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Grochowska A, Arkuszewski P. Rupture of an accessory spleen caused by blunt trauma. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02591-y. [PMID: 38980393 DOI: 10.1007/s00068-024-02591-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/18/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE The accessory spleen is quite a common abdominal anomaly. However, the traumatic accessory spleen rupture is an extremely rare condition requiring surgical intervention, even laparotomy. 9 cases of traumatic accessory spleen were found published between 1962 and 2022. The study aims to evaluate traumatic accessory spleen rupture cases regarding their causes, clinical course, and possible diagnosis without surgery and treatment. METHODS Desk research method using available online databases. Descriptive methods were employed to analyze the collected data. The results are summarized in the Table concerning gender, age, injury details, accessory spleen injury characteristics, treatment, and others such as previous splenectomy or primary spleen involvement in injury or accompanying abdominal injuries. RESULTS In total, there were 9 cases of traumatic accessory spleen, of which 2 were managed conservatively and the remaining 7 were treated operatively. All the patients survived. One-third of all included patients already had their primary spleen removed, which facilitated the diagnosis of traumatic rupture of an accessory spleen. The proper diagnosis of an accessory spleen rupture was concluded in 2 cases and confirmed in surgery. CONCLUSION The recognition of the traumatic rupture of an accessory spleen before surgery is challenging but can be made easier if the patient underwent splenectomy before. The traumatic accessory spleen rupture does not coexist with an injury of a primary spleen.
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Affiliation(s)
- Agata Grochowska
- Department of Biomedicine and Experimental Surgery, Student Scientific Club of Biomedicine and Experimental Surgery, Medical University of Lodz, 60 Narutowicza Street, Lodz, 90-136, Poland
| | - Piotr Arkuszewski
- Department of Biomedicine and Experimental Surgery, Medical University of Lodz, 60 Narutowicza Street, Lodz, 90-136, Poland.
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2
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Liu X, Li W, Qu J. Accessory spleen below the peritoneal reflection masquerading as metastatic rectal cancer: A case study. Asian J Surg 2024; 47:2880-2881. [PMID: 38383194 DOI: 10.1016/j.asjsur.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Affiliation(s)
- Xuejing Liu
- Department of General Surgery, Aerospace Center Hospital, Beijing 100049, China
| | - Wenqiang Li
- Department of General Surgery, Aerospace Center Hospital, Beijing 100049, China
| | - Jun Qu
- Department of General Surgery, Aerospace Center Hospital, Beijing 100049, China.
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3
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Rodríguez-Rodríguez S, Álvarez-Blanco JM, Sánchez-Díaz S, Rangel-Patiño J, Sierra-Salazar A, Apodaca-Chávez E, Demichelis-Gómez R. Are accessory spleen screening and resection in refractory immune cytopenia an effective strategy or a waste of resources? Ann Hematol 2023; 102:2309-2315. [PMID: 37439893 DOI: 10.1007/s00277-023-05360-w] [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] [Received: 05/10/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
Splenectomy remains an effective treatment for refractory immune cytopenia (RIC), which encompasses immune thrombocytopenia (ITP) and autoimmune hemolytic anemia (AIHA). Accessory spleens (AS) have been described without identifying specific risk factors. We retrospectively analyzed patients with RIC after splenectomy who underwent splenic scintigraphy (SS) at our institution. Seventy-one patients were included. Sixty-two patients had ITP, five had AIHA, and four had Evans syndrome. Seventy-five percent (n = 53) were women. Eleven patients (15.5%) had an AS detected by SS. A complete response (CR) to first-line steroids (odds ratio (OR) 5.75, 95% confidence interval (CI) 1.37-24.14, p = 0.017) and the absence of Howell-Jolly bodies (HJB) in peripheral blood smear (PBS) (OR 11.37, 95% CI 2.70-47.85, p = 0.001) were found to be risk factors. Patients with both elements had a higher rate of AS (83.3%) when compared to those with one or no factors (p < 0.001). Eight patients (73%) underwent an accessory splenectomy: seven (87.5%) achieved a CR, and none had perioperative complications. The presence of HJB in PBS changed from 25 to 87.5% after accessory splenectomy. We recommend the search for an AS via SS in patients with RIC due to ITP, who had a CR to corticosteroids and the absence of HJB in PBS. Accessory splenectomy is a safe and effective procedure.
