1
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Hilal MA, Kuemmerli C, Sijberden JP, Moekotte A, Zimmitti G, Alseidi A, Asbun HJ, Marudanayagam R, Bonds M, Kunzler F, Sutcliffe R, Eren E, Primrose JN, Williams AP. Autogenic splenic implantation versus splenectomy in patients undergoing distal pancreatectomy for benign or low-grade malignant lesions of the distal pancreas: study protocol for a multicentre, open-label, randomized controlled trial (RESTORE). Trials 2024; 25:31. [PMID: 38195501 PMCID: PMC10775497 DOI: 10.1186/s13063-023-07714-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/07/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The spleen plays a significant role in the clearance of circulating microorganisms. Sequelae of splenectomy, especially immunodeficiency, can have a deleterious effect on a patient's health and even lead to death. Hence, splenectomy should be avoided and spleen preservation during elective surgery has become a treatment goal. However, this cannot be achieved in every patient due to intraoperative technical difficulties or oncological reasons. Autogenic splenic implantation (ASI) is currently the only possible way to preserve splenic function when a splenectomy is necessary. Experience largely stems from trauma patients with a splenic rupture. Splenic immune function can be measured by the body's clearing capacity of encapsulated bacteria. The aim of this study is to assess the splenic immune function after ASI was performed during minimally invasive (laparoscopic or robotic) distal pancreatectomy with splenectomy. METHODS This is the protocol for a multicentre, randomized, open-labelled trial. Thirty participants with benign or low-grade malignant lesions of the distal pancreas requiring minimally invasive distal pancreatectomy and splenectomy will be allocated to either additional intraoperative ASI (intervention) or no further intervention (control). An additional 15 patients who will undergo spleen-preserving distal pancreatectomy serve as the control group with normal splenic function. Six months postoperatively, after assumed restoration of splenic function, patients will be given a Salmonella typhi (Typhim Vi™) vaccine. The Salmonella typhi vaccine is a polysaccharide vaccine. The specific antibody titres immediately before and 4 to 6 weeks after vaccination will be measured. The ratio between pre- and post-vaccination antibody count is the primary outcome measure and secondary outcome measures include intraoperative details, length of hospital stay, 30-day mortality and morbidity. DISCUSSION This study will investigate the splenic immune function of patients who undergo ASI during minimally invasive distal pancreatectomy with splenectomy. The splenic immune function will be measured using the surrogate outcome of specific antibody titre after vaccination with a Salmonella typhi vaccine. The results will reveal details about splenic function after ASI and guide further treatment options for patients when a splenectomy cannot be avoided. It might eventually lead to a new standard of care making sometimes more demanding and time-consuming spleen-preserving procedures redundant. TRIAL REGISTRATION International Standard Randomized Controlled Trials Number (ISRCTN) ISRCTN10171587. Prospectively registered on 18 February 2019.
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Affiliation(s)
- Mohammed Abu Hilal
- Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati, 57, 25124, Brescia, Italy.
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 2YD, UK.
| | - Christoph Kuemmerli
- Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati, 57, 25124, Brescia, Italy
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 2YD, UK
| | - Jasper P Sijberden
- Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati, 57, 25124, Brescia, Italy
- Department of Surgery, Amsterdam UMC Location, University of Amsterdam, Amsterdam, The Netherlands
| | - Alma Moekotte
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 2YD, UK
| | - Giuseppe Zimmitti
- Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati, 57, 25124, Brescia, Italy
| | - Adnan Alseidi
- Division of Hepatopancreatobiliary and Endocrine Surgery, Virginia Mason Medical Center, Seattle, WA, USA
- Department of Surgery, University of California - San Francisco, San Francisco, CA, USA
| | - Horacio J Asbun
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA
| | - Ravi Marudanayagam
- Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Morgan Bonds
- Division of Hepatopancreatobiliary and Endocrine Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Filipe Kunzler
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA
| | - Robert Sutcliffe
- Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Efrem Eren
- NIHR Southampton Clinical Research Facility, NIHR Southampton Biomedical Research Centre and Southampton NIHR CRUK Experimental Cancer Medicine Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - John N Primrose
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 2YD, UK
| | - Anthony P Williams
- NIHR Southampton Clinical Research Facility, NIHR Southampton Biomedical Research Centre and Southampton NIHR CRUK Experimental Cancer Medicine Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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2
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Calcification in Thoracic Splenosis. Case Rep Pulmonol 2022; 2022:9538355. [PMID: 36267804 PMCID: PMC9578903 DOI: 10.1155/2022/9538355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
Splenosis is a rare condition described as the implantation of ectopic splenic tissue, usually after a splenic rupture. Thoracic splenosis refers to acquired ectopic splenic tissue found within the thoracic cavity, often caused by thoracoabdominal trauma or surgery. Most cases are asymptomatic and many years may elapse before they are incidentally discovered on chest radiography or thoracic computed tomography. Splenosis is often misinterpreted as a malignancy on initial imaging. We wish to highlight a rare case of thoracic splenosis presenting with calcified and non-calcified nodules. Only two other cases of calcification have been reported in intrathoracic splenosis, neither of which provided CT images of this finding.
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Ajala O, Yoe L, Decatur T, Cole O. Thoracic Splenosis in the Setting of Abdominal Trauma. Cureus 2022; 14:e27851. [PMID: 36110491 PMCID: PMC9462062 DOI: 10.7759/cureus.27851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 12/03/2022] Open
Abstract
The uncommon case of thoracic splenosis is presented in this paper. A patient presents to the hospital with the complaint of dyspnea on exertion. He is incidentally found to have thoracic splenosis. The case of thoracic splenosis is a vital topic to discuss in order to accurately diagnose, recognize, treat symptoms, and explore how it can exacerbate pulmonary or cardiology pathology.
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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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5
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Wilson TM, Weber DG. Trauma splenectomy in a patient with previous total splenectomy. ANZ J Surg 2021; 92:1905-1906. [PMID: 34783425 DOI: 10.1111/ans.17371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Tamalee M Wilson
- State Major Trauma Unit, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.,UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
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6
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Allegrini M, Mille P, Gaillard C, Nyangoh-Timoh K, Lavoué V, Levêque J. Case report: A follow up of a major pelvic splenosis. J Gynecol Obstet Hum Reprod 2021; 51:102272. [PMID: 34785401 DOI: 10.1016/j.jogoh.2021.102272] [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: 08/02/2021] [Revised: 10/27/2021] [Accepted: 11/10/2021] [Indexed: 11/29/2022]
Abstract
The authors present a case of a young female with extensive pelvic splenosis, which was complicated by torsion of one of the splenosis nodules operated by laparoscopy. She has been followed during several years. The diagnosis was made on the basis of the history, imaging (ultrasound, CT scan, MRI, and Technetium 99m-labeled embrittled red blood cell scans), and blood workup. The diagnosis of splenosis can be made via complications such as torsion, infarction, hemorrhage, or most often incidentally. The treatment without symptoms is abstention.
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Affiliation(s)
- Marie Allegrini
- Département de Gynécologie Obstétrique et Reproduction Humaine, CHU Anne de Bretagne Rennes, Rennes, France
| | - Patrice Mille
- Service de Gynécologie, Polyclinique du Maine Laval, France
| | - Chloé Gaillard
- Département de Gynécologie Obstétrique et Reproduction Humaine, CHU Anne de Bretagne Rennes, Rennes, France
| | - Krystel Nyangoh-Timoh
- Département de Gynécologie Obstétrique et Reproduction Humaine, CHU Anne de Bretagne Rennes, Rennes, France
| | - Vincent Lavoué
- Département de Gynécologie Obstétrique et Reproduction Humaine, CHU Anne de Bretagne Rennes, Rennes, France
| | - Jean Levêque
- Département de Gynécologie Obstétrique et Reproduction Humaine, CHU Anne de Bretagne Rennes, Rennes, France.
