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Silva-Rojas R, Pérez-Guàrdia L, Simon A, Djeddi S, Treves S, Ribes A, Silva-Hernández L, Tard C, Laporte J, Böhm J. ORAI1 inhibition as an efficient preclinical therapy for tubular aggregate myopathy and Stormorken syndrome. JCI Insight 2024; 9:e174866. [PMID: 38516893 DOI: 10.1172/jci.insight.174866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/14/2024] [Indexed: 03/23/2024] Open
Abstract
Tubular aggregate myopathy (TAM) and Stormorken syndrome (STRMK) are clinically overlapping disorders characterized by childhood-onset muscle weakness and a variable occurrence of multisystemic signs, including short stature, thrombocytopenia, and hyposplenism. TAM/STRMK is caused by gain-of-function mutations in the Ca2+ sensor STIM1 or the Ca2+ channel ORAI1, both of which regulate Ca2+ homeostasis through the ubiquitous store-operated Ca2+ entry (SOCE) mechanism. Functional experiments in cells have demonstrated that the TAM/STRMK mutations induce SOCE overactivation, resulting in excessive influx of extracellular Ca2+. There is currently no treatment for TAM/STRMK, but SOCE is amenable to manipulation. Here, we crossed Stim1R304W/+ mice harboring the most common TAM/STRMK mutation with Orai1R93W/+ mice carrying an ORAI1 mutation partially obstructing Ca2+ influx. Compared with Stim1R304W/+ littermates, Stim1R304W/+Orai1R93W/+ offspring showed a normalization of bone architecture, spleen histology, and muscle morphology; an increase of thrombocytes; and improved muscle contraction and relaxation kinetics. Accordingly, comparative RNA-Seq detected more than 1,200 dysregulated genes in Stim1R304W/+ muscle and revealed a major restoration of gene expression in Stim1R304W/+Orai1R93W/+ mice. Altogether, we provide physiological, morphological, functional, and molecular data highlighting the therapeutic potential of ORAI1 inhibition to rescue the multisystemic TAM/STRMK signs, and we identified myostatin as a promising biomarker for TAM/STRMK in humans and mice.
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Affiliation(s)
- Roberto Silva-Rojas
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Inserm U1258, CNRS UMR7104, University of Strasbourg, Illkirch, France
| | - Laura Pérez-Guàrdia
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Inserm U1258, CNRS UMR7104, University of Strasbourg, Illkirch, France
| | - Alix Simon
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Inserm U1258, CNRS UMR7104, University of Strasbourg, Illkirch, France
| | - Sarah Djeddi
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Inserm U1258, CNRS UMR7104, University of Strasbourg, Illkirch, France
| | - Susan Treves
- Departments of Neurology and Biomedicine, Basel University Hospital, Basel, Switzerland
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Agnès Ribes
- Institute of Metabolic and Cardiovascular Disease, Inserm UMR1297 and University of Toulouse 3, Toulouse, France
- Laboratory of Hematology, University Hospital of Toulouse, Toulouse, France
| | - Lorenzo Silva-Hernández
- Neurology Service, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
| | - Céline Tard
- University Lille, Inserm, CHU Lille, U1172 Lille Neuroscience & Cognition, Center for Rare Neuromuscular Diseases Nord/Est/Ile-de-France, Lille, France
| | - Jocelyn Laporte
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Inserm U1258, CNRS UMR7104, University of Strasbourg, Illkirch, France
| | - Johann Böhm
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Inserm U1258, CNRS UMR7104, University of Strasbourg, Illkirch, France
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Valenzuela-Fuenzalida JJ, Martínez Hernández D, Milos-Brandenberg D, Koscina Z, Avila-Sepulveda R, Baez B, Perez-Jimenez D, Nova Baeza P, Orellana Donoso M, Bruna-Mejias A. Association between types of abdominopelvic cancer in patients with situs inversus total: Systematic review. Medicine (Baltimore) 2024; 103:e37093. [PMID: 38394506 DOI: 10.1097/md.0000000000037093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Situs inversus is a rare congenital anatomical variant that involves a group of anomalies regarding the arrangement of intrathoracic and intraabdominal organs. Being able to find in the abdominal region the liver, gallbladder, inferior vena cava, and head of the pancreas and ascending colon on the left side of the abdomen, while on the right side there is the spleen, the stomach, the body of the pancreas, the ligament of Treitz, descending colon among others. In this same way, the thoracic organs, lungs and heart, are changed in their position in a mirror translocation. METHODS We systematically searched MEDLINE, Web of Science, Google Scholar, CINAHL, Scopus, and LILACS; the search strategy included a combination of the following terms: "Situs inversus," "Situs inversus totalis," "Cancer," "Neoplasm," "Abdominopelvic regions," and "clinical anatomy." RESULTS Within the 41 included studies, 46 patients with situs inversus who had cancer, in addition to being found in this organ and in these regions, we also found as a result that the majority of the studies in the research were in stage II; finally, no one study could assert the direct relationship between the situs inversus totalis and the cancer. CONCLUSION If our hallmarks could make us think that more exhaustive follow-up of the stomach and other organs should be carried out in these patients, there could also be other predisposing factors for cancer, which is why more studies are suggested to give future diagnostic and treatment guidelines treatment.
