Intra-abdominal splenosis mimicking metastatic cancer

Mimics of primary ovarian cancer and primary peritoneal carcinomatosis - A pictorial review

Numerous conditions can mimic ovarian malignancy. Identifying the origin of a pelvic mass or disseminated peritoneal abnormality on imaging is important to ensure that the patient receives optimal management by the appropriate clinical team. Ovarian cancer mimics include infections and other neoplastic processes, for example, actinomycosis, lymphoma, and sarcoma. We will illustrate intraperitoneal and extraperitoneal ovarian and non-ovarian mimics. Primary peritoneal carcinomatosis mimics include processes such as deep infiltrating endometriosis and rare causes such as gliomatosis peritonei and diffuse peritoneal leiomyomatosis. We aim to illustrate the multimodality key imaging appearances of common and rarer types of mimics.

Various congenital anomalies and anatomical variations of the spleen: a multimodality pictorial review

There are various congenital anomalies and anatomical variations of the spleen (CAAVS). CAAVS are common and are often associated with systemic anomalies. Widespread use of computed tomography and magnetic resonance imaging in a variety of clinical situations has increased the detection of CAAVS. However, CAAVS are frequently overlooked and are occasionally misdiagnosed as pathologic disease entities. This article aimed to review the various manifestations of CAAVS with radiologic findings.

Subcutaneous Splenosis Presenting 37 years post-traumatic splenectomy; A Case Report

INTRODUCTION

The term splenosis refers to autotransplantation of splenic tissue in ectopic sites. Ectopic splenic tissue may be found in the liver, thorax, pelvis and subcutaneous tissues following traumatic splenectomy. Although clinically insignificant, local symptoms such as abdominal pain may arise. In this paper we report a case of subcutaneous splenosis presenting 37 years post-traumatic splenectomy.

CASE PRESENTATION

A 40-year-old medically free lady presented to our institution with a surgical history of post-traumatic splenectomy at the age of three and two cesarean sections. She complained for nonpainful right upper quadrant soft mass that has been stable in size over the years. Her laboratory results, including peripheral blood smear, were all within normal limits and no asplenic changes were detected. SPECT scan confirmed extraperitoneal splenosis in right upper quadrant.

DISCUSSION

Splenosis is an acquired form of ectopic splenic tissue that is defined as an auto-transplantation of a viable splenic tissue. It commonly occurs after traumatic rupture of the spleen.5 Splenosis has been widely reported around the world with an incidence of 16-67% after traumatic splenic rupture or splenectomy. Subcutaneous splenosis is an extremely rare condition, mostly observed in abdominal surgical scars. It is believed to follow laparotomy for splenectomy where splenic cells auto-implant or spread hematogenously at different locations.

CONCLUSION

Subcutaneous splenosis is a rare consequence of post-traumatic splenectomy that can manifest itself up to three decades after. Although concerning to the patient and alarming to the surgeon as it may resemble more serious entities such as abdominal wall sarcoma, surgical removal of asymptomatic splenosis is subject to the location of mass and patients' wishes.

Pelvic splenosis mimicking a suspicious adnexal mass

A 58-year-old asymptomatic woman was referred to our gynecologic oncology unit for the management of a left adnexal mass found during a routine gynecologic examination. Her personal history included an emergency splenectomy at the age of 4 years old, following traumatic splenic laceration after a car accident. The patient's work-up (including transvaginal ultrasound and MRI) confirmed a pelvic solid mass, which was reported as suspicious for malignancy and classified as Ovarian-Adnexal Reporting & Data System-MRI 5. An exploratory laparoscopy was performed, showing a reddish blue lesion located at the left broad ligament. Histologic analysis showed the presence of splenic tissue and normal adnexa. The postoperative follow-up was uneventful.Pelvic splenosis is a challenging diagnosis rarely made preoperatively due to concern for malignancy. In the presence of a pelvic mass, the collection of a detailed patient's history, including information about previous splenic rupture, might raise suspicion for pelvic splenosis.