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Affiliation(s)
- Sergio Rodríguez-Rodríguez
- Hematology and Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez, Tlalpan, 14080, Mexico City, ZC, Mexico
| | - José Miguel Álvarez-Blanco
- Hematology and Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez, Tlalpan, 14080, Mexico City, ZC, Mexico
| | - Susana Sánchez-Díaz
- Hematology and Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez, Tlalpan, 14080, Mexico City, ZC, Mexico
| | - Juan Rangel-Patiño
- Hematology and Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez, Tlalpan, 14080, Mexico City, ZC, Mexico
| | - Ana Sierra-Salazar
- Hematology and Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez, Tlalpan, 14080, Mexico City, ZC, Mexico
| | - Elia Apodaca-Chávez
- Hematology and Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez, Tlalpan, 14080, Mexico City, ZC, Mexico
| | - Roberta Demichelis-Gómez
- Hematology and Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez, Tlalpan, 14080, Mexico City, ZC, Mexico.
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M S P, Matthew C, Rajendran RR. Accessory Spleen Mimicking an Intrahepatic Neoplasm: A Rare Case Report. Cureus 2023; 15:e39185. [PMID: 37332428 PMCID: PMC10276632 DOI: 10.7759/cureus.39185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
Accessory spleen and splenosis are two types of ectopic spleen. An accessory spleen can be found in various sites in the abdomen, but an intrahepatic accessory spleen is very rare though many case reports of intrahepatic splenosis are available. This case report presents the incidental diagnosis of accessory spleen in the liver of a 57-year-old male while undergoing laparoscopic diaphragmatic repair. The patient had a history of splenectomy 27 years ago for hereditary spherocytosis, but his routine haemogram did not show any features of the ectopic splenic function. Intraoperatively, a mass was suspected in the liver and was resected. Histopathology revealed an accessory spleen with well-preserved red and white pulp architecture. Though a history of splenectomy suggested a diagnosis of splenosis, a well-encapsulated and preserved splenic architecture confirmed the diagnosis of accessory spleen. Accessory spleen or splenosis can be diagnosed radiologically using Tc-99m-labeled heat-denatured red blood cells (HRBC) and Tc-99m sulfur colloid scans, but the gold standard is histopathological examination. Ectopic spleen is mostly asymptomatic but usually results in unnecessary surgeries as it is difficult to differentiate from benign or malignant tumors. Thus, a high degree of suspicion and awareness is necessary for early and prompt diagnosis.
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Affiliation(s)
- Peethambaran M S
- Gastrointestinal Surgery, Avitis Institute of Medical Sciences, Palakkad, IND
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5
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Xu N, Xu Y, Zhu Q. Radiologic Findings of Single Accessory Splenic Infarction in a Patient with Accessory Spleens in the Abdominal Cavity: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040807. [PMID: 37109765 PMCID: PMC10144062 DOI: 10.3390/medicina59040807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
The presence of multiple accessory spleens in the abdominal cavity is typically limited to two, with cases involving a higher number being exceedingly rare. Concurrently, accessory spleen infarction is remarkably uncommon, primarily resulting from torsion of the vascular pedicle. In this report, we present a case of a 19-year-old male who experienced infarction in one of four accessory spleens. Imaging diagnosis proved challenging, with the definitive diagnosis being made through postoperative pathology, revealing no torsion in the affected accessory spleen. Following surgery combined with anti-inflammatory and analgesic treatment, the patient exhibited an uneventful recovery. No complications were observed at the 3-month follow-up. This case indicates the challenge and difficulty of diagnosing accessory splenic infarction without torsion in imaging diagnosis. Employing a multimodality approach and diffusion-weighted imaging may aid in confirming the diagnosis.
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Affiliation(s)
- Nan Xu
- Department of Ultrasonography, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yingchen Xu
- Department of General Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Qiang Zhu
- Department of Ultrasonography, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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6
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Kapur R, Audia S. Secondary spleen in immune thrombocytopenia: Not so accessory after all…. Br J Haematol 2023. [DOI: 10.1111/bjh.18776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023]
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7
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Pizzi M, Vianello F, Lorenzi L, Binotto G, Sbaraglia M, Scarmozzino F, De Crescenzo A, Guzzardo V, Zoletto S, d'Amore F, Friziero A, D'Adda M, Facchetti F, Dei Tos AP. Accessory spleens recapitulate the immune microenvironment of the main spleen in immune thrombocytopenia. Br J Haematol 2023. [PMID: 36916680 DOI: 10.1111/bjh.18749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/15/2023]
Abstract
Accessory spleens (AcS) may play a relevant role in immune thrombocytopenia (ITP) and possibly contribute to ITP relapse following splenectomy. Little is known about the immune microenvironment of AcS in ITP. To address this issue, we compared the histological features of eight matched AcS and main spleen (MS) samples, obtained from adult patients with primary ITP. AcS and MS had overlapping immune architectural features and lymphoid composition, suggesting that similar immunologic events occur in AcS and MS of ITP. These findings may have implications for the potential mechanisms of AcS-mediated ITP relapse. Further studies are needed to confirm these results and to dissect spleen immunity in ITP.