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Luu S, Sheldon J, Dendle C, Ojaimi S, Jones P, Woolley I. Prevalence and distribution of functional splenic tissue after splenectomy. Intern Med J 2021; 50:556-564. [PMID: 31449712 DOI: 10.1111/imj.14621] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/20/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Individuals splenectomised for trauma have lower infection rates than those splenectomised for other conditions. Residual functional splenic tissue (FST) after splenectomy may provide ongoing immunological protection. AIMS To quantify the prevalence and volume of residual FST post-splenectomy using standard testing. METHODS Splenectomised adults were recruited from the Spleen Australia clinical registry. Eligible individuals had been splenectomised at least 1 year prior to their visit and resided in Victoria. Splenic function was identified by evaluating Howell-Jolly bodies and IgM memory B cells. A 99m-Technetium-labelled, heat-denatured erythrocyte scintigraphic scan was performed if splenic function was detected. RESULTS Initially, 75 splenectomised individuals (all cause) were recruited, with a median of 58 years of age and who were splenectomised a median of 14 years previously. The most common indications for splenectomy were trauma (30.7%) and haematological disease (28.0%). Scintigraphy identified FST in nine individuals (12.0%). Eight had been splenectomised for trauma. In this cohort, 34.8% of individuals splenectomised for trauma had residual FST. To explore our findings further, 45 additional individuals were recruited, predominately individuals splenectomised for trauma. Twenty-five individuals completed assessments by December 2018. An additional 11 individuals had FST, of whom 9 had been splenectomised for trauma. Overall, we identified 20 individuals with residual FST. Volumes ranged from 2.2 to 216.0 cc. We saw individuals with accessory spleens and splenotic nodules and an individual with both. Seventeen individuals had been splenectomised for trauma. CONCLUSIONS Residual FST is commonly seen in individuals splenectomised for trauma. It can present in varying distributions and of varying volume. The clinical significance is unclear.
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Affiliation(s)
- Sarah Luu
- Monash Infectious Diseases, Monash University, Clayton, Victoria, Australia.,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
| | - James Sheldon
- Monash Imaging, Monash Health, Clayton, Victoria, Australia
| | - Claire Dendle
- Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia.,Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia
| | - Samar Ojaimi
- Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia.,Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia.,Monash Children's Infection and Immunity, Monash Health, Clayton, Victoria, Australia
| | - Penelope Jones
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
| | - Ian Woolley
- Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia.,Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia.,Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
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Isopi C, Vitali G, Pieri F, Solaini L, Ercolani G. Gastric splenosis mimicking a gastrointestinal stromal tumor: A case report. World J Gastrointest Surg 2020; 12:435-441. [PMID: 33194092 PMCID: PMC7642345 DOI: 10.4240/wjgs.v12.i10.435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/13/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mass lesions located in the wall of the stomach (and also of the bowel) are referred to as “intramural.” The differential diagnosis of such lesions can be challenging in some cases. As such, it may occur that an inconclusive fine needle aspiration (FNA) result give way to an unexpected diagnosis upon final surgical pathology. Herein, we present a case of an intramural gastric nodule mimicking a gastric gastrointestinal stromal tumor (GIST).
CASE SUMMARY A 47-year-old Caucasian woman, who had undergone splenectomy for trauma at the age of 16, underwent gastroscopy for long-lasting epigastric pain and dyspepsia. It revealed a 15 mm submucosal nodule bulging into the gastric lumen with smooth margins and normal overlying mucosa. A thoraco-abdominal computed tomography scan showed in the gastric fundus a rounded mass (30 mm in diameter) with an exophytic growth and intense enhancement after administration of intravenous contrast. Endoscopic ultrasound scan showed a hypoechoic nodule, and fine needle FNA was inconclusive. Gastric GIST was considered the most probable diagnosis, and surgical resection was proposed due to symptoms. A laparoscopic gastric wedge resection was performed. The postoperative course was uneventful, and the patient was discharged on the seventh postoperative day. The final pathology report described a rounded encapsulated accumulation of lymphoid tissue of about 4 cm in diameter consistent with spleen parenchyma implanted during the previous splenectomy.
CONCLUSION Splenosis is a rare condition that should always be considered as a possible diagnosis in splenectomized patients who present with an intramural gastric nodule.
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Affiliation(s)
- Claudio Isopi
- Department of Surgery, Morgagni-Pierantoni Hospital, Forli 47121, Italy
| | - Giulia Vitali
- Department of Surgery, Morgagni-Pierantoni Hospital, Forli 47121, Italy
| | - Federica Pieri
- Pathology Unit, Morgagni-Pierantoni Hospital, Forli 47121, Italy
| | - Leonardo Solaini
- Department of Surgery, Morgagni-Pierantoni Hospital, Forli 47121, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 47100, Italy
| | - Giorgio Ercolani
- Department of Surgery, Morgagni-Pierantoni Hospital, Forli 47121, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 47100, Italy
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Usmani S, Muzaffar S, Rahman U, Al Kandari F, Ahmed N. A Very Unusual Pattern of Intraperitoneal and Extraperitoneal Heterotropic Splenic Tissue-Mimicking Metastases Identified on 68Ga-DOTA-NOC Positron Emission Tomography/Computed Tomography and 99mTc Heat-denatured Erythrocyte Study. Indian J Nucl Med 2020; 35:255-257. [PMID: 33082689 PMCID: PMC7537915 DOI: 10.4103/ijnm.ijnm_45_20] [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] [Received: 03/11/2020] [Revised: 03/20/2020] [Accepted: 03/28/2020] [Indexed: 11/04/2022] Open
Abstract
The dissemination and autotransplantation of viable splenic tissue in different anatomic compartments of the body can present a diagnostic dilemma, especially when metastatic disease is suspected. We report a case of a 30-year-old male with well-differentiated gastric neuroendocrine tumor (Grade II) treated with surgery. Follow-up 68Ga-DOTA-NOC demonstrated a suspicious peritoneal soft-tissue nodule in the right paracolic gutter with increased tracer uptake. In view of splenectomy 10 years ago, the patient underwent 99mTc heat-denatured erythrocyte study which showed a very unusual pattern of multiple tracer-avid foci of splenic tissue in both intraperitoneal and extraperitoneal distributions. The integration of the patient's history and complementary nuclear imaging results led to the correct diagnosis of splenosis.
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Affiliation(s)
| | - Samreen Muzaffar
- Department of Nuclear Medicine, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Uzma Rahman
- Department of Nuclear Medicine, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | - Najeeb Ahmed
- Department of Nuclear Medicine, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
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Le Bars F, Pascot R, Ricordel C, Corbineau H, Verhoye JP, Richard De Latour B, Rouzé S. Thoracic splenosis: Case report of a symptomatic case. Chin J Traumatol 2020; 23:185-186. [PMID: 32532660 PMCID: PMC7296354 DOI: 10.1016/j.cjtee.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/29/2020] [Accepted: 05/06/2020] [Indexed: 02/04/2023] Open
Abstract
Thoracic splenosis is the autotransplantation of splenic tissue in the left thoracic cavity as a result of a splenic injury. This rare pathology is usually asymptomatic and may be discovered on incidental imaging, but the diagnosis often requires invasive procedures such as surgery in order to eliminate a neoplasic origin. We report a rare symptomatic case of a 39-year-old man presenting with chest pain and multiple nodules revealed on a computed tomography scan. The patient underwent a surgical exploration and the pathological studies concluded to a thoracic splenosis. Indeed, the previous medical history of the patient revealed a left thoraco-abdominal traumatism during childhood. The aim of this paper is to emphasize that the diagnosis can now be performed using only imaging techniques such as technetium-99 sulfur colloid or labelled heat-denatured red blood cell scintigraphy to avoid unnecessary invasive procedures including thoracotomy.
