1
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Li X, Hu X, Wang P, Hu G, Zhou B, Cai J. A large gastric splenosis mimicking gastrointestinal stromal tumor: A case report and literature review. Exp Ther Med 2024; 27:186. [PMID: 38533436 PMCID: PMC10964733 DOI: 10.3892/etm.2024.12474] [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: 11/13/2023] [Accepted: 02/13/2024] [Indexed: 03/28/2024] Open
Abstract
Splenosis pertains to the phenomenon wherein a segment of the spleen undergoes detachment and becomes embedded in other anatomical regions subsequent to traumatic rupture or therapeutic resection, and then progressively establishing blood circulation to foster the regeneration of splenic tissue. Existing literature posits that splenosis predominantly manifests within the confines of the abdominal and pelvic cavities. The objective of the current study was to present an uncommon case involving the occurrence of splenosis within the gastric myometrium, thereby contributing to the current knowledge regarding splenosis. A 16-year-old female sought medical assistance owing to recurrent abdominal pain persisting for a duration of six months, and had a history of splenectomy two years prior. Gastroscopy, endoscopic ultrasound and computed tomography (CT) examination collectively identified a lesion in the submucosal prominence of the fundus of the stomach. Initial considerations based on imaging examinations leaned towards a gastrointestinal stromal tumor. Consequently, an endoscopic resection was undertaken. Remarkably, the pathological findings and histochemistry concurred with the alterations associated with ectopic spleen implantation, leading to a stable postoperative course. In conclusion, splenosis denotes the implantation of a segment of the spleen into extraneous anatomical sites, attributable to traumatic rupture or therapeutic resection. The preoperative diagnosis of splenosis can pose a challenge, potentially culminating in unnecessary radical clinical interventions. Therefore, the acquisition of a comprehensive medical history, with a particular focus on surgical and trauma events, emerges as pivotal for an accurate diagnosis. In light of novel diagnostic modalities, the non-invasive technology of nuclear medicine can efficaciously visualize ectopic splenic tissue, thereby averting superfluous surgical procedures. It is both feasible and imperative to implement individualized treatment strategies for patients afflicted with splenosis.
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Affiliation(s)
- Xiaotian Li
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
- Department of Nuclear Medicine, People's Hospital of Qianxinan Buyi and Miao Minority Autonomous Prefecture, Xingyi, Guizhou 562400, P.R. China
| | - Xianwen Hu
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Pan Wang
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Guiyun Hu
- Department of Nuclear Medicine, People's Hospital of Qianxinan Buyi and Miao Minority Autonomous Prefecture, Xingyi, Guizhou 562400, P.R. China
| | - Bin Zhou
- Department of Nuclear Medicine, People's Hospital of Qianxinan Buyi and Miao Minority Autonomous Prefecture, Xingyi, Guizhou 562400, P.R. China
| | - Jiong Cai
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
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2
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Gil J, Suh M, Choi H, Paeng JC, Cheon GJ, Kang KW. [ 18F]FDOPA PET/CT in Solid Pseudopapillary Tumor of the Pancreas: a Recurred Tumor Mimicking Splenosis. Nucl Med Mol Imaging 2024; 58:81-85. [PMID: 38510822 PMCID: PMC10948710 DOI: 10.1007/s13139-023-00826-1] [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: 09/14/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 03/22/2024] Open
Abstract
Solid pseudopapillary tumor (SPT) of the pancreas is a neoplasm with low malignant potential. It is often challenging to diagnose SPT due to its nonspecific clinical and radiological features, and [18F]FDOPA is effective in diagnosing SPT, particularly in differentiating SPT from benign conditions such as splenosis. A 55-year-old woman underwent distal pancreatectomy and splenectomy for histologically confirmed SPT. She was also initially diagnosed with splenosis. During follow-up, sizes of multiple nodular lesions were increased, raising the possibility of peritoneal seeding of SPT. For diagnosis, a spleen scan and SPECT/CT were performed using 99mTc-labeled damaged red blood cells, which showed no uptake in the peritoneal nodules. Subsequent [18F]FDOPA PET/CT revealed [18F]FDOPA-avidity of the nodules. The patient underwent tumor resection surgery, and the nodules were pathologically confirmed as SPT.