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Affiliation(s)
- Marco Pizzi
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Fabrizio Vianello
- Haematology & Clinical Immunology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Luisa Lorenzi
- Section of Pathology, Department of Molecular and Translational Medicine, University of Brescia School of Medicine, Spedali Civili di Brescia, Brescia, Italy
| | - Gianni Binotto
- Haematology & Clinical Immunology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Marta Sbaraglia
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Federico Scarmozzino
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Andrea De Crescenzo
- Haematology & Clinical Immunology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Vincenza Guzzardo
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Simone Zoletto
- Haematology & Clinical Immunology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Fabio d'Amore
- Haematology & Clinical Immunology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Alberto Friziero
- 1st Surgical Clinic, Department of Surgical Oncological and Gastroenterological Sciences, University of Padua School of Medicine, Padua, Italy
| | - Mariella D'Adda
- Haematology Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Fabio Facchetti
- Section of Pathology, Department of Molecular and Translational Medicine, University of Brescia School of Medicine, Spedali Civili di Brescia, Brescia, Italy
| | - Angelo Paolo Dei Tos
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
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8
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Paul DA, La PBD, Abasszade JH. Splenunculus mimicking splenomegaly in a patient with synchronous herpes simplex 1 viremia and myelosuppression. Clin Case Rep 2022; 10:e6616. [DOI: 10.1002/ccr3.6616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/15/2022] [Accepted: 11/05/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Dion A. Paul
- Department of General Medicine Monash Health Clayton Victoria Australia
| | - Paul Bao Duy La
- Department of General Medicine Monash Health Clayton Victoria Australia
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9
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Hou S, Cheng B, Gao Z, Ye Y. Congenital accessory spleen in the fundus of stomach mimicking a gastrointestinal stromal tumor. Asian J Surg 2022; 46:1585-1586. [PMID: 36688237 DOI: 10.1016/j.asjsur.2022.09.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023] Open
Affiliation(s)
- Sen Hou
- Department of Gastrointestinal Surgery, Peking University People`s Hospital, Beijing, 100044, PR China; Laboratory of Surgical Oncology, Peking University People`s Hospital, Beijing, 100044, PR China.
| | - Baosen Cheng
- Department of Gastrointestinal Surgery, Peking University People`s Hospital, Beijing, 100044, PR China; Laboratory of Surgical Oncology, Peking University People`s Hospital, Beijing, 100044, PR China.
| | - Zhidong Gao
- Department of Gastrointestinal Surgery, Peking University People`s Hospital, Beijing, 100044, PR China; Laboratory of Surgical Oncology, Peking University People`s Hospital, Beijing, 100044, PR China; Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People`s Hospital, Beijing, 100044, PR China.
| | - Yingjiang Ye
- Department of Gastrointestinal Surgery, Peking University People`s Hospital, Beijing, 100044, PR China; Laboratory of Surgical Oncology, Peking University People`s Hospital, Beijing, 100044, PR China; Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People`s Hospital, Beijing, 100044, PR China.
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10
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Zhang Y, Shi G, Meng L, Wu J, Hu Q, Xv D, Zhang K, Lu Z, Wu J, Jiang K. Laparoscopic treatment for an intrapancreatic accessory spleen: A case report. Front Oncol 2022; 12:972883. [PMID: 36276164 PMCID: PMC9581263 DOI: 10.3389/fonc.2022.972883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022] Open
Abstract
Malignant pancreatic tumors have early metastasis, aggressive behavior and poor prognosis. Surgeons often need to judge whether a patient needs prompt surgery when a pancreatic lesion is found. The accessory spleen is a congenital developmental malformation rather than a tumor and does not require surgical resection. Here, we report a 47-year-old man who underwent routine gastroscopic examination, and a submucosal eminence of the duodenal bulb was detected. The patient was asymptomatic and laboratory tests were unremarkable. Duodenal neuroendocrine neoplasm (G2) was considered following endoscopic submucosal dissection (ESD). Further examination showed a lesion in the tail of the pancreas and multiple accessory spleens. The lesion in the tail of the pancreas was Ga-68 positive and was highly considered a pancreatic neuroendocrine tumor (pNET). Based on this clinical evidence, laparoscopic spleen-preserving distal pancreatectomy (Kimura) was performed. However, the results of the postoperative pathological diagnosis indicated an intrapancreatic accessory spleen (IPAS). Given the findings of this case, we should explore more accurate diagnostic methods for IPAS to avoid unnecessary surgery.