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Affiliation(s)
- Florent Le Bars
- Department of Cardiothoracic Surgery, University Hospital Centre, Rennes, France,Corresponding author.
| | - Rémy Pascot
- Department of Vascular Surgery, University Hospital Centre, Rennes, France
| | - Charles Ricordel
- Department of Pneumology, University Hospital Centre, Rennes, France
| | - Hervé Corbineau
- Department of Cardiothoracic Surgery, University Hospital Centre, Rennes, France
| | | | | | - Simon Rouzé
- Department of Cardiothoracic Surgery, University Hospital Centre, Rennes, France
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Al Dandan O, Hassan A, Alsaif HS, Altalaq S, Al-Othman A, Aljawad B, Alhajjaj G, Alshomimi S. Splenosis of the Mesoappendix with Acute Appendicitis: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e921685. [PMID: 32301443 PMCID: PMC7194463 DOI: 10.12659/ajcr.921685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Splenosis is a benign condition involving the auto-transplantation of splenic tissue at various locations, resulting from splenic injury or splenectomy. CASE REPORT A 40-year-old male, with a history of remote exploratory laparotomy with splenectomy secondary to blunt abdominal trauma, presented with symptoms consistent with acute appendicitis, which was subsequently confirmed by computed tomography scan of the abdomen that further demonstrated the presence of multiple abdominal nodules, one of which was adjacent to the appendix. A laparoscopic appendectomy was then performed along with resection of the nodule located in the mesoappendix, which was confirmed to be a splenic tissue based on histopathological examination. CONCLUSIONS Abdominal splenosis is not an uncommon condition in patients with a history of splenic injury. However, the involvement of the mesoappendix, which may or may not contribute to acute inflammation of the appendix, is very rare.
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Affiliation(s)
- Omran Al Dandan
- Department of Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Ali Hassan
- Department of Emergency Medicine, Bahrain Specialist Hospital, Al-Juffair, Bahrain
| | - Hind S Alsaif
- Department of Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Sukaina Altalaq
- Department of Pathology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Anas Al-Othman
- Department of General Surgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Bayan Aljawad
- Department of General Surgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Ghadeer Alhajjaj
- Department of General Surgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Saeed Alshomimi
- Department of General Surgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
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Zhao Y, Maule J, McCracken J, Xing J, Wang E. Incidental finding of abdominal splenosis with mononucleated cell infiltration leading to a diagnosis of acute myeloid leukemia. Pathol Res Pract 2020; 216:152818. [PMID: 31964552 DOI: 10.1016/j.prp.2020.152818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 11/25/2022]
Abstract
Splenosis refers to ectopic splenic implants that are often found incidentally years after splenic rupture/splenectomy, and the nodules of splenosis are usually small, less than 3 cm for the majority. We report a case of splenosis with a 5-centimeter large mass in the anterior abdomen in a 79 year-old male with a remote history of splenic rupture/splenectomy. Unexpectedly, needle core biopsy of the abdominal mass demonstrated splenic tissue with a mononucleated cell infiltrate blurring the splenic architecture that was highlighted only by CD8 stain. This finding prompted a bone marrow examination resulting in the diagnosis of acute myeloid leukemia in the patient. Retrospectively, enlargement of this ectopic spleen may have been caused by this leukemic infiltrate. This case underscores the importance of being aware of this rare pathological condition and its retained vulnerability for involvement by hematolymphoid neoplasms, as well as significance of identifying splenic architecture highlighted by CD8 stain to reach a correct diagnosis.
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Affiliation(s)
- Yue Zhao
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, PR China; Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Jake Maule
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Jenna McCracken
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Jalen Xing
- Department of Pathology, Duke University Medical Center, Durham, NC, USA; Summer Intern, CA, USA
| | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, NC, USA.
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13
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Kefeli U, Mehtap O, Cakir O, Eruyar AT, İsgoren S, Ucuncu Kefeli A. Follicular lymphoma in a patient with splenosis: a case report. J Int Med Res 2019; 48:300060519890200. [PMID: 31802706 PMCID: PMC7607283 DOI: 10.1177/0300060519890200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Splenosis refers to the seeding of splenic cells associated with surgery or trauma.
Splenosis mimicking other diseases has been reported in the literature. To the best of our
knowledge, this is the first case of follicular lymphoma in a patient with splenosis whose
diagnosis of lymphoma was delayed because of a known history of splenosis. We report a
48-year-old male patient who underwent splenectomy because of injury from a high fall 20
years previously. He had no symptoms other than mild abdominal pain until 2 years
previously, which was thought to be associated with splenosis. When his symptoms began to
increase, he had explorative laparotomy for diagnosis, which was later confirmed as
follicular lymphoma. Splenosis may delay the diagnosis of other conditions that can be
underestimated. Clinicians should be aware of unusual symptoms in patients with
splenosis.
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Affiliation(s)
- Umut Kefeli
- Department of Medical Oncology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Ozgur Mehtap
- Department of Hematology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Ozgur Cakir
- Department of Radiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Ahmet Tugrul Eruyar
- Department of Pathology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Serkan İsgoren
- Department of Nuclear Medicine, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Aysegul Ucuncu Kefeli
- Department of Radiation Oncology, Kocaeli University School of Medicine, Kocaeli, Turkey
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14
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Solav SV, Patil AM, Savale SV. Radionuclide Liver-Spleen Scan to Detect Splenosis. Indian J Surg 2019. [DOI: 10.1007/s12262-019-01911-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Khan A, Khan S, Pillai S. Symptomatic Intrathoracic Splenosis More than Forty Years After a Gunshot Injury. Cureus 2019; 11:e5985. [PMID: 31807373 PMCID: PMC6876915 DOI: 10.7759/cureus.5985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Thoracic splenosis is a rare heterotopic autotransplantation of the spleen into the thorax that occurs after trauma or surgery involving the spleen. It is most commonly found incidentally on imaging in the left hemithorax. To the best of our knowledge, only six symptomatic cases of thoracic splenosis have been described in the literature so far. We present a case of thoracic splenosis in a male with a remote history of a gunshot injury during childhood, who presented with chest pain and shortness of breath.
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Affiliation(s)
- Adnan Khan
- Critical Care, Freeman Health System, Joplin, USA
| | - Sana Khan
- Internal Medicine, Sindh Medical College, Karachi, PAK
| | - Saran Pillai
- Emergency Medicine, Kerala Institute of Medical Sciences Hospital, Trivandrum, IND
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16
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Surendran A, Smith M, Houli N, Usatoff V, Spelman D, Choi J. Splenic autotransplantation: a systematic review. ANZ J Surg 2019; 90:460-466. [PMID: 31576640 DOI: 10.1111/ans.15383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/19/2019] [Accepted: 06/22/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Splenectomy is a surgical procedure indicated in a variety of medical conditions including trauma. Post-operatively, there is a lifelong risk of developing overwhelming sepsis from encapsulated bacteria, most commonly due to Streptococcus pneumoniae. Splenic autotransplantation has been proposed as a method to recover splenic function in patients requiring splenectomy with otherwise normal spleens. This study aims to systematically review the literature to determine the efficacy of spleen autotransplantation. METHODS MEDLINE, PubMed and the Cochrane Library were searched for all studies assessing splenic autotransplantation (January 1947 to July 2018). Data were extracted on study characteristics, outcomes assessed, including spleen scintigraphy results, blood film counts and serum immunoglobulin (Ig) levels. RESULTS Data were obtained from 18 primary studies. All studies demonstrated return of regenerated spleen tissue in the majority of their patients (95.3%) on spleen scintigraphy. In 12 studies, 90.2% of patients had blood films return to normal following transplantation. Ig levels were shown to return to normal in all 12 studies where it was assessed. In 11 studies, 3.7% of patients had post-operative complications. In five studies, 1.3% of patients had post-operative infections in the follow-up period. CONCLUSION Splenic autotransplantation is a safe procedure with minimal complications that can return splenic filtration function and Ig levels to normal ranges. It has not been confirmed whether autotransplantation provides meaningful protection against overwhelming post-splenectomy infections.