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Affiliation(s)
- Joonhyung Gil
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Minseok Suh
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Hongyoon Choi
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Keon Wook Kang
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
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3
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Chen J, Russo R, Yung G, Yeong C, Mansberg R. False positive metastatic disease due to combined thoracic and subcutaneous splenosis. Radiol Case Rep 2024; 19:872-875. [PMID: 38188960 PMCID: PMC10770489 DOI: 10.1016/j.radcr.2023.11.050] [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] [Received: 10/31/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 01/09/2024] Open
Abstract
A 56-year-old man presented with dyspnea secondary to pulmonary emboli and dilated cardiomyopathy. His past medical history included a history of emergency laparotomy, splenectomy, and splenic flexure resection following a gunshot injury 30 years ago. CT and MRI imaging demonstrated multiple homogeneously enhancing lobulated lesions at the left-sided pleura and chest wall with an irregular calcified spleen. The aforementioned lesions demonstrated a similar level of tracer uptake to the splenic activity with no evidence of other FDG avid malignancy on the follow-up 18F-FDG PET study. All the above-mentioned pleural and chest wall lesions demonstrated intense tracer accumulation on technetium-99m labeled heat-damaged red cell scintigraphy, consistent with combined thoracic and subcutaneous splenosis.
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Affiliation(s)
- Jeffrey Chen
- Department of Molecular Imaging Concord Hospital, Concord, NSW, Australia
| | - Robert Russo
- Department of Molecular Imaging Concord Hospital, Concord, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Grace Yung
- Department of Molecular Imaging Concord Hospital, Concord, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Clarence Yeong
- Department of Respiratory and Sleep Medicine, Concord Hospital, Concord, NSW, Australia
| | - Robert Mansberg
- Department of Molecular Imaging Concord Hospital, Concord, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, NSW, Australia
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4
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Mort JF, Tran DT, Dougherty SC, Zielinski R, Williams MD, Davidson KM. Refractory Immune Thrombocytopenic Purpura with Abdominal Splenosis: A Complex Case. Case Rep Hematol 2023; 2023:9714457. [PMID: 37388486 PMCID: PMC10307128 DOI: 10.1155/2023/9714457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/24/2023] [Accepted: 06/09/2023] [Indexed: 07/01/2023] Open
Abstract
Immune thrombocytopenia (ITP) is an acquired thrombocytopenia resulting from immune-mediated platelet destruction via antiplatelet antibodies and T cells. Medical management of ITP includes corticosteroids and multiple other adjunct therapies, with splenectomy generally being reserved for severe, refractory cases. In this clinical case report, we describe the evaluation of a 35-year-old male with a history of prior traumatic splenic injury who presented to the emergency department endorsing easy bruising and a petechial rash, ultimately found to have severe thrombocytopenia. The patient was diagnosed with primary ITP that proved to be refractory to a number of first- and second-line medical therapies. His course was complicated by the presence of abdominal splenosis discovered at the time of planned splenectomy and intra-abdominal hemorrhage requiring splenic artery embolization thereafter. To our knowledge, this is one of few published cases of ITP complicated by abdominal splenosis, highlighting the need to consider splenosis and the presence of accessory splenic tissue in cases of refractory ITP.
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Affiliation(s)
- Joseph F. Mort
- University of Virginia, Department of Medicine, 1215 Lee Street Box 800466, Charlottesville, VA 22908, USA
| | - Danh T. Tran
- University of Virginia, Department of Medicine, 1215 Lee Street Box 800466, Charlottesville, VA 22908, USA
| | - Sean C. Dougherty
- University of Virginia, Department of Medicine, 1215 Lee Street Box 800466, Charlottesville, VA 22908, USA
| | - Robert Zielinski
- University of Virginia, Department of Medicine, 1215 Lee Street Box 800466, Charlottesville, VA 22908, USA
| | - Michael D. Williams
- University of Virginia, Department of Surgery, 1300 Jefferson Park Avenue, Charlottesville, VA 22903, USA
| | - Kelly M. Davidson
- University of Virginia, Department of Medicine, Division of Hematology & Oncology, 1300 Jefferson Park Avenue Box 800716, Charlottesville, VA 22908, USA
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KB S, PK H. Hepatic Splenosis: A Rare Entity and Great Mimicker. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1758123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
AbstractSplenosis is a benign and rare condition that is usually caused by trauma or splenectomy or other procedures involving splenic tissue. The patient is usually asymptomatic and often diagnosed incidentally especially when presents as intrahepatic lesion, can be misdiagnosed as neoplasm. Here, we present case report of a 56-year-old male patient, who was incidentally detected to have focal liver lesion on routine ultrasound check up. He was further evaluated with computed tomography (CT) and magnetic resonance imaging (MRI) and the lesion was indistinguishable from neoplastic lesions and misdiagnosed to be hepatic adenoma. Retrospectively analyzing, the patient had history of splenectomy following road traffic accident 10 years before the present presentation. Following laparotomy, the liver lesion was resected and histopathology confirmed the diagnosis of hepatic splenosis. In this case report and review, we present the diagnostic features and the criteria that help in the diagnosis of splenosis which is a great mimicker.