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Affiliation(s)
- Yihan Zhang
- Pancreas Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Pancreas Institute, Nanjing Medical University, Nanjing, China
| | - Guodong Shi
- Pancreas Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Pancreas Institute, Nanjing Medical University, Nanjing, China
| | - Lingdong Meng
- Pancreas Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Pancreas Institute, Nanjing Medical University, Nanjing, China
| | - Jing Wu
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qingqiao Hu
- Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dong Xv
- Pancreas Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Pancreas Institute, Nanjing Medical University, Nanjing, China
| | - Kai Zhang
- Pancreas Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Pancreas Institute, Nanjing Medical University, Nanjing, China
| | - Zipeng Lu
- Pancreas Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Pancreas Institute, Nanjing Medical University, Nanjing, China
| | - Junlii Wu
- Pancreas Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Pancreas Institute, Nanjing Medical University, Nanjing, China
- *Correspondence: Kuirong Jiang, ; Junlii Wu,
| | - Kuirong Jiang
- Pancreas Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Pancreas Institute, Nanjing Medical University, Nanjing, China
- *Correspondence: Kuirong Jiang, ; Junlii Wu,
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11
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Trujillo SG, Saleh S, Burkholder R, Shibli F, Shah B. Accessory Spleen: A Rare and Incidental Finding in the Stomach Wall. Cureus 2022; 14:e24977. [PMID: 35698709 PMCID: PMC9188829 DOI: 10.7759/cureus.24977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 12/15/2022] Open
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12
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Smith HC, Kakar N, Shadid AM. Accessory Spleen Masquerading as an Intrapancreatic Tumor: A Case Report. Cureus 2022; 14:e24677. [PMID: 35663712 PMCID: PMC9159715 DOI: 10.7759/cureus.24677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/05/2022] Open
Abstract
The finding of splenic tissue within the pancreas, also known as splenosis or intrapancreatic accessory spleen (IPAS), is a relatively uncommon condition that presents as an intrapancreatic mass. The discovery of an intrapancreatic mass often prompts a thorough diagnostic workup for a primary pancreatic malignancy, often exposing patients to unnecessary risks associated with invasive testing and even surgery. The benign, asymptomatic nature of this finding places emphasis on utilizing non-invasive techniques for confirmation of the diagnosis, reducing risks of morbidity and mortality in this patient population. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) will display near-identical signal intensities (SI) between the spleen and the intrapancreatic mass, as well as identical contrast-enhancement patterns. Nuclear medicine evaluation with Tc-99m heat-damaged red blood cells (HDRBCs) is often used as a confirmatory test and allows for differentiation from malignancies.
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Affiliation(s)
- Harrison C Smith
- Medical School, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Nandita Kakar
- Medical School, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
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13
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B Cell Lymphoma in an Intrapancreatic Accessory Spleen. J Gastrointest Surg 2022; 26:261-262. [PMID: 34494217 DOI: 10.1007/s11605-021-05108-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/22/2021] [Indexed: 01/31/2023]
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14
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Caye A, Lemons S, Mathias L, Collins Z, Miller K, Rohr A. Percutaneous Splenule Ablation for Recurrent Idiopathic Thrombocytopenia Following Splenectomy- A Case Series. J Vasc Interv Radiol 2021; 33:352-354. [PMID: 34922015 DOI: 10.1016/j.jvir.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 10/19/2022] Open
Affiliation(s)
- Adrien Caye
- M.D. Candidate, Class of 2024, University of Kansas Medical Center, Department of Radiology, 3901 Rainbow Boulevard, Mail Stop 4032, Kansas City, Kansas 66160.