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Affiliation(s)
- Juan José Valenzuela-Fuenzalida
- Department of Morphology and Function, Faculty of Health and Social Sciences, Universidad de las Américas, Santiago, Chile
- Departamento de Ciencias Química y Biológicas, Facultad de Ciencias de la Salud, Universidad Bernardo O'Higgins, Santiago, Chile
| | | | | | - Zmilovan Koscina
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile
| | | | - Belen Baez
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile
| | - Daniela Perez-Jimenez
- Department of Morphology and Function, Faculty of Health and Social Sciences, Universidad de las Américas, Santiago, Chile
| | - Pablo Nova Baeza
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile
| | - Mathias Orellana Donoso
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile
- Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - Alejandro Bruna-Mejias
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile
- Departamento de Ciencias y Geografía, Facultad de Ciencias Naturales y Exactas, Universidad de Playa Ancha, Valparaíso 2360072, Chile
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Byer J, Buell MI, Farkouh A, Kuang R, Cheng KW, Chamberlin DA, Chamberlin JD. Echidna Splenule: A Case Study of Continuous Splenogonadal Fusion. Urology 2024; 183:209-211. [PMID: 37774850 DOI: 10.1016/j.urology.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023]
Abstract
Splenogonadal fusion (SGF) is a rare congenital anomaly of an aberrant accessory spleen-gonad connection. We present a rare case of continuous splenogonadal fusion in a full-term male with a left undescended testis, multiple congenital limb anomalies, and syndromic facies. Diagnostic laparoscopy revealed the "Echidna Splenule," a snake-like intraperitoneal splenule coursing from the spleen along the left paracolic region and engulfing an atrophic intra-abdominal testis preventing spontaneous descent and distally herniating into the left open internal inguinal ring. The atrophic testis and Echidna Splenule were resected. Splenogonadal fusion should be considered in children with left undescended testis and concomitant limb and facial anomalies.
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Affiliation(s)
- Jeanette Byer
- Loma Linda University, School of Medicine, Loma Linda, CA
| | - Matthew I Buell
- Loma Linda University Children's Hospital, Department of Urology, Loma Linda, CA
| | - Ala'a Farkouh
- Loma Linda University Children's Hospital, Department of Urology, Loma Linda, CA
| | - Ruby Kuang
- Loma Linda University Children's Hospital, Department of Urology, Loma Linda, CA
| | - Kai Wen Cheng
- Loma Linda University Children's Hospital, Department of Urology, Loma Linda, CA
| | - David A Chamberlin
- Loma Linda University Children's Hospital, Department of Urology, Loma Linda, CA
| | - Joshua D Chamberlin
- Loma Linda University Children's Hospital, Department of Urology, Loma Linda, CA.