Perirectal intraperitoneal splenosis: A case report of MRI with laparoscopic correlation

Splenosis is a benign acquired condition, which appears after rupture of the spleen and heterotopic auto-transplantation. Mostly found as an incidental finding on cross-sectional imaging, definitive diagnosis is frequently made histologically after resection or tissue sampling. We report a case of a 36-year-old male patient who presented with increased susceptibility to infections, chronic fatigue, and a history of traumatic splenic rupture. Cross-sectional imaging showed perirectal formations within the mesorectal fascia, and extraperitoneal splenosis was suspected. Due to the radiologically unclear entity of the masses, diagnostic laparoscopy with tissue sampling was performed. Intraoperatively the masses turned out to be intraperitoneal. Histological workup showed splenic tissue, consistent with intraperitoneal splenosis after splenic rupture. In this article we want to discuss important imaging findings and their differentials, as well as clinical implications for this rare entity.

Laparoscopic Resection of a Left Upper Quadrant Mass Leading to a Surprise Diagnosis

Background. Resplenectomy is most commonly done for the treatment of recurrent idiopathic thrombocytopenic purpura (ITP) refractory to medical management due to the regrowth of a missed accessory spleen. Case Report. A 66-year-old male had undergone open splenectomy for traumatic rupture 40 years ago. He presented with a leiomyosarcoma of his leg, which was surgically removed. When he developed metastatic disease, chemotherapy was started. He developed left upper quadrant pain, and on CT scan, a 5 cm mass compatible with a sarcoma was found between the tail of the pancreas and the left adrenal gland. During laparoscopy, dense adhesion of the omentum to the abdominal wall and the stomach from his previous splenectomy was divided. The lesser sac was opened through the gastrocolic ligament, and the splenic flexure was taken down. Superior and dorsal to the tail of the pancreas next to the left adrenal gland, the mass was identified and carefully dissected out. The vascular pedicle, which originated from a side branch of the splenic vessels at the tail of the pancreas, was stapled. The gastric fundus showed multiple nodules, and therefore, a modified sleeve gastrectomy was done; also, a 2 cm nodule in segment 5 of the liver and an omental nodule were removed. The tumors and gastrectomy specimen were placed in an endobag and removed through a periumbilical mini-incision. The patient recovered without any complications from the procedure and his LUQ pain resolved. Pathology revealed no sarcoma metastases but accessory spleens in all specimens. Discussion. Splenosis with multiple implants within the abdomen after splenectomy for trauma is a rare condition. In our patient, this seems to have been triggered by chemotherapy for his sarcoma resulting in extramedullary hemopoiesis. Laparoscopic removal of accessory spleens can be safely done.

Simultaneous small bowel and colon obstruction due to splenosis. A case report and review of literature

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Splenosis is an autotransplantation of splenic tissues throughout the body post splenic rupture or splenectomy.

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Symptomatic when hematological diseases have recurred.

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Abdominal splenosis may rarely be associated with abdominal pain and/or gastrointestinal symptoms.

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Further evaluation and treatment is mandatory when bowel obstruction is present.

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Treatment consists of resection of problematic splenic nodules.

Introduction

Splenosis, an autotransplantation of splenic tissues in another compartment of the body, is only symptomatic when hematologic diseases have recurred or compression of other adjacent structures have occurred. Therefore, we report a clinical case of a patient with bowel obstruction due to splenosis.

Case presentation

A patient with a history of splenectomy, presented to the emergency room for abdominal pain and obstipation, suggesting intestinal obstruction which is also seen on CT scan. During laparotomy, multiple splenic nodules were seen on the mesentery of the small bowel and colon, with vascular bridges between them, resulting in bowel obstruction. Resection of splenic nodules was performed. The post-operative course was uneventful and the patient was discharged a week after.

Discussion

Although very rare, gastrointestinal symptoms may sometimes be described in patients with splenosis. Bleeding or obstruction can occur because of intramural grow or external compression, respectively. Treatment consists of resection of these nodules.