| | - Steven Lemons
- University of Kansas Medical Center, Department of Radiology
| | - Larry Mathias
- University of Kansas Medical Center, Department of Radiology
| | - Zachary Collins
- University of Kansas Medical Center, Department of Radiology
| | - Kirk Miller
- University of Kansas Medical Center, Department of Radiology
| | - Aaron Rohr
- University of Kansas Medical Center, Department of Radiology
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15
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Kindel TL, Dirks RC, Collings AT, Scholz S, Abou-Setta AM, Alli VV, Ansari MT, Awad Z, Broucek J, Campbell A, Cripps MW, Hollands C, Lim R, Quinteros F, Ritchey K, Whiteside J, Zagol B, Pryor AD, Walsh D, Haggerty S, Stefanidis D. Guidelines for the performance of minimally invasive splenectomy. Surg Endosc 2021; 35:5877-5888. [PMID: 34580773 DOI: 10.1007/s00464-021-08741-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Minimally invasive splenectomy (MIS) is increasingly favored for the treatment of benign and malignant diseases of the spleen over open access approaches. While many studies cite the superiority of MIS in terms of decreased morbidity and length of stay over a traditional open approach, the comparative effectiveness of specific technical and peri-operative approaches to MIS is unclear. OBJECTIVE To develop evidence-based guidelines that support clinicians, patients, and others in decisions on the peri-operative performance of MIS. METHODS A guidelines committee panel of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) including methodologists used the Grading of Recommendations Assessment, Development and Evaluation approach to grade the certainty of evidence and formulate recommendations. RESULTS Informed by a systematic review of the evidence, the panel agreed on eight recommendations for the peri-operative performance of MIS for adults and children in elective situations addressing six key questions. CONCLUSIONS Conditional recommendations were made in favor of lateral positioning for non-hematologic disease, intra-operative platelet administration for patients with idiopathic thrombocytopenic purpura instead of preoperative administration, and the use of mechanical devices to control the splenic hilum. Further, a conditional recommendation was made against routine intra-operative drain placement.
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Affiliation(s)
- Tammy L Kindel
- Department of Surgery, Medical College of Wisconsin, Wauwatosa, USA
| | - Rebecca C Dirks
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Amelia T Collings
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Stefan Scholz
- Department of Surgery, Division of Pediatric Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Ahmed M Abou-Setta
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Vamsi V Alli
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, USA
| | - Joseph Broucek
- Department of Surgery, Vanderbilt University Medical Center, Nashville, USA
| | - Andre Campbell
- Department of Surgery, University of California, San Francisco, San Francisco, USA
| | - Michael W Cripps
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Celeste Hollands
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Robert Lim
- Department of Surgery, University of Oklahoma School of Medicine Tulsa, Tulsa, USA
| | | | - Kim Ritchey
- Division of Pediatric Hematology and Oncology, University of Pittsburgh, Pittsburgh, USA
| | - Jake Whiteside
- Indiana University School of Medicine, Indianapolis, USA
| | - Bradley Zagol
- Charles George Veterans Affairs Medical Center, Asheville, USA
| | - Aurora D Pryor
- Department of Surgery, Stony Brook University, Stony Brook, USA
| | - Danielle Walsh
- Department of Surgery, East Carolina University, Greenville, USA
| | | | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA.
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16
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Trenker C, Görg C, Freeman S, Jenssen C, Dong Y, Caraiani C, Ioanițescu ES, Dietrich CF. WFUMB Position Paper-Incidental Findings, How to Manage: Spleen. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2017-2032. [PMID: 34052061 DOI: 10.1016/j.ultrasmedbio.2021.03.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications entitled "Incidental Imaging Findings-The Role of Medical Ultrasound." IFs are less commonly encountered in the spleen than in many other abdominal organs but remain a frequent dilemma in clinical practice. A histological diagnosis is rarely necessary for patient management. Many IFs, such as secondary spleens and splenic cysts, are harmless and do not require any further investigation. The diagnosis of many other focal splenic lesions is, however, often problematic. The following overview is intended to illustrate a variety of incidentally detected spleen pathologies such as size variants, shape variants, secondary spleens, focal splenic lesions and splenic calcifications. It should aid the examiner in establishing the diagnosis. Moreover, it should help the ultrasound practitioner decide which pathologies need no further investigation, those requiring interval imaging and cases in which immediate further diagnostic procedures are required.
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Affiliation(s)
- Corinna Trenker
- Department of Hematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstrasse, Marburg, Germany
| | - Christian Görg
- Department of gastroenterology, Interdisciplinary Center of Ultrasound, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstrasse Marburg, Germany
| | - Simon Freeman
- University Hospitals Plymouth, Imaging Directorate, Derriford Hospital, Plymouth, United Kingdom
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch Oderland GmbH Strausberg/Wriezen, Akademisches Lehrkrankenhaus Medizinische Hochschule Brandenburg "Theodor Fontane", Germany; Brandenburg Institute for Clinical Ultrasound at Medical University Brandenburg "Theodor Fontane", Neuruppin, Germany
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cosmin Caraiani
- Department of Medical Imaging, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Elena Simona Ioanițescu
- Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Center of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland.