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Dalrymple A, Tan L, Byard RW. Unexpected death involving the spleen - an overview. Med Sci Law 2023; 63:316-323. [PMID: 37537888 DOI: 10.1177/00258024231191828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
The spleen is located in the left upper quadrant of the abdominal cavity and has both immunological and haematological functions. A variety of quite different entities may be associated with sudden death due to splenic involvement. These range from simple traumatic disruption of the parenchyma of a normal spleen with marked intra-abdominal haemorrhage, to conditions such as malaria and infectious mononucleosis where splenomegaly predisposes to rupture. Haematological diseases such as malignancies and haemoglobinopathies may causes sudden death due to haemorrhage or red cell sequestration. Asplenia or polysplenia may be associated with significant congenital heart disease. Hyposplenia, both structural and functional, may also result in rapid demise from sometimes unusual bacterial infections. Vascular abnormalities causing death include entities such as splenic artery aneurysms. Thus, deaths from splenic pathology may be due to localised issues or may be part of more generalised disease. For this reason the autopsy in cases of splenic-associated deaths must be comprehensive and include special testing such as microbiological screening and/or haematologic/genetic evaluation.
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Affiliation(s)
- Alice Dalrymple
- Flinders University, Bedford Park Adelaide, South Australia
- Forensic Science SA, Adelaide, South Australia
| | - Luzern Tan
- Adelaide School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Roger W Byard
- Forensic Science SA, Adelaide, South Australia
- Adelaide School of Medicine, The University of Adelaide, Adelaide, Australia
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So K, Shinagawa T, Yoshizato T, Fukahori S, Asagiri K, Maeno Y, Hayashida S, Ushijima K. Difficulty in the Diagnosis of Biliary Atresia Splenic Malformation Syndrome In Utero. Kurume Med J 2023; 68:265-268. [PMID: 37380446 DOI: 10.2739/kurumemedj.ms6834011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
The fetus of a 30-year-old pregnant Japanese woman was diagnosed with absence of inferior vena cava (IVC) and azygos continuation of interrupted IVC without cardiac anomalies at 34 weeks of gestation, and a healthy male neonate weighing 2,910 g was delivered at 37 weeks of gestation. On day 42 after birth, direct bilirubin predominant hyperbilirubinemia and high serum gamma-GTP levels were detected. Computed tomography revealed the presence of a lobulated and accessory spleen, and laparotomy demonstrated type III biliary atresia (BA), confirming the final diagnosis of BA splenic malformation (BASM) syndrome. In retrospect, non-visualization of the gallbladder was missed in utero. The combination of the absence of IVC and BA without cardiac anomalies is far less likely to occur in left isomerism. Although BA remains difficult to detect in utero, special attention should be paid to cases of BA associated with findings of left isomerism, including the absence of IVC, to enable early diagnosis and treatment of BASM.
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Affiliation(s)
- Kunio So
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Takaaki Shinagawa
- Department of Obstetrics and Gynecology, National Hospital Organization Saga Hospital
| | - Toshiyuki Yoshizato
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Suguru Fukahori
- Department of Pediatric Surgery, Kurume University School of Medicine
| | - Kimio Asagiri
- Department of Pediatric Surgery, Kurume University School of Medicine
| | - Yasuki Maeno
- Department of Pediatrics, Kurume University School of Medicine
| | - Shintaro Hayashida
- Department of Pediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University
| | - Kimio Ushijima
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
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Shen D, Li Y, Zhang Y, Chang X, Zhao X, Li J, Zhang X, Guo G. Seminoma arising in splenogonadal fusion: a case report and literature review. Diagn Pathol 2023; 18:42. [PMID: 36998078 PMCID: PMC10064669 DOI: 10.1186/s13000-023-01332-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/22/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Splenogonadal fusion (SGF) is a rare congenital malformation in which the spleen is abnormally connected to the gonads or to the mesonephric derivatives. There is no obvious causality between SGF and testicular neoplasm. However, cryptorchidism, which is a well-known risk factor of testicular germ cell tumors, are the most frequent malformations associated with SGF. To our knowledge, there are only four reported cases of SGF associated with testicular neoplasm so far. Herein, we reported a patient of this condition, and briefly reviewed the related literature. CASE PRESENTATION A 48-year-old man was diagnosed with bilateral cryptorchidism 30 years prior, and only underwent a right orchiopexy for the left testicle could not be explored during the operation. At that time, doctors failed to realize the possibility of SGF due to the lack of sufficient knowledge of this condition. This time, the patient was treated for a left abdomen mass that was diagnosed as stage III metastatic seminoma. Then, a right orchiectomy, robot-assisted laparoscopic left retroperitoneal tumor resection, and left retroperitoneal lymph node dissection was performed after four cycles of BEP (bleomycin + etoposide + cisplatin) systemic chemotherapy in our center. The final diagnosis of SGF was made by postoperative pathology. The patient was re-examined in our center at 3 months and 6 months after the operation, and no obvious abnormalities were found. CONCLUSIONS Surgeons should always bear in mind the possibility of association between bilateral cryptorchidism and splenogonadal fusion to avoid malignant transformation caused by delayed treatment.