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Affiliation(s)
- Shruthi KB
- Imaging and Interventional Radiology, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India
| | - Hanan PK
- Imaging and Interventional Radiology, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India
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6
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The Benign Side of the Abdominal Wall: A Pictorial Review of Non-Neoplastic Diseases. Diagnostics (Basel) 2022; 12:diagnostics12123211. [PMID: 36553218 PMCID: PMC9778078 DOI: 10.3390/diagnostics12123211] [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] [Received: 11/27/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
The abdominal wall is the location of a wide spectrum of pathological conditions, from benign to malignant ones. Imaging is often recommended for the evaluation of known palpable abdominal masses. However, abdominal wall pathologies are often incidentally discovered and represent a clinical and diagnostic challenge. Knowledge of the possible etiologies and complications, combined with clinical history and laboratory findings, is crucial for the correct management of these conditions. Specific imaging clues can help the radiologist narrow the differential diagnosis and distinguish between malignant and benign processes. In this pictorial review, we will focus on the non-neoplastic benign masses and processes that can be encountered on the abdominal wall on cross-sectional imaging, with a particular focus on their management. Distinctive sonographic imaging clues, compared with computed tomography (CT) and magnetic resonance (MR) findings will be highlighted, together with clinical and practical tips for reaching the diagnosis and guiding patient management, to provide a complete diagnostic guide for the radiologist.
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7
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Holzgreve A, Völter F, Delker A, Kunz WG, Fabritius MP, Brendel M, Albert NL, Bartenstein P, Unterrainer M, Unterrainer LM. Detection of Splenic Tissue Using 99mTc-Labelled Denatured Red Blood Cells Scintigraphy—A Quantitative Single Center Analysis. Diagnostics (Basel) 2022; 12:diagnostics12020486. [PMID: 35204576 PMCID: PMC8871479 DOI: 10.3390/diagnostics12020486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Red blood cells (RBC) scintigraphy can be used not only for detection of bleeding sites, but also of spleen tissue. However, there is no established quantitative readout. Therefore, we investigated uptake in suspected splenic lesions in direct quantitative correlation to sites of physiologic uptake in order to objectify the readout. Methods: 20 patients with Tc-99m-labelled RBC scintigraphy and SPECT/low-dose CT for assessment of suspected splenic tissue were included. Lesions were rated as vital splenic or non-splenic tissue, and uptake and physiologic uptake of bone marrow, pancreas, and spleen were then quantified using a volume-of-interest based approach. Hepatic uptake served as a reference. Results: The median uptake ratio was significantly higher in splenic (2.82 (range, 0.58–24.10), n = 47) compared to other lesions (0.49 (0.01–0.83), n = 7), p < 0.001, and 5 lesions were newly discovered. The median pancreatic uptake was 0.09 (range 0.03–0.67), bone marrow 0.17 (0.03–0.45), and orthotopic spleen 14.45 (3.04–29.82). Compared to orthotopic spleens, the pancreas showed lowest uptake (0.09 vs. 14.45, p = 0.004). Based on pancreatic uptake we defined a cutoff (0.75) to distinguish splenic from other tissues. Conclusion: As the uptake in extra-splenic regions is invariably low compared to splenules, it can be used as comparator for evaluating suspected splenic tissues.
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Affiliation(s)
- Adrien Holzgreve
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.V.); (A.D.); (M.B.); (N.L.A.); (P.B.); (L.M.U.)
- Correspondence:
| | - Friederike Völter
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.V.); (A.D.); (M.B.); (N.L.A.); (P.B.); (L.M.U.)
| | - Astrid Delker
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.V.); (A.D.); (M.B.); (N.L.A.); (P.B.); (L.M.U.)
| | - Wolfgang G. Kunz
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (W.G.K.); (M.P.F.); (M.U.)
| | - Matthias P. Fabritius
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (W.G.K.); (M.P.F.); (M.U.)
| | - Matthias Brendel
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.V.); (A.D.); (M.B.); (N.L.A.); (P.B.); (L.M.U.)
| | - Nathalie L. Albert
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.V.); (A.D.); (M.B.); (N.L.A.); (P.B.); (L.M.U.)