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Kowalczyk KA, Majewski A. Analysis of surgical errors associated with anatomical variations clinically relevant in general surgery. Review of the literature. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2020.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Muehler MR, Rendell VR, Bergmann LL, Winslow ER, Reeder SB. Ferumoxytol-enhanced MR imaging for differentiating intrapancreatic splenules from other tumors. Abdom Radiol (NY) 2021; 46:2003-2013. [PMID: 33377995 PMCID: PMC8131292 DOI: 10.1007/s00261-020-02883-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 12/21/2022]
Abstract
Objectives Ferumoxytol is an ultra-small superparamagnetic iron oxide (USPIO) agent that is taken up by splenic tissue. This study describes our initial institutional experience of ferumoxytol-enhanced MRI (feMRI) for differentiating intrapancreatic splenules (IPS) from other pancreatic lesions. Methods In this retrospective study, patients with computed tomographic imaging that identified small enhancing lesions in the tail of the pancreas subsequently underwent feMRI for further characterization. The feMRI protocol included T2-weighted (T2w) imaging with and without fat suppression (FS), R2* mapping, diffusion-weighted imaging (DWI), and T1-weighted (T1w) imaging with FS, prior to contrast injection. Immediately after slow intravenous infusion with 3 mg/kg body weight ferumoxytol, T1w was repeated. Delayed imaging with all sequences were obtained 24–72 h after ferumoxytol administration. Results Seven patients underwent feMRI. In two patients, the pancreatic lesions were presumed as pancreatic neuroendocrine tumor (PNET) from feMRI and in the remaining 5 IPS. One of the two patients with PNET was symptomatic for NET. In another symptomatic patient with pathologically proven duodenal NET and suspected PNET, the pancreatic lesion was proven to be an IPS on feMRI. IPS demonstrated strong negative enhancement in feMRI on T2w and increased R2* values consistent with splenic tissue, while the presumed PNETs did not enhance. T2w FS was helpful on the pre-contrast images to identify IPS, while R2* did on post-contrast images. Neither DWI nor T1w contributed to differentiating PNETs from IPS. Conclusions This study demonstrates the potential utility of feMRI as a helpful adjunct diagnostic tool for differentiating IPS from other pancreatic lesions. Further studies in larger patient cohorts are needed.
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Affiliation(s)
- M R Muehler
- Department of Radiology, University of Wisconsin, Madison, WI, USA.
- Department of Radiology and Neuroradiology, University Greifswald, Greifswald, Germany.
| | - V R Rendell
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - L L Bergmann
- Department of Radiology, University of Texas Southwestern, Dallas, TX, USA
| | - E R Winslow
- Medstar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC, USA
| | - S B Reeder
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
- Department Medical Physics, University of Wisconsin, Madison, WI, USA
- Department of Medicine, University of Wisconsin, Madison, WI, USA
- Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA
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Gilani SM, Muniraj T, Farrell JJ, Aslanian HR, Cai G. Endoscopicultrasound‐guidedfine needle aspiration of accessory spleen: Cytomorphologic features and diagnostic considerations. Diagn Cytopathol 2020; 48:623-628. [DOI: 10.1002/dc.24434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/09/2020] [Accepted: 03/27/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Syed M. Gilani
- Department of PathologyYale School of Medicine New Haven Connecticut USA
| | - Thiruvengadam Muniraj
- Department of Internal Medicine, Section of Digestive DiseasesYale School of Medicine New Haven Connecticut USA
| | - James J. Farrell
- Department of Internal Medicine, Section of Digestive DiseasesYale School of Medicine New Haven Connecticut USA
| | - Harry R. Aslanian
- Department of Internal Medicine, Section of Digestive DiseasesYale School of Medicine New Haven Connecticut USA
| | - Guoping Cai
- Department of PathologyYale School of Medicine New Haven Connecticut USA
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Luo J, Chen J, Huang F, Zhou P, Huang P. Heterotopic accessory spleen with squamous epithelial cyst in pancreas mimicking other pancreatic tumor: a case report. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:507. [PMID: 32395551 PMCID: PMC7210170 DOI: 10.21037/atm.2020.03.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A 49-year-old female undergoing a periodic health examination at other hospital revealed a mass in the tail of pancreas. The patient denied any personal history of surgery except subtotal hysterectomy because of multiple myomas in uterus 7 years ago, family history of abdominal cancer and trauma. Physical examination and laboratory finding (including tumor marker) were unremarkable. Chest X-ray result was normal. Contrast enhanced ultrasound (CEUS) examination showed a well-defined hypoechoic pancreatic mass which was suggestive of solid pseudopapillary tumor. Contrast enhanced computed tomography (CE-CT) of the abdomen revealed a mass of hypodensity suggestive of intraductal papillary mucinous neoplasm. Because of the risk of bleeding and exclusion of surgical contraindications, patient underwent laparoscopic surgery. Intraoperatively, a solid mass was identified in the tail of pancreas, the intraoperative frozen pathological examination suggested a heterotopic accessary spleen (HAS) with squamous epithelial cyst. Partial pancreatectomy was performed. The uniqueness of this case is that the spleen can be ectopic to the pancreas, what is even more unexpected is that the HAS undergone cystic change. When encountering a pancreatic mass, we need to think about the possibility of HAS. In conclusion, it is important to diagnose HAS with squamous cyst in the pancreatic tail presenting as other pancreatic masses.