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Affiliation(s)
- Donglai Shen
- Department of Urology, The Third Medical Center of Chinese PLA General Hospital, 69 Yong Ding Rd, Beijing, 100039, China
| | - Yuzhu Li
- Department of Urology, The Third Medical Center of Chinese PLA General Hospital, 69 Yong Ding Rd, Beijing, 100039, China
| | - Yu Zhang
- Department of Urology, The Third Medical Center of Chinese PLA General Hospital, 69 Yong Ding Rd, Beijing, 100039, China
| | - Xiao Chang
- Department of Urology, The Third Medical Center of Chinese PLA General Hospital, 69 Yong Ding Rd, Beijing, 100039, China
| | - Xupeng Zhao
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, 100853, China
| | - Jiabin Li
- Department of Urology, The Third Medical Center of Chinese PLA General Hospital, 69 Yong Ding Rd, Beijing, 100039, China
| | - Xu Zhang
- Department of Urology, The Third Medical Center of Chinese PLA General Hospital, 69 Yong Ding Rd, Beijing, 100039, China.
| | - Gang Guo
- Department of Urology, The Third Medical Center of Chinese PLA General Hospital, 69 Yong Ding Rd, Beijing, 100039, China.
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Kerkeni Y, Hannachi W, Zouaoui A, Houidi S, Jouini R. Splenogonadal fusion misdiagnosed as spermatic cord cyst: a case report. Tunis Med 2022; 100:730-732. [PMID: 36571759 PMCID: PMC9841463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Splenogonadal fusion is a rare congenital anomaly. The aim of this study was to report a case of splenogonadal fusion mimicking a spermatic cord cyst, and discuss therapeutic management of this rare congenital malformation. OBSERVATION An eight-years old patient was presented with an asymptomatic three-centimeter oval scrotal mass mistaken for a spermatic cord cyst. Surgical exploration has revealed tow purple-red, firm encapsulated masses. The first mass was two cm long and adherent to the upper pole of the left testis with a cleavage plane. The second mass was four cm long, attached to the first by a fibrous cord and drawn on its superior pole by a serpiginous vascular structure that extended inside the abdomen. The spermatic cord was individualized. Extemporaneous anatomopathological examination of the first mass, totally excised, has concluded to benign lesion. Therefore, the peritoneum was opened, and the superior mass was excised as high as it could be reached without orchiectomy. Definitive Anatomopathological examination concluded to an ectopic splenic tissue. The final diagnosis was a continuous splenogonadal fusion. CONCLUSION This case highlights the clinical characteristics of this condition, with a special focus on the signs and findings that might help prevent unnecessary orchiectomy. Consequently, it is essential to include this malformation in the differential diagnosis of scrotal masses in children.