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Affiliation(s)
| | - Marty Smith
- Department of Upper Gastrointestinal/Hepatobiliary Surgery, Western Health, Melbourne, Victoria, Australia
| | - Nezor Houli
- Department of Upper Gastrointestinal/Hepatobiliary Surgery, Western Health, Melbourne, Victoria, Australia
| | - Val Usatoff
- Department of Upper Gastrointestinal/Hepatobiliary Surgery, Western Health, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Denis Spelman
- Department of Infectious Diseases, The Alfred, Melbourne, Victoria, Australia
| | - Julian Choi
- Department of Upper Gastrointestinal/Hepatobiliary Surgery, Western Health, Melbourne, Victoria, Australia
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17
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Abstract
Splenosis is a benign condition that can occur after splenic trauma or after surgery involving the spleen. These splenic implants are most often seen within the abdominal and pelvic cavities. On imaging, splenosis can be confused with multiple additional entities including metastatic disease, peritoneal carcinomatosis, peritoneal mesothelioma, abdominal lymphoma, renal cancer, hepatic adenomas, or endometriosis depending on its distribution. In all patients with history of splenic surgery or trauma, splenosis should be on the differential diagnosis of soft tissue nodules in the abdomen and pelvis, especially in the absence of systemic symptoms, to avoid unnecessary biopsy, chemotherapy, or surgery.
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Affiliation(s)
- Yasmeen K Tandon
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA.
| | - Christopher P Coppa
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA
| | - Andrei S Purysko
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA
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18
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Santos MA. Chronic Abdominal Pain from Disseminated Splenosis. J Gen Intern Med 2018; 33:976-977. [PMID: 29611090 PMCID: PMC5975174 DOI: 10.1007/s11606-018-4414-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Michael A Santos
- WellSpan Good Samaritan Hospital, Lebanon, PA, USA. .,Penn State Milton S Hershey Medical Center, Hershey, PA, USA.
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19
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20
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Micronucleated Erythrocytes in Peripheral Blood from Neonate Rats Exposed by Breastfeeding to Cyclophosphamide, Colchicine, or Cytosine-Arabinoside. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9161648. [PMID: 28018917 PMCID: PMC5149595 DOI: 10.1155/2016/9161648] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/31/2016] [Accepted: 11/03/2016] [Indexed: 01/16/2023]
Abstract
Genotoxic exposure to chemical substances is common, and nursing mothers could transmit harmful substances or their metabolites to their offspring through breast milk. We explored the possibility of determining genotoxic effects in the erythrocytes of breastfeeding rat pups whose mothers received a genotoxic compound while nursing. Ten groups of female rats and five pups per dam were studied. The control group received sterile water, and the experimental groups received one of three different doses of cyclophosphamide, colchicine, or cytosine-arabinoside. Blood smears were prepared from samples taken from each dam and pup every 24 h for six days. There were increased numbers of micronucleated erythrocytes (MNEs) and micronucleated polychromatic erythrocytes (MNPCEs) in the samples from pups in the experimental groups (P < 0.02) and increased MNPCE frequencies in the samples from the dams (P < 0.05). These results demonstrate the vertical transmission of the genotoxic effect of the compounds tested. In conclusion, assessing MNEs in breastfeeding neonate rats to assess DNA damage may be a useful approach for identifying genotoxic compounds and/or cytotoxic effects. This strategy could help in screening for therapeutic approaches that are genotoxic during the lactation stage and these assessments might also be helpful for developing preventive strategies to counteract harmful effects.
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21
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Tulinský L, Ihnát P, Mitták M, Guňková P, Zonča P. Intrathoracic splenosis - lesson learned: a case report. J Cardiothorac Surg 2016; 11:72. [PMID: 27118208 PMCID: PMC4845488 DOI: 10.1186/s13019-016-0474-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 04/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intrathoracic splenosis presents an extremely rare thoracic lesion occurring after a simultaneous rupture of the spleen and diaphragm as a consequence of heterotopic autotransplantation and implantation of splenic tissue. Intrathoracic splenosis is usually an asymptomatic, incidental finding, which should be ideally managed without surgical intervention. CASE PRESENTATION We present a case of 68-year old woman with intrathoracic splenosis. Patient presented with a 2-month history of a dry cough unresponsive to administered antibiotics and antimycotics. Computed tomography (CT) of the chest revealed two homogeneous pleural nodules (diameters of 2 and 4 cm) in the left upper lung field. Two consequent CT-assisted transthoracic core-cut biopsies were performed. Histopathology examination of both biopsy specimens was inconclusive (haemorrhagic and non-specific tissue). After that, patient was referred to the department of thoracic surgery with a suspicion of malignant mesothelioma or metastatic lesions. Thoracoscopic revision of the left pleural cavity was performed and the presence of pleural nodules was confirmed. Bloody looking nodules were resected (standard thoracoscopic resection). Postoperative recovery was uneventful. The histopathology examination of the specimen showed normal splenic tissue. Only with the histopathology report in hand, a detailed medical history was taken. It revealed a gunshot injury requiring splenectomy (without known diaphragm or lung injury) 44 years ago (one of the longest time periods in the literature). CONCLUSIONS We would like to point out that following the recommendations regarding splenosis may be very difficult in daily routine practice. The simple question regarding abdominal trauma in a patient's history can lead the clinician to the diagnosis of splenosis, which can be unequivocally established via scintigraphy. The importance of thorough medical history taking, therefore, cannot be underestimated.
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Affiliation(s)
- Lubomír Tulinský
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 70852, Czech Republic. .,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic.
| | - Peter Ihnát
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 70852, Czech Republic.,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic
| | - Marcel Mitták
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 70852, Czech Republic.,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic
| | - Petra Guňková
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 70852, Czech Republic.,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic
| | - Pavel Zonča
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 70852, Czech Republic.,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic
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22
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Chiu SN, Shao PL, Wang JK, Hsu HW, Lin MT, Chang LY, Lu CY, Lee PI, Huang LM, Wu MH. Low immunoglobulin M memory B-cell percentage in patients with heterotaxy syndrome correlates with the risk of severe bacterial infection. Pediatr Res 2016; 79:271-7. [PMID: 26524717 DOI: 10.1038/pr.2015.221] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 08/05/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients with heterotaxy syndrome, commonly associated with complex congenital heart disease (CHD), exhibit a higher risk of severe bacterial infection (SBI). We sought to define the change of a novel immunologic marker, the immunoglobulin M (IgM) memory B-cell percentage, and its association with SBI. METHODS We enrolled 46 (M/F 29/17) heterotaxy syndrome patients (42 right atrial isomerism (RAI) and 4 left atrial isomerism (LAI)) aged > 1 y during the period 2010-2012 in a tertiary care center. We analyzed IgM(+)CD27(+) memory B-cell percentages. Patients with simple and complex CHD served as controls. RESULTS The mean IgM memory B-cell percentages were the lowest in the heterotaxy syndrome group, compared with those in complex and simple CHD groups (1.8 ± 2.1 vs. 3.9 ± 3.2 vs. 5.1 ± 4.7, P < 0.001). In the heterotaxy syndrome group, 41.3% had low IgM memory B-cell percentages (<1% of B cells). Seven had a history of community-acquired SBI and 85.7% of these had low IgM memory B-cell percentages, which was the only significant factors related to community-acquired SBI (P = 0.028). CONCLUSION The memory B cell and IgM memory B-cell percentages are low in patients with heterotaxy syndrome, and the presence of IgM memory B-cell percentage < 1% correlates with community-acquired SBI.