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.V.); (A.D.); (M.B.); (N.L.A.); (P.B.); (L.M.U.)
| | - Marcus Unterrainer
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (W.G.K.); (M.P.F.); (M.U.)
| | - Lena M. Unterrainer
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.V.); (A.D.); (M.B.); (N.L.A.); (P.B.); (L.M.U.)
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8
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Sangster GP, Malikayil K, Donato M, Ballard DH. MDCT Findings of Splenic Pathology. Curr Probl Diagn Radiol 2022; 51:262-269. [PMID: 33461801 PMCID: PMC8267054 DOI: 10.1067/j.cpradiol.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/18/2020] [Accepted: 12/31/2020] [Indexed: 01/28/2023]
Abstract
The delineation and characterization of splenic lesions and other abnormalities can be challenging on computed tomography. Many splenic lesions are incidentally found, imaging features tend to overlap, and without the appropriate clinical context, differentials can range from benign to malignant. Radiologists should be familiar with the wide variety of pathologies seen on computed tomography as it is often the first imaging modality a splenic lesion is seen. The purpose of this MDCT-focused review is to understand normal splenic anatomy and its variants, to illustrate and describe typical and atypical imaging patters of inflammatory, infectious, vascular, traumatic, benign, and malignant tumors of the spleen and provide clues in reaching the appropriate differential diagnosis and management.
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Affiliation(s)
- Guillermo P. Sangster
- Department of Radiology, Louisiana State University Health Shreveport. 1501 Kings Hwy, Shreveport, Louisiana, USA
| | - Kiran Malikayil
- Department of Radiology, Louisiana State University Health Shreveport. 1501 Kings Hwy, Shreveport, Louisiana, USA
| | - Maren Donato
- Fundación Medica de Río Negro y Neuquén, Cipolletti, Río Negro, Argentina
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine. 510 S. Kingshighway Blvd, St. Louis, Missouri, USA
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Vernuccio F, Messina C, Merz V, Cannella R, Midiri M. Resectable and Borderline Resectable Pancreatic Ductal Adenocarcinoma: Role of the Radiologist and Oncologist in the Era of Precision Medicine. Diagnostics (Basel) 2021; 11:2166. [PMID: 34829513 PMCID: PMC8623921 DOI: 10.3390/diagnostics11112166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/22/2021] [Accepted: 11/19/2021] [Indexed: 12/24/2022] Open
Abstract
The incidence and mortality of pancreatic ductal adenocarcinoma are growing over time. The management of patients with pancreatic ductal adenocarcinoma involves a multidisciplinary team, ideally involving experts from surgery, diagnostic imaging, interventional endoscopy, medical oncology, radiation oncology, pathology, geriatric medicine, and palliative care. An adequate staging of pancreatic ductal adenocarcinoma and re-assessment of the tumor after neoadjuvant therapy allows the multidisciplinary team to choose the most appropriate treatment for the patient. This review article discusses advancement in the molecular basis of pancreatic ductal adenocarcinoma, diagnostic tools available for staging and tumor response assessment, and management of resectable or borderline resectable pancreatic cancer.
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Affiliation(s)
- Federica Vernuccio
- Radiology Unit, University Hospital "Paolo Giaccone", 90127 Palermo, Italy
| | - Carlo Messina
- Oncology Unit, A.R.N.A.S. Civico, 90127 Palermo, Italy
| | - Valeria Merz
- Department of Medical Oncology, Santa Chiara Hospital, 38122 Trento, Italy
| | - Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Via del Vespro 129, 90127 Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Massimo Midiri
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Via del Vespro 129, 90127 Palermo, Italy
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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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Franke D, Anupindi SA, Barnewolt CE, Green TG, Greer MLC, Harkanyi Z, Lorenz N, McCarville MB, Mentzel HJ, Ntoulia A, Squires JH. Contrast-enhanced ultrasound of the spleen, pancreas and gallbladder in children. Pediatr Radiol 2021; 51:2229-2252. [PMID: 34431006 DOI: 10.1007/s00247-021-05131-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/30/2021] [Accepted: 06/10/2021] [Indexed: 12/14/2022]
Abstract
Gray-scale and color/power Doppler ultrasound (US) are the first-line imaging modalities to evaluate the spleen, gallbladder and pancreas in children. The increasing use of contrast-enhanced ultrasound (CEUS) as a reliable and safe method to evaluate liver lesions in the pediatric population promises potential for imaging other internal organs. Although CEUS applications of the spleen, gallbladder and pancreas have been well described in adults, they have not been fully explored in children. In this manuscript, we present an overview of the applications of CEUS for normal variants and diseases affecting the spleen, gallbladder and pancreas. We highlight a variety of cases as examples of how CEUS can serve in the diagnosis and follow-up for such diseases in children. Our discussion includes specific examination techniques; presentation of the main imaging findings in various benign and malignant lesions of the spleen, gallbladder and pancreas in children; and acknowledgment of the limitations of CEUS for these organs.