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Affiliation(s)
- Jieli Luo
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Jianshe Chen
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Fengbo Huang
- Department of Pathology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Panpan Zhou
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Pintong Huang
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China
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Luu S, Spelman D, Woolley IJ. Post-splenectomy sepsis: preventative strategies, challenges, and solutions. Infect Drug Resist 2019; 12:2839-2851. [PMID: 31571940 PMCID: PMC6748314 DOI: 10.2147/idr.s179902] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/30/2019] [Indexed: 12/26/2022] Open
Abstract
Removal of the spleen had already been established as a routine technique to treat splenic trauma and other diseases affecting the spleen before the anatomy, physiology, and function of the spleen were known in the mid-twentieth century. It is now widely accepted that the splenectomized individual is at increased risk for infection, in particular, overwhelming post-splenectomy infection (OPSI). OPSI is a syndrome of fulminant sepsis occurring in splenectomized (asplenic) or hyposplenic individuals that is associated with high mortality and morbidity. Poorly opsonized bacteria such as encapsulated bacteria, in particular, Streptococcus pneumoniae, are often implicated in sepsis. The spleen is a reticuloendothelial organ that facilitates opsonization and phagocytosis of pathogens, in addition to cellular maintenance. Splenectomy is associated with an impairment in immunoglobulin production, antibody-mediated clearance, and phagocytosis, leading to an increased risk of infection and sepsis. Early identification of the at-risk patient, early blood cultures prior to antibiotic administration, urgent blood smears and fast pathogen-detection tests, and sepsis bundles should be utilized in these patients. Prompt management and aggressive treatment can alter the course of disease in the at-risk splenectomized patient. Overwhelming post-splenectomy infection can be prevented through vaccination, chemoprophylaxis, and patient education. This article evaluates post-splenectomy sepsis by summarizing the anatomy and function of the spleen, physiological changes after splenectomy that predispose the splenectomized patient to infection, and current management and prevention strategies.
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Affiliation(s)
- Sarah Luu
- Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
| | - Denis Spelman
- Department of Infectious Diseases and Microbiology, Alfred Health, Melbourne, Victoria, Australia.,Spleen Australia, Alfred Health, Melbourne, Victoria, Australia
| | - Ian J Woolley
- Spleen Australia, Alfred Health, Melbourne, Victoria, Australia.,Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia.,Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia
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Wcislak SM, Stiles ZE, Deneve JL, Glazer ES, Behrman SW, Farooq FT, Dickson PV. Hypervascular lesions of the pancreas: Think before you act. Am J Surg 2019; 218:362-367. [DOI: 10.1016/j.amjsurg.2018.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/12/2018] [Accepted: 11/14/2018] [Indexed: 12/31/2022]
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Rendell VR, Mühler MR, Winslow ER, Reeder SB. Letter to the Editor: Intrapancreatic Accessory Spleen Masquerading as a Pancreatic Neuroendocrine Tumor. J Gastrointest Surg 2019; 23:1717-1718. [PMID: 31152350 PMCID: PMC6650345 DOI: 10.1007/s11605-019-04110-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/06/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Victoria R. Rendell
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Matthias R. Mühler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Emily R. Winslow
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Scott B. Reeder
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Heat-Damaged Red Blood Cell Scintigraphy in Helping Interpretation of 68Ga-DOTATATE PET/CT. Clin Nucl Med 2019; 44:927-928. [PMID: 31306208 DOI: 10.1097/rlu.0000000000002730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Ga-DOTATATE PET/CT was performed to determine the cause of endogenous Cushing syndrome in a 10-year-old boy whose MRI studies did not reveal pituitary or adrenal gland abnormality. The PET/CT images demonstrated an intense activity in a small soft tissue nodule in the left upper abdomen where splenules are commonly located. Heat-damaged Tc-labeled red blood cell imaging showed that this soft tissue nodule did not have increased red blood cell activity, which indicated that this lesion was a true somatostatin receptor-rich lesion. The pathology result following surgical resection of the lesion confirmed adrenocorticotropic hormone-producing neuroendocrine tumor.