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Affiliation(s)
- Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Pei-Lan Shao
- Department of Laboratory Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan.,Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Hui-Wen Hsu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Luan-Yin Chang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-Yi Lu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
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23
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Affiliation(s)
- Hein Maung
- Department of General Surgery, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Kenneth Buxey
- Department of General Surgery, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Janez Cernelc
- Department of Anatomical Pathology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Tobias Evans
- Department of General Surgery, Royal Hobart Hospital, Hobart, Tasmania, Australia
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24
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Splenosis: A Rare Etiology for Bowel Obstruction-A Case Report and Review of the Literature. Case Rep Surg 2015; 2015:890602. [PMID: 26543660 PMCID: PMC4620401 DOI: 10.1155/2015/890602] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/27/2015] [Indexed: 01/31/2023] Open
Abstract
Splenosis is a historically uncommon etiology for bowel obstruction. Autotransplanted splenic tissues following surgery or trauma of the spleen are known to occur in multiple locations of the abdominal cavity and pelvis. The small bowel mesentery is a blood vessel-rich environment for growth of splenic fragments. We present a case of a 36-year-old male patient who sustained a gunshot wound to his left abdomen requiring a splenectomy and bowel resection fifteen years prior to his presentation with small bowel obstruction requiring exploration, adhesiolysis, and resection of the mesenteric splenic deposit. Our aim in this report is to provide awareness of splenosis as an etiology for bowel obstruction, especially with increased incidence and survival following abdominal traumas requiring splenectomies. We also stress on the importance of history and physical examination to include splenosis on the list of differential diagnoses for bowel obstruction.
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25
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Wang Q, Xiong B, Zheng C, Liang M, Han P. Splenic Arterial Embolization in the Treatment of Severe Portal Hypertension Due to Pancreatic Diseases: The Primary Experience in 14 Patients. Cardiovasc Intervent Radiol 2015; 39:353-8. [PMID: 26304614 PMCID: PMC4742494 DOI: 10.1007/s00270-015-1199-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 08/04/2015] [Indexed: 12/22/2022]
Abstract
Objective This retrospective study reports our experience using splenic arterial particle embolization and coil embolization for the treatment of sinistral portal hypertension (SPH) in patients with and without gastric bleeding. Methods From August 2009 to May 2012, 14 patients with SPH due to pancreatic disease were diagnosed and treated with splenic arterial embolization. Two different embolization strategies were applied; either combined distal splenic bed particle embolization and proximal splenic artery coil embolization in the same procedure for acute hemorrhage (1-step) or interval staged distal embolization and proximal embolization in the stable patient (2-step). The patients were clinically followed. Results In 14 patients, splenic arterial embolization was successful. The one-step method was performed in three patients suffering from massive gastric bleeding, and the bleeding was relieved after embolization. The two-step method was used in 11 patients, who had chronic gastric variceal bleeding or gastric varices only. The gastric varices disappeared in the enhanced CT scan and the patients had no gastric bleeding during follow-up. Conclusions Splenic arterial embolization, particularly the two-step method, proved feasible and effective for the treatment of SPH patients with gastric varices or gastric variceal bleeding.
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Affiliation(s)
- Qi Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, People's Republic of China.
| | - Bin Xiong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, People's Republic of China.
| | - ChuanSheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, People's Republic of China.
| | - Ming Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, People's Republic of China.
| | - Ping Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, People's Republic of China.
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26
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Lai T, Meng C. Silent pelvic splenosis: Case report. Int J Surg Case Rep 2015; 13:129-30. [PMID: 26197096 PMCID: PMC4529608 DOI: 10.1016/j.ijscr.2014.10.100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 10/29/2014] [Accepted: 10/29/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Splenosis is a benign, usually asymptomatic, condition involving autotransplantation of splenic tissue that occurs frequently after splenic rupture caused by trauma or surgery [1]. Up to 67% of the patients presenting splenic rupture may develop splenosis [2]. The interval of time between the initial trauma and the diagnosis varies from 3 to 45 years with an average interval of 21 years [3]. Since the finding of this entity is usually accidental, the real incidence is not well known. Although splenosis following traumatic splenectomy after traffic accidents is well-documented in the literature, there do not seem to be many reported cases where splenosis produced gynecological complications [4]. There were fewer than 100 cases of splenosis reported since the first report of Buchbinder and Lipkoff in 1939 [5] in the English language medical literature of which only a minority appeared in the gynecological literature. PRESENTATION OF CASE A case of pelvic and omentum majus splenosis in a patient is presented. DISCUSSION Pelvic splenosis remains a rare finding in clinical practice. In most reported cases in the literature, the diagnosis was not considered before surgery. This approach may obviate the need for invasive evaluation for a primary or secondary neoplasm, and thus unnecessary surgery, and therefore preserve probable functional splenic tissue. Our case was diagnosed using non-surgical modalities. CONCLUSION Our case emphasizes the rare diagnosing of pelvic splenosis in the evaluating pelvic mass with the tissue evidence instead of surgery.
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Affiliation(s)
- Tingmin Lai
- Department of Gynecology, No.1Hospital of China Medical University, Shenyang 110001, China
| | - Chunfeng Meng
- Department of Gynecology, No.1Hospital of China Medical University, Shenyang 110001, China
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27
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Klair JS, Duvoor C, Meena N. A rare benign intrathoracic mass in a patient with history of rocket explosion. Respir Med Case Rep 2014; 14:4-6. [PMID: 26029565 PMCID: PMC4356165 DOI: 10.1016/j.rmcr.2014.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Thoracic splenosis is rare benign condition that follows trauma leading to diaphragmatic injury. Most of the patients including ours present with a clear traumatic event leading to autotransplantation of spleen in thoracic cavity. Mostly diagnosed incidentally and we need to avoid unnecessary workup including radiological and invasive. It is a very important case which signifies importance of good history taking and initial imaging for making diagnosis and making our pulmonogist and internist aware of this diagnosis.
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Affiliation(s)
- Jagpal Singh Klair
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Chitharanjan Duvoor
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Nikhil Meena
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Department of Pulmonary and Critical Care, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Corresponding author. Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences (UAMS), 4301 W. Markham Street, Little Rock 72205, USA.
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28
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Deng Y, Jin Y, Li F, Zhou Y. Splenosis mimicking an extramural duodenal mass: A case report. Oncol Lett 2014; 8:2811-2813. [PMID: 25364471 PMCID: PMC4214512 DOI: 10.3892/ol.2014.2609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 09/30/2014] [Indexed: 02/05/2023] Open
Abstract
Splenosis is a common disease, patients with splenosis are generally asymptomatic and therapy is not indicated. Splenosis is frequently observed in the abdomen and pelvic cavity and may mimic malignancy on imaging, often leading to unnecessary surgical intervention. The current study presents the case of a 55-year-old female patient, with a rare case of duodenal splenosis, who underwent unnecessary laparotomy due to a misdiagnosis of a malignant duodenal stromal tumor. Although splenosis was confirmed by intraoperative tissue biopsy, this mass was resected due to the lack of information with regard to this condition, an increased suspicion of progressive growth of the mass and chronic duodenal compression. The aim of this report is to raise the awareness of this entity in patients post-splenectomy, to avoid unnecessary surgery, particularly with an increased prevalence of patients with previous splenic trauma due to road traffic accidents. Therefore, the possibility of abdominal splenosis must be included in the differential diagnosis of patients with abdominal mass as the main clinical manifestation, where there is a history of splenic trauma or splenectomy and no other systemic symptoms. In the future noninvasive nuclear scintigraphy may serve as a suitable diagnostic approach for splenosis, thereby avoiding unnecessary laparotomies.