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Affiliation(s)
- Yosra Kerkeni
- Service de Chirurgie Pédiatrique "A". Hôpital d'Enfants "Béchir Hamza" de Tunis / Université de Tunis El Manar. Faculté de médecine de Tunis
| | - Wiem Hannachi
- Service de Chirurgie Pédiatrique "A". Hôpital d'Enfants "Béchir Hamza" de Tunis / Université de Tunis El Manar. Faculté de médecine de Tunis
| | - Arije Zouaoui
- Service de Chirurgie Pédiatrique "A". Hôpital d'Enfants "Béchir Hamza" de Tunis / Université de Tunis El Manar. Faculté de médecine de Tunis
| | - Senda Houidi
- Service de Chirurgie Pédiatrique "A". Hôpital d'Enfants "Béchir Hamza" de Tunis / Université de Tunis El Manar. Faculté de médecine de Tunis
| | - Riadh Jouini
- Service de Chirurgie Pédiatrique "A". Hôpital d'Enfants "Béchir Hamza" de Tunis / Université de Tunis El Manar. Faculté de médecine de Tunis
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de la Fuente-Munoz E, Van Den Rym A, García-Solis B, Ochoa Grullón J, Guevara-Hoyer K, Fernández-Arquero M, Galán Dávila L, Matías-Guiú J, Sánchez-Ramón S, Pérez de Diego R. Case Report: Novel STIM1 Gain-of-Function Mutation in a Patient With TAM/STRMK and Immunological Involvement. Front Immunol 2022; 13:917601. [PMID: 35812399 PMCID: PMC9263075 DOI: 10.3389/fimmu.2022.917601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/27/2022] [Indexed: 11/20/2022] Open
Abstract
Gain-of-function (GOF) mutations in STIM1 are responsible for tubular aggregate myopathy and Stormorken syndrome (TAM/STRMK), a clinically overlapping multisystemic disease characterised by muscle weakness, miosis, thrombocytopaenia, hyposplenism, ichthyosis, dyslexia, and short stature. Several mutations have been reported as responsible for the disease. Herein, we describe a patient with TAM/STRMK due to a novel L303P STIM1 mutation, who not only presented clinical manifestations characteristic of TAM/STRMK but also manifested immunological involvement with respiratory infections since childhood, with chronic cough and chronic bronchiectasis. Despite the seemingly normal main immunological parameters, immune cells revealed GOF in calcium signalling compared with healthy donors. The calcium flux dysregulation in the immune cells could be responsible for our patient’s immune involvement. The patient’s mother carried the mutation but did not exhibit TAM/STRMK, manifesting an incomplete penetrance of the mutation. More cases and evidence are necessary to clarify the dual role of STIM1 in immune system dysregulation and myopathy.
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Affiliation(s)
| | - Ana Van Den Rym
- Laboratory of Immunogenetics of Human Diseases, IdiPAZ Institute for Health Research, La Paz University Hospital, Madrid, Spain
- Innate Immunity Group, IdiPAZ Institute for Health Research, La Paz University Hospital, Madrid, Spain
- Interdepartmental Group of Immunodeficiencies, Madrid, Spain
| | - Blanca García-Solis
- Laboratory of Immunogenetics of Human Diseases, IdiPAZ Institute for Health Research, La Paz University Hospital, Madrid, Spain
- Innate Immunity Group, IdiPAZ Institute for Health Research, La Paz University Hospital, Madrid, Spain
- Interdepartmental Group of Immunodeficiencies, Madrid, Spain
| | | | | | - Miguel Fernández-Arquero
- Clinical Immunology Department, San Carlos Clinical Hospital, Madrid, Spain
- Interdepartmental Group of Immunodeficiencies, Madrid, Spain
| | | | | | - Silvia Sánchez-Ramón
- Clinical Immunology Department, San Carlos Clinical Hospital, Madrid, Spain
- Interdepartmental Group of Immunodeficiencies, Madrid, Spain
| | - Rebeca Pérez de Diego
- Laboratory of Immunogenetics of Human Diseases, IdiPAZ Institute for Health Research, La Paz University Hospital, Madrid, Spain
- Innate Immunity Group, IdiPAZ Institute for Health Research, La Paz University Hospital, Madrid, Spain
- Interdepartmental Group of Immunodeficiencies, Madrid, Spain
- *Correspondence: Rebeca Pérez de Diego,
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Lenti MV, Corazza GR, Di Sabatino A. COVID-19 and asplenia: a Janus-faced issue. Intern Emerg Med 2021; 16:2341-2342. [PMID: 34156664 PMCID: PMC8217775 DOI: 10.1007/s11739-021-02761-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 10/26/2022]
Affiliation(s)
- Marco Vincenzo Lenti
- Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Golgi 19, 27100, Pavia, Italy
| | - Gino Roberto Corazza
- Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Golgi 19, 27100, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Golgi 19, 27100, Pavia, Italy.