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Kim GE, Morris JD, Anand N, DePalma F, Greenwald BD, Kim RE, Laczek J, Lee WJ, Papadopoulas I, Uradomo L, Young P, Darwin PE. Recognizing intrapancreatic accessory spleen via EUS: Interobserver variability. Endosc Ultrasound 2019; 8:392-397. [PMID: 31417068 PMCID: PMC6927143 DOI: 10.4103/eus.eus_35_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background and Objective: Accessory spleen (AS) may be encountered as an intrapancreatic lesion on EUS. This can look similar to other pancreatic pathologies and may lead to unnecessary interventions. The goal of this study was to evaluate the accuracy of EUS in distinguishing intrapancreatic AS (IPAS) from other pancreatic lesions. Materials and Methods: Twelve sets of endoscopic images of the spleen and various pancreatic lesions confirmed on histology or cytology were gathered. Ten endosonographers were asked to characterize and identify the lesions. The responses were analyzed via Excel and the interobserver agreement was analyzed using Gwet's agreement coefficient statistic via Stata I/C v15. Results: In our sample, the interobserver agreement was 0.37 (−1–1; 0–0.2 poor, 0.2–0.4 fair, 0.4–0.6 moderate, 0.6–0.8 substantial, and 0.8–1.0 almost perfect) for determining whether or not the pancreatic lesion is IPAS. The reviewers were able to correctly determine IPAS endosonographically with a sensitivity of 77%, specificity of 74%, and positive and negative predictive values of 50% and 92%, respectively. Conclusion: There is a moderate-to-substantial interobserver agreement in describing the sonographic characteristics of the pancreatic lesions, such as the shape, echogenicity compared to spleen, echotexture, and border of the lesions. However, the interobserver agreement is only fair when deciding if the pancreatic lesion is an IPAS. The similar profile of IPAS and pancreatic neuroendocrine tumor could confound the diagnosis of IPAS, thus contributing to the decreased interobserver agreement. This study demonstrates that EUS criteria alone are not accurate for IPAS diagnosis. Fine-needle aspiration (FNA) may be required for a confirmatory diagnosis.
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Affiliation(s)
- Grace E Kim
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - John D Morris
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Naveen Anand
- Division of Gastroenterology and Hepatology, Norwalk Hospital, Norwalk, CT, USA
| | | | - Bruce D Greenwald
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Raymond E Kim
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jeffery Laczek
- Department of Gastroenterology, Walter Reed National Military Medical Center and Uniformed Services University, Bethesda, MD, USA
| | - Woo Jung Lee
- Department of Gastroenterology, Temple University Hospital, Philadelphia, PA, USA
| | | | - Lance Uradomo
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Patrick Young
- Department of Gastroenterology, Walter Reed National Military Medical Center and Uniformed Services University, Bethesda, MD, USA
| | - Peter E Darwin
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
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Incomplete penetrance for isolated congenital asplenia in humans with mutations in translated and untranslated RPSA exons. Proc Natl Acad Sci U S A 2018; 115:E8007-E8016. [PMID: 30072435 DOI: 10.1073/pnas.1805437115] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Isolated congenital asplenia (ICA) is the only known human developmental defect exclusively affecting a lymphoid organ. In 2013, we showed that private deleterious mutations in the protein-coding region of RPSA, encoding ribosomal protein SA, caused ICA by haploinsufficiency with complete penetrance. We reported seven heterozygous protein-coding mutations in 8 of the 23 kindreds studied, including 6 of the 8 multiplex kindreds. We have since enrolled 33 new kindreds, 5 of which are multiplex. We describe here 11 new heterozygous ICA-causing RPSA protein-coding mutations, and the first two mutations in the 5'-UTR of this gene, which disrupt mRNA splicing. Overall, 40 of the 73 ICA patients (55%) and 23 of the 56 kindreds (41%) carry mutations located in translated or untranslated exons of RPSA. Eleven of the 43 kindreds affected by sporadic disease (26%) carry RPSA mutations, whereas 12 of the 13 multiplex kindreds (92%) carry RPSA mutations. We also report that 6 of 18 (33%) protein-coding mutations and the two (100%) 5'-UTR mutations display incomplete penetrance. Three mutations were identified in two independent kindreds, due to a hotspot or a founder effect. Finally, RPSA ICA-causing mutations were demonstrated to be de novo in 7 of the 23 probands. Mutations in RPSA exons can affect the translated or untranslated regions and can underlie ICA with complete or incomplete penetrance.
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