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Affiliation(s)
- Yilei Deng
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yanwen Jin
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Fuyu Li
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yong Zhou
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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29
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Langlois V, Armengol G, Girszyn N, Lepileur L, Armengol-Debeir L, Benhamou Y, Lévesque H. [Multiple intra-abdominal nodules]. Rev Med Interne 2014; 35:840-2. [PMID: 24503384 DOI: 10.1016/j.revmed.2013.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 12/26/2013] [Indexed: 11/27/2022]
Affiliation(s)
- V Langlois
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - G Armengol
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
| | - N Girszyn
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - L Lepileur
- Département d'hépato-gastroentérologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - L Armengol-Debeir
- Département d'hépato-gastroentérologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - Y Benhamou
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - H Lévesque
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
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Fukuhara S, Tyagi S, Yun J, Karpeh M, Reyes A. Intrathoracic splenosis presenting as persistent chest pain. J Cardiothorac Surg 2012; 7:84. [PMID: 22958283 PMCID: PMC3444340 DOI: 10.1186/1749-8090-7-84] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 09/03/2012] [Indexed: 12/04/2022] Open
Abstract
Thoracic splenosis is a rare entity resulting from splenic and diaphragmatic injury. Patients remain asymptomatic, and surgical intervention is not indicated in the majority of cases. We report a case of a 50-year-old male with a history of splenectomy due to a gunshot wound 30 years previously who presented with vague, progressively worsening chest pain. He was found to have a large intrathoracic splenosis. Unique features of our patient include the presence of symptoms, the significant interval growth of the splenic tissue, and the unprecedented size of the mass, which we believe to be the largest among those previously described.
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Affiliation(s)
- Shinichi Fukuhara
- Department of Surgery, Beth Israel Medical Center, Albert Einstein College of Medicine, 317 E,17th St,, New York, NY 10003, USA.
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31
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Wood JH, Partrick DA, Hays T, Sauaia A, Karrer FM, Ziegler MM. Contemporary pediatric splenectomy: continuing controversies. Pediatr Surg Int 2011; 27:1165-71. [PMID: 21626013 DOI: 10.1007/s00383-011-2929-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE We undertook the current study to update the literature on pediatric splenectomy in the age of minimally invasive proficiency among pediatric surgeons. The study is designed to address specific concerns among surgeons about the suitability of the laparoscopic approach in specific situations and among hematologists about the relative benefits and risks of splenectomy in children. METHODS Retrospective analysis of clinicopathologic data for 118 children who underwent open (OS) or laparoscopic (LS) splenectomy at an urban tertiary children's hospital from January 2000 to July 2008. RESULTS One hundred and three cases (87%) were started as LS. Operative times were equivalent for LS and OS (P = 0.8). In the LS group, there were four conversions (3.9%) from LS to OS and five early post-operative complications (4.9%). Median length of stay was 2 days for LS and 4 days for both OS and LS converted to OS (P < 0.0001). The ten largest spleens removed by LS had greater mass (P = 0.02) and tended to have greater volume (P = 0.1) than those removed by OS. Children with hereditary spherocytosis, ITP, and hemoglobinopathy had favorable clinical outcomes, regardless of operative approach. There were no cases of overwhelming post-splenectomy sepsis in this series. CONCLUSIONS Laparoscopic splenectomy is the preferred approach for splenectomy in children with hematological diseases, with or without splenomegaly. Compared to open splenectomy, laparoscopic splenectomy has equivalent operative time and improved length of stay. Both approaches have excellent therapeutic outcomes for appropriate indications.
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Affiliation(s)
- James H Wood
- Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO, USA
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Abstract
PURPOSE Although the efficacy of spleen autotransplantation is debated, this approach remains the only possibility for preserving splenic function after traumatic splenectomy. This report describes an alternative method for splenic autotransplantation in case of splenic trauma. METHODS After splenectomy, the organ was weighed and the undamaged part was cut transversely to prepare a segment of approximately 4 × 3 × 2 cm in size and of 35 g of weight to be transplanted. The greater omentum was pedunculated in its left lateral portion, and the previously prepared splenic tissue was implanted in a pouch created at the lower edge of the omentum. The omental peduncle containing the splenic tissue was fixed to the parietal peritoneum of posterior left upper quadrant of the abdomen where the native spleen was previously located. RESULTS This technique was performed in 4 patients after informed consent had been obtained. The functionality of the splenic implant was assessed after 3 months by abdominal computed tomography and scintigraphy. These exams showed the functioning of the trasplanted splenic tissue in all patients. CONCLUSION This new technique needs further evaluation, but it appears to be an easy and safe alternative for spleen autotransplantation.
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Abstract
The spleen is crucial in regulating immune homoeostasis through its ability to link innate and adaptive immunity and in protecting against infections. The impairment of splenic function is defined as hyposplenism, an acquired disorder caused by several haematological and immunological diseases. The term asplenia refers to the absence of the spleen, a condition that is rarely congenital and mostly post-surgical. Although hyposplenism and asplenia might predispose individuals to thromboembolic events, in this Review we focus on infectious complications, which are the most widely recognised consequences of these states. Because of the high mortality, the fulminant course, and the refractoriness to common treatment of overwhelming infections caused by encapsulated bacteria, prevention through vaccination and antibiotic prophylaxis is the basis of the management of patients who have had splenectomy or have hyposplenism. In this Review, we critically assess clinical and diagnostic aspects of splenic dysfunction and highlight new perspectives in the prevention of overwhelming post-splenectomy infections.
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Affiliation(s)
- Antonio Di Sabatino
- First Department of Medicine, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S Matteo, University of Pavia, Italy
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Bresciani C, Ferreira NR, Perez RO, Jacob CE, Zilberstein B, Cecconello I. Esplenose mimetizando gist: relato de caso e revisão da literatura. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2011. [DOI: 10.1590/s0102-67202011000200019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Khan AM, Manzoor K, Malik Z, Avsar Y, Yasim A, Shim C. Thoracic splenosis: know it--avoid unnecessary investigations, interventions, and thoracotomy. Gen Thorac Cardiovasc Surg 2011; 59:245-53. [PMID: 21484550 DOI: 10.1007/s11748-010-0706-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Accepted: 09/01/2010] [Indexed: 11/28/2022]
Abstract
Thoracic splenosis (TS) is autoimplantation of ectopic splenic tissue in the thoracic cavity that occurs following splenic injury. Most cases of TS are asymptomatic and are diagnosed during the course of an evaluation of incidentally discovered pulmonary lesions. Some cases may be difficult to diagnose, especially if features suggesting TS are not recognized. This may lead to an extensive workup and unnecessary invasive diagnostic procedures including thoracotomy. Multiple, asymptomatic, left-sided pleura-based lesions associated with a history of thoracoabdominal injury and splenectomy are the key points that should alert one to suspect TS, which can then simply be confirmed with a (99m)Tcsulfa colloid radionuclide scan. If TS is suspected and radionuclide imaging studies are performed, further extensive investigations, such as bronchoscopy, biopsy, thoracoscopy, and thoracotomy, are not required as the radionuclide scan is definitive for diagnosis. Most cases are asymptomatic, so further treatment is rarely required; all cases are managed conservatively. We emphasize that all physicians, radiologists, pathologists, and interventionalists should recognize key features that suggest the diagnosis of TS, order appropriate imaging when it is suspected, and avoid unnecessary invasive diagnostic procedures including thoracotomy.