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Rathner P, Fahrner M, Cerofolini L, Grabmayr H, Horvath F, Krobath H, Gupta A, Ravera E, Fragai M, Bechmann M, Renger T, Luchinat C, Romanin C, Müller N. Interhelical interactions within the STIM1 CC1 domain modulate CRAC channel activation. Nat Chem Biol 2021; 17:196-204. [PMID: 33106661 PMCID: PMC7610458 DOI: 10.1038/s41589-020-00672-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/04/2020] [Accepted: 09/11/2020] [Indexed: 01/28/2023]
Abstract
The calcium release activated calcium channel is activated by the endoplasmic reticulum-resident calcium sensor protein STIM1. On activation, STIM1 C terminus changes from an inactive, tight to an active, extended conformation. A coiled-coil clamp involving the CC1 and CC3 domains is essential in controlling STIM1 activation, with CC1 as the key entity. The nuclear magnetic resonance-derived solution structure of the CC1 domain represents a three-helix bundle stabilized by interhelical contacts, which are absent in the Stormorken disease-related STIM1 R304W mutant. Two interhelical sites between the CC1α1 and CC1α2 helices are key in controlling STIM1 activation, affecting the balance between tight and extended conformations. Nuclear magnetic resonance-directed mutations within these interhelical interactions restore the physiological, store-dependent activation behavior of the gain-of-function STIM1 R304W mutant. This study reveals the functional impact of interhelical interactions within the CC1 domain for modifying the CC1-CC3 clamp strength to control the activation of STIM1.
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Affiliation(s)
- Petr Rathner
- Institute of Organic Chemistry, Johannes Kepler University Linz, Linz, Austria
- Institute of Inorganic Chemistry, Johannes Kepler University Linz, Linz, Austria
| | - Marc Fahrner
- Institute of Biophysics, Johannes Kepler University Linz, Linz, Austria
| | - Linda Cerofolini
- Magnetic Resonance Center (CERM), University of Florence and Consorzio Interuniversitario Risonanze Magnetiche di Metallo Proteine (CIRMMP), Sesto Fiorentino, Italy
| | - Herwig Grabmayr
- Institute of Biophysics, Johannes Kepler University Linz, Linz, Austria
| | - Ferdinand Horvath
- Institute for Theoretical Physics, Johannes Kepler University Linz, Linz, Austria
| | - Heinrich Krobath
- Institute for Theoretical Physics, Johannes Kepler University Linz, Linz, Austria
| | - Agrim Gupta
- Institute of Organic Chemistry, Johannes Kepler University Linz, Linz, Austria
| | - Enrico Ravera
- Magnetic Resonance Center (CERM), University of Florence and Consorzio Interuniversitario Risonanze Magnetiche di Metallo Proteine (CIRMMP), Sesto Fiorentino, Italy
- Department of Chemistry, University of Florence, Sesto Fiorentino, Italy
| | - Marco Fragai
- Magnetic Resonance Center (CERM), University of Florence and Consorzio Interuniversitario Risonanze Magnetiche di Metallo Proteine (CIRMMP), Sesto Fiorentino, Italy
- Department of Chemistry, University of Florence, Sesto Fiorentino, Italy
| | - Matthias Bechmann
- Institute of Organic Chemistry, Johannes Kepler University Linz, Linz, Austria
| | - Thomas Renger
- Institute for Theoretical Physics, Johannes Kepler University Linz, Linz, Austria
| | - Claudio Luchinat
- Magnetic Resonance Center (CERM), University of Florence and Consorzio Interuniversitario Risonanze Magnetiche di Metallo Proteine (CIRMMP), Sesto Fiorentino, Italy
- Department of Chemistry, University of Florence, Sesto Fiorentino, Italy
| | - Christoph Romanin
- Institute of Biophysics, Johannes Kepler University Linz, Linz, Austria.
| | - Norbert Müller
- Institute of Organic Chemistry, Johannes Kepler University Linz, Linz, Austria.
- Faculty of Science, University of South Bohemia, České Budějovice, Czech Republic.