Conclusion

Splenosis should always be thought in patients with previous splenic rupture and presenting with incidental nodules seen on imaging, with further investigations when symptoms are present.

Intrahepatic Splenosis: Incidental Liver Lesion after Splenectomy

We describe the case of a 50-year-old man with history of remote splenectomy who underwent routine lung cancer screening chest computed tomography and was incidentally found to have a liver lesion. Dedicated liver protocol computed tomography demonstrated "archiform" enhancement pattern in the arterial phase and homogenous filling-in enhancement on portal venous and delayed phases. Multiple other smaller enhancing intraperitoneal lesions were also found. These findings along with history of splenectomy confirmed a diagnosis of intrahepatic and intraperitoneal splenosis and helped avoid biopsy. Intrahepatic splenules can be challenging to diagnose owing to its unusual location and similarity in appearance to a liver neoplasm or metastasis. However, careful evaluation of enhancement pattern and review of medical history can lead to an accurate diagnosis and avoidance of invasive biopsy.

IMAGING DIAGNOSIS-ECTOPIC SPLEEN MIMICKING HEPATIC TUMOR WITH INTRA-ABDOMINAL METASTASES INVESTIGATED VIA TRIPLE-PHASE HELICAL COMPUTED TOMOGRAPHY IN A DOG

A 10-year-old castrated male miniature dachshund was presented with an abdominal mass. The dog had a history of splenectomy. Triple-phase helical computed tomography was utilized, revealing a hepatic mass and multiple intra-abdominal solid masses. In triple-phase helical computed tomography the images, hepatic mass and two of four intra-abdominal masses were heterogenous in all phases. Therefore, we diagnosed a malignant hepatic tumor and presumed intra-abdominal metastases. The masses were surgically removed and were histologically composed of normal spleen tissues, findings which were consistent with ectopic spleen.

Gallbladder splenosis: a hereto unreported mimicker of a gallbladder neoplasm

Splenosis is a completely benign entity that can mimic a primary mass or metastasis. Herein we report the first known case of gallbladder splenosis in a 49-year-old woman with an extensive surgical and medical history. Cross-sectional computed tomography and MRI demonstrated a single mass arising from the gallbladder fundus. Revelation of splenectomy, confirmed to be traumatic from medical records, raised the suspicion for splenosis. The diagnosis was confirmed with a Technecium-99m-labeled heat-damaged blood cell scan, considered the gold-standard for detection of ectopic splenic tissue.

Case report of tc-99m sulfur colloid single-photon emission computed tomography/computed tomography study differentiating tumor from accessory spleen

We present a case report where Tc-99m sulfur colloid single-photon emission computed tomography (SPECT)/computed tomography (CT) scan was useful in characterizing a soft tissue abdominal mass and helped with patient management. A 63-year-old male with no previous history of trauma had an incidental finding of a soft tissue nodule adjacent to the splenic hilum, unchanged in size over 4 months and with similar enhancing features as the spleen. A Tc-99m sulfur colloid SPECT/CT scan was performed to determine the nature of the nodule. It showed no uptake of tracer within this mass, therefore excluding splenic tissue. This prompted subsequent investigations and this tissue was found to represent a pancreatic neuroendocrine tumor, which was excised.

Abdominal splenosis mimicking peritoneal deposits - A case report

Splenosis is a benign condition among patients with a history of splenic trauma or surgery. Most cases of splenosis are intra abdominal due to direct seeding of surrounding structures, although these heterotopic rests may occur almost anywhere in the body, and its diffuse nature may raise the suspicion of metastatic cancer. The increased prevalence of abdominal trauma due to road accidents and the growing armamentarium of available imaging modalities suggest that abdominal splenosis may be expected more often than ever. We, in this article emphasize the crucial role of taking a thorough patient's medical history concerning splenic trauma in the past and the use of novel non invasive diagnostics modalities that allow accurate diagnosis.