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Affiliation(s)
- Amir Maqbul Khan
- Department of Pulmonary Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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36
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Biron-Schneider AC, Clemenson A, Tiffet O, Perrot JL, Peoc’h M, Gentil-Perret A. Splénose thoracique mimant une atteinte pleuropulmonaire métastatique. Ann Pathol 2010; 30:382-5. [DOI: 10.1016/j.annpat.2010.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 06/22/2010] [Accepted: 07/05/2010] [Indexed: 10/18/2022]
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37
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Hovius JWR, Verberne HJ, Bennink RJ, Blok WL. The (re)generation of splenic tissue. BMJ Case Rep 2010; 2010:2010/sep08_1/bcr0320102833. [PMID: 22778202 DOI: 10.1136/bcr.03.2010.2833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 48-year-old man with a history of a traumatic splenic rupture followed by splenectomy at the age of 5 years was referred to the outpatient clinic with markedly elevated liver enzymes. He was diagnosed with alcoholic liver cirrhosis. Ultrasound of the upper abdomen revealed hepatomegaly and suggested a central mass in the liver. Subsequent MRI of the abdomen did not show a hepatic mass, but revealed multiple intraperitoneal and retroperitoneal ovoid structures with a maximum diameter of 3 cm. A peripheral blood smear did not reveal Howell-Jolly bodies suggesting intact splenic function. The diagnosis splenosis-that is, autotransplantation of splenic tissue after iatrogenic/traumatic rupture of the spleen-was considered and confirmed by SPECT-CT with technetium-99m ((99m)Tc) labelled heat-denatured autologous red blood cells.
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Affiliation(s)
- J W R Hovius
- Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
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38
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Abstract
The authors describe a patient in whom pararenal splenosis nodules were initially interpreted as probable pheochromocytoma. A 22-year-old man with chronic glomerulonephritis, hypertension and a childhood history of splenectomy was hospitalized for a hypertensive emergency. He did not improve with aggressive antihypertensive therapy. A pheochromocytoma was suspected, and a renal ultrasound and a magnetic resonance imaging showed 2 left pararenal masses. Laboratory evaluation for pheochromocytoma and aldosteronoma were negative. Biopsies of the masses were planned, but the masses were subsequently shown to be splenic tissue by a (99m)technnetium heat-damaged red blood cell scan. Ectopic splenic masses, eg, splenosis or accessory spleens, should be considered in patients with undiagnosed abdominal or kidney masses and a history of splenectomy.
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39
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Kim K, Choi HJ, Kim YM, Kwon WJ, Lee WC, Suh JH. Thoracic splenosis: a case report and the importance of clinical history. J Korean Med Sci 2010; 25:299-303. [PMID: 20119587 PMCID: PMC2811301 DOI: 10.3346/jkms.2010.25.2.299] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 09/03/2008] [Indexed: 12/01/2022] Open
Abstract
We present a case of thoracic splenosis in a 42-yr-old man with a medical history of abdominal surgery for a penetration injury with an iron bar of the left abdomen and back. He had been in good condition, but a chest radiograph taken during a regular checkup showed a multinodular left pleura-based mass. Computed tomography (CT) showed that the mass was well-enhanced and homogeneous, indicating a sclerosing hemangioma. Following its removal by video-assisted thoracoscopic surgery, the mass appeared similar to a hemangioma, with marked adhesion to the left side diaphragmatic pleura and lung parenchyma. Frozen section showed that the lesion was a solid mass consisted with abundant lymphoid cells, suggesting a low grade lymphoma. On permanent section, however, the mass was found to be composed of white pulp, red pulp, a thick capsule and trabeculae and was diagnosed as ectopic splenic tissue, or thoracic splenosis. Review of the patient's history and chest CT at admission revealed that the patient had undergone a splenectomy for the penetration injury 20 yr previously.
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Affiliation(s)
- Kyungeun Kim
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hye-Jeong Choi
- Department of Pathology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Young Min Kim
- Department of Pathology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Woon Jung Kwon
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Won Chan Lee
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Jae Hee Suh
- Department of Pathology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
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40
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Riera M, Buczacki S, Khan ZAJ. Splenic regeneration following splenectomy and impact on sepsis: a clinical review. J R Soc Med 2009; 102:139-42. [PMID: 19349505 DOI: 10.1258/jrsm.2009.090039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Manuel Riera
- Department of General Surgery, Queen Elizabeth Hospital, King's Lynn Norfolk PE30 4ET, UK
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41
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42
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Abstract
Thoracic splenosis (TS) is autoimplantation of ectopic splenic tissue in the thoracic cavity that occurs following splenic injury. The majority of cases of TS are asymptomatic and are diagnosed in the course of an evaluation of incidentally discovered pulmonary lesions. Some cases may be difficult to diagnose, especially if features suggesting TS are not recognized. This may lead to an extensive work-up and unnecessary invasive diagnostic procedures including thoracotomy. This case report describes a 40-year-old man, who was diagnosed incidentally with TS, several years after the initial injury. Multiple, asymptomatic, left-sided pleural based lesions associated with a history of thoracoabdominal injury and splenectomy are the key points that should alert suspicion of TS, which can then simply be confirmed by a Tc-99m sulphur colloid radionuclide scan. Most patients are treated conservatively unless they are symptomatic. Physicians must recognize the key features suggesting a diagnosis of TS, order appropriate imaging studies and avoid unnecessary invasive diagnostic procedures.
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Affiliation(s)
- Amir M Khan
- Department of Pulmonary, Jacobi and Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA.
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43
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Sweeney JD, Keane FB, Freyne PJ, Temperley IJ, McCann SR. Accessory splenic tissue in a patient with relapsed idiopathic thrombocytopenic purpura. CLINICAL AND LABORATORY HAEMATOLOGY 2008; 4:309-12. [PMID: 6890886 DOI: 10.1111/j.1365-2257.1982.tb00080.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Corazza GR, Ginaldi L, Zoli G, Frisoni M, Lalli G, Gasbarrini G, Quaglino D. Howell-Jolly body counting as a measure of splenic function. A reassessment. CLINICAL AND LABORATORY HAEMATOLOGY 2008; 12:269-75. [PMID: 2125541 DOI: 10.1111/j.1365-2257.1990.tb00037.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Non-surgical and surgical asplenia predisposes to fatal infections; therefore, simple, non-invasive and repeatable tests for assessing splenic function are required, even in non-specialized medical institutions. Howell-Jolly bodies are the most characteristic peripheral blood abnormality after splenectomy, but their counting is not considered a reliable measure of splenic function. In this study, in a group of splenectomized subjects and of patients with non-surgical hyposplenism, we have compared counting of Howell-Jolly bodies, stained by both the May-Grünwald/Giemsa method and the Feulgen reaction, with pitted cell counting which is considered a reliable technique for the assessment of splenic hypofunction. A significant correlation has been found between Howell-Jolly body counts, stained by either technique, and pitted cell counts (P less than 0.0001). Through Howell-Jolly bodies were never detectable when pitted cell counts fell between 4 and 8%, values consistent with a very mild splenic hypofunction, for pitted cell counts above 8% their increase was always associated with increasing Howell-Jolly body counts. These data suggest that, although pitted cell counting represents a more sensitive method for evaluating splenic function, Howell-Jolly body counting may still be regarded as a simple and reliable technique for identifying and monitoring those cases associated with a real risk of overwhelming infections.
