Laparoscopic splenectomy for isolated splenic sarcoidosis: A case report. Int J Surg Case Rep. 2019;60:79-81. [PMID: 31207531 PMCID: PMC6580116 DOI: 10.1016/j.ijscr.2019.04.031]

A Pesky Spleen: A Painful Presentation of Extrapulmonary Sarcoidosis

Sarcoidosis is an inflammatory and granulomatous disease of uncertain etiology that can impact various organ systems and exhibits diverse clinical presentations, which adds to the complexity of disease diagnosis and management. Pathologically, it is distinguished by the presence of noncaseating granulomas within the affected organ system. In this case report, we describe a 34-year-old Caucasian female patient with isolated splenic and possible hepatic involvement of sarcoidosis, presenting with severe abdominal pain. The absence of the typical pulmonary, cutaneous, or joint involvement posed challenges in achieving a definitive diagnosis and determining the appropriate management. Imaging studies revealed hepatic and splenic hypodensities, necessitating consideration of various differential diagnoses, including lymphoproliferative disorders, immunological disorders, environmental particle exposure, infectious causes, neoplasms, and drug reactions. The severity of symptoms in this case required hospital admission for pain and nausea control, biopsy, and eventual splenectomy with pathology that confirmed the diagnosis of splenic sarcoidosis.

Isolated splenic sarcoidosis: a rare cause of hypercalcaemia in a patient with type 1 diabetes

A 30-year-old man was admitted to Intensive Therapy Unit (ITU) with status epilepticus secondary to severe hypoglycaemia on a background of type 1 diabetes. CT of the brain showed generalised cerebral oedema. He was successfully stepped down to a medical ward after 2 weeks. He was noted to have persistently high calcium, which required multiple doses of pamidronate. Parathyroid hormone level was appropriately low. CT of the thorax, abdomen and pelvis showed mild hepatosplenomegaly with small pathological lymph nodes throughout the abdomen. Bone marrow biopsy was unremarkable. Lymph node biopsy was difficult to achieve, and therefore a positron emission tomography scan was arranged. This showed an enlarged and hypermetabolic spleen. Differential diagnoses at this point included lymphoma and sarcoidosis. He underwent diagnostic splenectomy, and the diagnosis of sarcoidosis was confirmed histologically. Calcium level remained normal 17 months after splenectomy.

Incidentally discovered asymptomatic splenic hamartoma misdiagnosed as an aneurysm: A case report

BACKGROUND

Splenic hamartoma (SH) is a rare, benign vascular proliferation that is often found incidentally. It may be misdiagnosed as a splenic aneurysm or splenic malignancy.

CASE SUMMARY

A 21-year-old male patient was admitted to our hospital with a complaint of an incidentally discovered asymptomatic splenic space-occupying lesion for 2 wk. Abdominal computed tomography (CT) scan showed a circular low-density shadow in the hilum of the spleen. Contrast-enhanced CT revealed an aneurysm located in the hilum of the spleen before operation. Laparoscopic splenectomy was performed and postoperative pathology revealed the presence of SH.

CONCLUSION

Imaging studies are insufficient for the differential diagnosis of SH from other diseases, and laparoscopic splenectomy is a less invasive procedure and useful for the diagnostic purpose as well.

Sarcoidosis with Splenic Involvement Diagnosed with Endoscopic Ultrasound-guided Fine-needle Aspiration

Splenic sarcoidosis is often diagnosed by splenectomy or an ultrasound-guided splenic biopsy. However, splenectomy is invasive and costly, and a percutaneous biopsy is sometimes difficult. We herein report a case of splenic sarcoidosis diagnosed with endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). A 71-year-old man was referred to our hospital for abnormal shadows on a chest roentgenogram. Computed tomography showed multiple lesions in the spleen and pulmonary consolidations. Bronchoscopy revealed no definitive diagnosis. We therefore performed EUS-FNA for a splenic lesion that led to the diagnosis. This case suggests that EUS-FNA is useful in confirming the diagnosis of sarcoidosis with suspected splenic lesions.