Diffuse abdominal splenosis mimicking peritoneal metastases in a 35-year-old man with a resectable carcinoma of the ampulla of vater

A 35-year-old man with a history of blunt abdominal trauma and splenic rupture was diagnosed with an ampullary adenocarcinoma. At workup, a CT scan showed multiple intra-abdominal lesions similar to peritoneal carcinosis, and the patient was referred for palliative chemotherapy. On clinical suspicion, however, a biopsy was performed on an intra-abdominal lesion, establishing the diagnosis of abdominal splenosis. A radical pancreaticoduodenectomy ad modum Whipple was performed, followed by adjuvant chemotherapy with gemcitabine. At the 18-month follow-up, the patient was free from recurrent disease. We conclude that splenosis should be considered as a differential diagnosis of peritoneal metastases in cancer patients with a history of abdominal trauma and/or splenectomy. Other reports on splenosis in cancer patients and diagnostic workup are discussed.

Diffuse intra-abdominal splenosis presenting as carcinomatosis exhibiting positron emitted tomography hypermetabolic activity

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Splenosis can mimic carcinomatosis upon many imaging modalities.

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History of splenectomy must be considered when evaluating carcinomatosis.

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Scintigraphy is the preferred for confirming the presence of splenosis.

Post-traumatic intrahepatic splenosis mimicking a neuroendocrine tumour

A 52-year-old man presented with abdominal pain with a background of splenectomy 25 years previously. Initial investigations lead to suspicion of a neuroendocrine tumour. Positron emission tomography octreotide scanning and chromogranin were raised. He subsequently underwent a lateral segmentectomy. The histopathology was consistent with splenosis. 1. Splenosis must be considered as differential in any patient with abdominal symptoms post-traumatic splenectomy. 2. Positron emission tomography (PET) octreotide scanning can detect splenosis giving false positives for a neuroendocrine tumour. This is the first case to describe such an association.

CT of splenosis: patterns and pitfalls

OBJECTIVE

After traumatic splenic injury or splenectomy, small isolated spleens may develop. These implants are not limited to the left upper quadrant, and splenosis in other locations can mimic other pathologic entities. This pictorial essay presents the range of appearances of intraabdominal and pelvic splenosis.

CONCLUSION

Radiologists can suggest or establish the correct diagnosis of splenosis in the appropriate clinical setting, particularly in less typical cases, to avert unnecessary tissue sampling.

High uptake of (68)Ga-DOTATOC in spleen as compared to splenosis: measurement by PET/CT

AIM

The aim of this study is to ascertain the high somatostatin receptor (SSTR) uptake in spleen and to compare the uptake in spleen and splenosis using SSTR PET/CT using( 68)Ga-DOTATOC.

MATERIALS AND METHODS

SUV(max) of spleen on (68)Ga-DOTATOC SSTR PET/CT (acquired for initial staging) in 10 patients with known neuroendocrine neoplasm of pancreatic tail was analyzed. All patients underwent left pancreatectomy and splenectomy. Diagnosis of splenosis was confirmed on CT, and SUV(max) was noted on follow-up SSTR PET/CT.

RESULTS

SUV(max)was 28.8 ± 12.5 in normal spleen and 10.5 ± 4.3 in splenosis.

CONCLUSION

The high uptake of( 68)Ga-DOTATOC (which has a high affinity to SSTR 2) in the spleen as compared to splenosis, which has a different histology, suggests white pulp as the probable site of high SSTR 2 expression.

Abdominal multiple splenosis mimicking liver and colon tumors: a case report and review of the literature

Splenosis is not an uncommon disease. However, it is often misdiagnosed as malignant tumors, and then the patients underwent unnecessary operations. Unfortunately, it is very difficult to diagnose it prior to operation. We report a rare case of a 49-year-old female patient with liver and colon splenosis, misdiagnosed as liver and colon tumors, and summarize experience how to diagnose it preoperatively according to literatures. We come to conclusion that in patients who ever underwent splenectomy especially owning to trauma, and were found mass in abdomen, clinicians must consider the existence of splenosis, and take some measures, such as scintigraphy with (99m) Tc labelled heat-denatured erythrocyte rather than biopsy, to diagnose it correctly to prevent unnecessary operations.