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Affiliation(s)
- G R Corazza
- Department of Internal Medicine, University of L'Aquila, Italy
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45
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Dokal IS, Deenmamode M, Lewis SM. Detection and functional assessment of accessory splenic tissue (splenunculi) with radiolabelled heat damaged autologous erythrocytes. CLINICAL AND LABORATORY HAEMATOLOGY 2008; 12:387-93. [PMID: 2081379 DOI: 10.1111/j.1365-2257.1990.tb00350.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Eight patients (six with idiopathic thrombocytopenic purpura, one with immune pancytopenia, and one with autoimmune haemolytic anaemia), who had previously been splenectomized, were found to have splenunculi using radioactively labelled heat damaged autologous erythrocytes. In all patients the splenunculi were found to have significant 'splenic function'. However, there was a poor correlation between the size and the function of the splenunculi. Splenunculectomies were carried out in two patients. This led to a complete haematological remission in one patient and partial remission in the other. In three patients, where splenunculectomies could not be undertaken, the patients had to remain on significant doses of immunosuppressive therapy. In one patient complete remission was achieved using a course of immunosuppressive therapy alone and in the remaining two there was insufficient information to draw valid conclusions. Blood clearance kinetic studies of heat damaged erythrocytes were found to provide an accurate functional assessment of the splenunculi in all patients. However, the presence of a functional splenunculus was found to be the cause of disease relapse in only some patients. Therefore, the management of similar patients should perhaps be along the same lines as that at their initial presentation, that is, immunosuppressive therapy should be tried if they are not on any at the time of relapse, if they are already on it, then splenunculectomy should be done.
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Affiliation(s)
- I S Dokal
- Department of Haematology, Royal Postgraduate Medical School and Hammersmith Hospital, London, England
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46
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Limonard G, Joosten J, Berk Y, De Kievit I, Zomer S, Keemers M. A 37-year-old woman with an incidentally found mediastinal nodule. Chest 2008; 133:1508-1511. [PMID: 18574297 DOI: 10.1378/chest.07-2513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Gijs Limonard
- Department of Pulmonary Diseases, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands.
| | - Joris Joosten
- Department of General Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Yvonne Berk
- Department of Pulmonary Diseases, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Ineke De Kievit
- Department of Pathology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Saskia Zomer
- Department of Pathology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Mariël Keemers
- Department of General Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
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47
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Cadili A, de Gara C. Complications of splenectomy. Am J Med 2008; 121:371-5. [PMID: 18456028 DOI: 10.1016/j.amjmed.2008.02.014] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 01/26/2008] [Accepted: 02/01/2008] [Indexed: 12/11/2022]
Abstract
Surgical removal of the spleen, splenectomy, is a procedure that has significantly decreased in frequency as our understanding of the infectious complications of the asplenic state increased. The full spectrum and details of splenic function, however, have yet to be fully outlined. As a result, our comprehension of the long-term consequences of splenectomy remains incomplete. We review the evidence relating to the effects of splenectomy on infection, malignancy, thrombosis, and transplantation. Perhaps the best-defined and most widely understood complication of splenectomy is the asplenic patient's susceptibility to infection. In response to this concern, novel techniques have emerged to attempt to preserve splenic function in those patients for whom surgical therapy of the spleen is necessary. The efficacy of these techniques in preserving splenic function and staving off the complications associated with splenectomy is also reviewed in this article.
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48
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Immunocompetence of the severely injured spleen verified by differential interference contrast microscopy: the red blood cell pit test. ACTA ACUST UNITED AC 2008; 63:1087-91; discussion 1091-2. [PMID: 17993955 DOI: 10.1097/ta.0b013e3181507329] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the immunocompetence of the successfully nonoperatively managed injured spleen warranting vaccinations for overwhelming postsplenectomy sepsis by differential interference contrast microscopy (DICM). METHODS Cull an urban Level I trauma systems data bank for all patients with grade IV or V splenic injuries (those with the greatest potential to compromise immunologic function) successfully managed nonoperatively and those who have required splenectomies since 1996 and verify the Association for the Surgery of Trauma grading. Contact or obtain written consent of these patients and acquire a blood sample for DICM (red blood cell [RBC] pit analysis) and IgM levels (as a control). Compare values of those sustaining splenic injuries with those of two control groups: patients with splenectomies and those with normal splenic function. RESULTS Forty patients were contacted, consented, and volunteered blood samples: 10 patients with grade IV splenic injuries, 1 patient with a grade V injury, 14 patients with splenectomies, and 15 controls. Average RBC pit levels and IgM levels for patients sustaining injuries (15) and successfully nonoperatively managed were 0.6% (0%-2% nL) and 91 mg/dL (46-304 nL), respectively. Patients with splenectomies had levels of 20.4% and 86 mg/dL whereas controls had levels of 0.7% and 110 mg/dL, respectively. The average time frame from injury to RBC pit test was 3.1 years. Comparing the successfully nonoperatively managed group with the splenectomy group using t test with Satterthwaite's method because of unequal variances, there was a statistically significant difference (p = 0.0002). Comparing the same study group with those with normal splenic function using t test with pooled variance, there was no statistical significant difference between groups (p = 0.489). CONCLUSION DICM, a commonly used test to evaluate splenic-based immunocompetence in patients with sickle cell anemia, hemoglobinopathies, and patients undergoing partial splenectomies, also confirms splenic immunocompetence in patients sustaining up to grade IV splenic injuries. IgM levels earlier thought to be low in patients after splenectomy normalize.
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49
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Abstract
Splenosis is a common benign condition that occurs after splenic rupture via trauma or surgery. Splenosis is usually found incidentally and unless symptomatic, therapy is not indicated. However, since radiographically it can mimic malignancy, most patients have an extensive workup. The diagnostic method of choice is nuclear scintigraphy, specifically, a heat-damaged red blood cell scan. Splenosis usually occurs within the abdominal and pelvic cavities, but patients have been described with intrathoracic, subcutaneous, intrahepatic and intracranial lesions.
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Affiliation(s)
- Richard D Fremont
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
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50
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Abstract
Celiac disease is a common systemic disorder that can have multiple hematologic manifestations. Patients with celiac disease may present to hematologists for evaluation of various hematologic problems prior to receiving a diagnosis of celiac disease. Anemia secondary to malabsorption of iron, folic acid, and/or vitamin B12 is a common complication of celiac disease and many patients have anemia at the time of diagnosis. Celiac disease may also be associated with thrombocytosis, thrombocytopenia, leukopenia, venous thromboembolism, hyposplenism, and IgA deficiency. Patients with celiac disease are at increased risk of being diagnosed with lymphoma, especially of the T-cell type. The risk is highest for enteropathy-type T-cell lymphoma (ETL) and B-cell lymphoma of the gut, but extraintestinal lymphomas can also be seen. ETL is an aggressive disease with poor prognosis, but strict adherence to a gluten-free diet may prevent its occurrence.
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Affiliation(s)
- Thorvardur R. Halfdanarson
- Division of Hematology and
- Correspondence: Joseph A. Murray,
Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St, SW, Rochester MN 55905; e-mail:
; or Thorvardur R. Halfdanarson,
Mayo Clinic College of Medicine, Division of Hematology, 200 First St SW, Rochester, MN 55905; e-mail:
| | | | - Joseph A. Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN
- Correspondence: Joseph A. Murray,
Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St, SW, Rochester MN 55905; e-mail:
; or Thorvardur R. Halfdanarson,
Mayo Clinic College of Medicine, Division of Hematology, 200 First St SW, Rochester, MN 55905; e-mail:
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