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Abstract
An estimated 1 million people in the United States have functional or anatomic asplenia or hyposplenia. Infectious complications due to encapsulated organisms such as Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae can lead to fulminant sepsis and death, particularly in young children, in the period shortly after splenectomy, and in immunocompromised patients. Patients with asplenia are also at risk for less common infections due to Capnocytophaga, Babesia, and malaria. Antibiotic prophylaxis, vaccines, and patient and family education are the mainstays of prevention in these at-risk patients. Recommendations for antibiotic prophylaxis typically target high-risk periods, such as 1 to 3 years after splenectomy, children ≤5 years of age, or patients with concomitant immunocompromise. However, the risk for sepsis is lifelong, with infections occurring as late as 40 years after splenectomy. Currently available vaccines recommended for patients with asplenia include pneumococcal vaccines (13-valent pneumococcal conjugate vaccine followed by the 23-valent pneumococcal polysaccharide vaccine), meningococcal vaccines (meningococcal conjugate vaccines for serogroups A, C, Y and W-135 and serogroup B meningococcal vaccines), H. influenzae type b vaccines, and inactivated influenza vaccines. Ongoing booster doses are also recommended for pneumococcal and meningococcal vaccines to maintain protection. Despite the availability of prevention tools, adherence is often a challenge. Dedicated teams or clinics focused on patient education and monitoring have demonstrated substantial improvements in vaccine coverage rates for individuals with asplenia and reduced risk of infection. Future efforts to monitor the quality of care in patients with asplenia may be important to bridge the know-do gap in this high-risk population.
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Affiliation(s)
- Grace M Lee
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
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12
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Johnson SC, Kosut J, Ching N. Disseminated Cat Scratch Disease in Pediatric Patients in Hawai'i. Hawaii J Health Soc Welf 2020; 79:64-70. [PMID: 32490388 PMCID: PMC7260883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cat scratch disease is known to be a generally benign, self-resolving illness associated with non-specific symptoms, including lymphadenopathy, fever, fatigue, anorexia, and headaches. However, it can also cause disseminated disease with a wide range of manifestations, including liver and spleen microabscesses, osteomyelitis, encephalitis, and uveitis. Eighteen pediatric cases of disseminated cat scratch disease at a single center in Hawai'i are described. This case series emphasizes the importance of disease recognition and use of appropriate diagnostic tools and disease management. The disease burden of pediatric patients with disseminated cat scratch disease in the state of Hawai'i has a high incidence and should be considered in pediatric patients with prolonged febrile illnesses.
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Affiliation(s)
| | - Jessica Kosut
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI
| | - Natascha Ching
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI
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13
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Giuffrida P, Aronico N, Rosselli M, Lenti MV, Cococcia S, Roccarina D, Saffioti F, Delliponti M, Thorburn D, Miceli E, Corazza GR, Pinzani M, Di Sabatino A. Defective spleen function in autoimmune gastrointestinal disorders. Intern Emerg Med 2020; 15:225-229. [PMID: 31214883 DOI: 10.1007/s11739-019-02129-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/06/2019] [Indexed: 12/22/2022]
Abstract
Defective spleen function increases susceptibility to bacterial infections which can be prevented by vaccine prophylaxis. Splenic hypofunction can be found in a number of autoimmune disorders; however, no data are available regarding autoimmune atrophic gastritis (AAG), autoimmune enteropathy (AIE) and autoimmune liver disease (AILD). Peripheral blood samples from patients with AAG (n = 40), AIE (n = 3) and AILD (n = 40) were collected. Patients affected by autoimmune disorders already known to be associated with splenic hypofunction, i.e. coeliac disease (CD) and ulcerative colitis (UC), were included as disease controls, while splenectomised patients and healthy subjects were evaluated as positive and negative controls, respectively. Counting of erythrocytes with membrane abnormalities, i.e. pitted red cells, was used as an indicator of spleen function (normal upper limit 4%). Defective splenic function was observed in 22 of the 40 patients with AAG (55.0%), in two of the three patients with AIE (66.6%) and in 35 of the 40 patients with AILD (87.5%). As expected, in untreated CD, refractory CD and UC there was a high prevalence of hyposplenism (43.7%, 88.2% and 54.4%, respectively). Due to the high prevalence of splenic hypofunction, patients with AAG, AILD and AIE should undergo pitted red cell evaluation and, if hyposplenic, they should be candidate to vaccine prophylaxis against encapsulated bacteria.