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Affiliation(s)
- Doris Franke
- Department of Pediatric Kidney, Liver and Metabolic Diseases, MHH, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Sudha A Anupindi
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Carol E Barnewolt
- Department of Radiology, Boston Children's Hospital, Harvard University, Boston, MA, USA
| | - Thomas G Green
- Department of Radiology, Crouse Hospital, Syracuse, NY, USA
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Zoltan Harkanyi
- Department of Radiology, Heim Pal National Pediatric Institute, Budapest, Hungary
| | - Norbert Lorenz
- Children's Hospital, Dresden Municipal Hospital, Teaching-Hospital of Technical University Dresden, Dresden, Germany
| | - M Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Hans-Joachim Mentzel
- Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital, Jena, Germany
| | - Aikaterini Ntoulia
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Judy H Squires
- Department of Radiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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12
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Richardson L, Gardner K, Eberhardt S, Thompson W. A case of hepatic splenosis in the setting of iron overload; multimodal and literature review. Radiol Case Rep 2021; 16:2499-2504. [PMID: 34257788 PMCID: PMC8259227 DOI: 10.1016/j.radcr.2021.05.037] [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: 04/26/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022] Open
Abstract
Hepatic splenosis, a rare entity, is the ectopic implantation of splenic tissue into the hepatic parenchyma, most often incidentally seen in patients with a history of splenic trauma and splenectomy. We present a unique case of hepatic splenosis in a patient with hemosiderosis and splenectomy following the incidental finding of hepatic masses on pretransplant imaging. Final diagnosis was made based on cross-sectional imaging characteristics matching that of the left upper quadrant splenules alone. We discuss common characteristics of hepatic splenosis on multiple modalities, the effect of iron deposition on the imaging characteristics of hepatic and splenic tissue and how that impacts the differential and diagnosis. This case highlights the unique imaging characteristics hepatic splenosis can have particularly in the setting of hemosiderosis. Hepatic splenosis imaging diagnosis has a significant advantage over tissue diagnosis in terms of decreased risk, time and cost.
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13
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Kripalani S, Patel V, Joneja U, Talwar S, Parikh M, Barshay V, Chaaya A. Intrapancreatic Accessory Spleen Diagnosed As Neuroendocrine Tumor: The Dangers of False Positives and Their Implications in Subsequent Management. Cureus 2021; 13:e15891. [PMID: 34336412 PMCID: PMC8312822 DOI: 10.7759/cureus.15891] [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: 06/24/2021] [Indexed: 11/20/2022] Open
Abstract
This case serves as a reminder to consider ectopic splenic tissue in the differential diagnosis of pancreatic masses. The literature shows a lack of awareness and overtreatment of this condition due to clinical and radiologic concern for malignancy, namely neuroendocrine tumors (NETs) identified on positron emission tomography (PET)-CT NETSPOT. Given the vast difference in management and prognosis of ectopic splenic anomalies and malignant neoplasms involving the pancreas, accurate diagnosis is imperative to avoid unnecessary invasive procedures such as Whipple or distal pancreatectomy and splenectomy, which are associated with increased morbidity and mortality.
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Affiliation(s)
- Simran Kripalani
- Department of Gastroenterology, Cooper Medical School of Rowan University, Camden, USA
| | - Vikram Patel
- Department of Gastroenterology, Cooper University Hospital, Camden, USA
| | - Upasana Joneja
- Department of Pathology, Cooper University Hospital, Camden, USA
| | - Shikha Talwar
- Department of Medicine, Cooper University Hospital, Camden, USA
| | - Meet Parikh
- Department of Gastroenterology, Cooper University Hospital, Camden, USA
| | - Veniamin Barshay
- Department of Radiology, Cooper University Hospital, Camden, USA
| | - Adib Chaaya
- Department of Gastroenterology, Cooper University Hospital, Camden, USA
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