palermo, Italy
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Angelova EA, Bagherpour A, Schnadig VJ, He J. Gamna-Gandy bodies in fine-needle aspiration from abdominal splenosis: A clue to underlying portal hypertension. Diagn Cytopathol 2020; 48:670-674. [PMID: 32271504 DOI: 10.1002/dc.24429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/07/2020] [Accepted: 03/27/2020] [Indexed: 11/10/2022]
Abstract
A 40-year-old woman presented with abdominal pain and jaundice. Past medical history was significant only for splenectomy following a motor vehicle accident. Owing to presence of multiple peritoneal nodules on computerized tomography (CT) and elevated serum CA-125, ovarian peritoneal carcinomatosis was suspected. Ultrasound-guided fine-needle aspiration (FNA) revealed presence of abundant hemosiderin, leukocytes, endothelial cells, and fungal hypha-like structures. No evidence of neoplasia was found. Findings were consistent with Gamna-Gandy bodies (GGBS) within splenic tissue. Based on history of splenectomy and FNA findings, a diagnosis of abdominal splenosis with presence of GGBS was made. Workup for hepatic cirrhosis and portal hypertension was recommended. Liver biopsy confirmed presence of cirrhosis. To our knowledge, this is the first report of GGBS identified within abdominal splenosis. It is important for pathologists to be able to recognize GGBS and to be aware of their relationship to portal hypertension and other conditions associated with severe vascular congestion or hemorrhage. History and pathogenesis of GGBS, their diagnostic morphologic features and a review of cases of GGBS diagnosed via cytology are given.
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Affiliation(s)
| | - Arya Bagherpour
- Department of Pathology, University of Texas Medical Branch at Galveston, Galveston, Texas, United States
| | - Vicki J Schnadig
- Department of Pathology, University of Texas Medical Branch at Galveston, Galveston, Texas, United States
| | - Jing He
- Department of Pathology, University of Texas Medical Branch at Galveston, Galveston, Texas, United States
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Koç ZP, Özcan Kara P, Tombak A. Splenosis Mimicking Lymphoma Relapse Confirmed by 18F-FDG PET/CT and Tc-99m Nano-colloid Scintigraphy Thirty Years After Splenectomy for Trauma. Mol Imaging Radionucl Ther 2019; 28:38-40. [PMID: 30942062 PMCID: PMC6455096 DOI: 10.4274/mirt.galenos.2018.44227] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Splenosis is implantation of the splenic tissue in the abdominal region or elsewhere in the body as a consequence of trauma or splenectomy, which might mimic intra-abdominal involvement of several malignancies. This case report presents a patient with abdominal implants without 18F-FDG accumulation confirmed to be splenosis by Tc-99m nano-coloid scintigraphy.
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Affiliation(s)
- Zehra Pınar Koç
- Mersin University Faculty of Medicine, Department of Nuclear Medicine, Mersin, Turkey
| | - Pelin Özcan Kara
- Mersin University Faculty of Medicine, Department of Nuclear Medicine, Mersin, Turkey
| | - Anıl Tombak
- Mersin University Faculty of Medicine, Department of Hematology, Mersin, Turkey
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Computed tomography imaging of ovarian peritoneal carcinomatosis: a pictorial review. Pol J Radiol 2018; 83:e500-e509. [PMID: 30655930 PMCID: PMC6334186 DOI: 10.5114/pjr.2018.80247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/24/2018] [Indexed: 01/29/2023] Open
Abstract
Gynaecological malignancies are the most common malignancies in women and also an important public health issue. In developing countries, there is a paucity of screening facilities and cancer awareness, so patients present at an advanced stage of disease, which severely limits the prognosis and clinical outcome. Among the gynaecological malignancies, ovarian malignancy has the second highest incidence in women according to the incidences. Ovarian malignancy is usually diagnosed at the advanced stages, and to improve the patient’s survival, debulking surgery is very important. Advanced-stage disease is treated with either debulking surgery followed by adjuvant chemotherapy or initial neoadjuvant chemotherapy followed by debulking surgery. Imaging is very important in patient selection, in determining who will benefit from neoadjuvant chemotherapy just before debulking surgery. This article highlights the role of computed tomography (CT) in the detection of patterns of spread of ovarian malignancy, important for staging and management.
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Martínez Lorca A, Coronado Poggio M, Hernández Pérez I, Ramírez Escalante Y, Rizkallal Monzon S, Marín Ferrer M. Utility of 99mTc-labelled heat-denatured erythrocyte scintigraphy and 18F-FDG PET-CT to differentiate accessory spleens from tumoral metastases. A case report. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2014.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Martínez Lorca A, Coronado Poggio M, Hernández Pérez I, Ramírez Escalante Y, Rizkallal Monzon S, Marín Ferrer MD. [Utility of (⁹⁹m)Tc-labelled heat-denatured erythrocyte scintigraphy and ¹⁸F-FDG PET-CT to differentiate accessory spleens from tumoral metastases. A case report]. Rev Esp Med Nucl Imagen Mol 2014; 34:68-9. [PMID: 24970049 DOI: 10.1016/j.remn.2014.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/12/2014] [Accepted: 03/20/2014] [Indexed: 11/28/2022]
Affiliation(s)
- A Martínez Lorca
- Servicio de Medicina Nuclear, Hospital Universitario La Paz, Madrid, España.
| | - M Coronado Poggio
- Servicio de Medicina Nuclear, Hospital Universitario La Paz, Madrid, España
| | - I Hernández Pérez
- Servicio de Medicina Nuclear, Hospital Universitario La Paz, Madrid, España
| | | | - S Rizkallal Monzon
- Servicio de Medicina Nuclear, Hospital Universitario La Paz, Madrid, España
| | - M D Marín Ferrer
- Servicio de Medicina Nuclear, Hospital Universitario La Paz, Madrid, España
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Kellert B, Caster M, Des Jean R, Vaccarello L. Diffuse intra-abdominal splenosis presenting as carcinomatosis exhibiting positron emitted tomography hypermetabolic activity. GYNECOLOGIC ONCOLOGY CASE REPORTS 2013; 5:46-8. [PMID: 24371695 PMCID: PMC3862292 DOI: 10.1016/j.gynor.2013.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 03/22/2013] [Indexed: 12/28/2022]
Abstract
Splenosis can mimic carcinomatosis upon many imaging modalities. History of splenectomy must be considered when evaluating carcinomatosis. Scintigraphy is the preferred for confirming the presence of splenosis.
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Affiliation(s)
- Brian Kellert
- The Ohio State University/Mount Carmel Health OB/GYN Residency Program, 395 W State St, 5th Floor, Columbus, OH 43210, United States
- Corresponding author at: The Ohio State University/Mount Carmel Health OB/GYN Residency Program, 395 W State St, 5th Floor, Columbus, OH 43210, United States. Fax: + 1 614 293 5877.
| | - Michelle Caster
- The Ohio State University/Mount Carmel Health OB/GYN Residency Program, 395 W State St, 5th Floor, Columbus, OH 43210, United States
| | - Ryan Des Jean
- Mount Carmel Health System, Mount Carmel East Hospital, Department of Pathology, 5959 E Broad Street, Columbus, OH 43213, United States
| | - Luis Vaccarello
- The Zangmeister Cancer Center, 3100 Plaza Properties Blvd, Columbus, OH 43219, United States
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