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Affiliation(s)
- Paolo Giuffrida
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Nicola Aronico
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Matteo Rosselli
- Institute for Liver and Digestive Health, Royal Free Hospital, University College London, London, UK
| | - Marco Vincenzo Lenti
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Sara Cococcia
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Davide Roccarina
- Institute for Liver and Digestive Health, Royal Free Hospital, University College London, London, UK
| | - Francesca Saffioti
- Institute for Liver and Digestive Health, Royal Free Hospital, University College London, London, UK
| | - Mariangela Delliponti
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Douglas Thorburn
- Institute for Liver and Digestive Health, Royal Free Hospital, University College London, London, UK
| | - Emanuela Miceli
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Gino Roberto Corazza
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Massimo Pinzani
- Institute for Liver and Digestive Health, Royal Free Hospital, University College London, London, UK
| | - Antonio Di Sabatino
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
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14
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Uchino K, Ato F, Yamada S, Matsumura S, Kanasugi J, Nakamura A, Takasugi S, Horio T, Murakami S, Mizuno S, Yamamoto H, Watarai M, Hanamura I, Takami A. [Emergence of Howell-Jolly bodies in a patient with splenic hypoplasia complicated by fulminant pneumococcal infection]. Rinsho Ketsueki 2020; 61:318-321. [PMID: 32378573 DOI: 10.11406/rinketsu.61.318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We report the case of a patient with fulminant pneumococcal infection along with the presence of Howell-Jolly bodies (HJBs) and splenic hypoplasia at the onset. A 71-year-old man developed fever during outpatient chemotherapy for IgG-κ multiple myeloma and was diagnosed with septic shock due to invasive pneumococcal infection. HJBs were observed on peripheral blood smears at this visit. Computed tomography revealed marked hypoplasia of spleen, suggesting the presence of hyposplenic function. Antibacterial therapy was initiated and the pneumococcal infection was cured; however, there was no notable change in his splenic hypoplasia. Splenic hypoplasia can be associated with fatal infections; hence, care should be taken when it is found in the elderly and in patients with cancer and those receiving immunosuppressive treatment. Even today, when automated hematology analyzers have become common, not all patients with hematological diseases have peripheral blood smears checked with a normal optical microscope. This study suggests that HJBs may be useful for simple and rapid screening of splenic hypofunction. The importance of detecting HJBs in peripheral blood smears with a normal optical microscope should be re-recognized.
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Affiliation(s)
- Kaori Uchino
- Department of Hematology, Aichi Medical University School of Medicine
| | - Fuminori Ato
- Postgraduate clinical training center, Aichi Medical University Hospital
| | - Saki Yamada
- Department of Hematology, Aichi Medical University School of Medicine
| | - Saori Matsumura
- Department of Hematology, Aichi Medical University School of Medicine
| | - Jo Kanasugi
- Department of Hematology, Aichi Medical University School of Medicine
| | - Ayano Nakamura
- Department of Hematology, Aichi Medical University School of Medicine
| | - Soichi Takasugi
- Department of Hematology, Aichi Medical University School of Medicine
| | - Tomohiro Horio
- Department of Hematology, Aichi Medical University School of Medicine
| | - Satsuki Murakami
- Department of Hematology, Aichi Medical University School of Medicine
| | - Shohei Mizuno
- Department of Hematology, Aichi Medical University School of Medicine
| | - Hidesuke Yamamoto
- Department of Hematology, Aichi Medical University School of Medicine
| | - Masaya Watarai
- Department of Hematology, Aichi Medical University School of Medicine
| | - Ichiro Hanamura
- Department of Hematology, Aichi Medical University School of Medicine
| | - Akiyoshi Takami
- Department of Hematology, Aichi Medical University School of Medicine
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15
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Xie L, Tao Y, Wu R, Ye Q, Xu H, Li Y. Congenital asplenia due to a tlx1 mutation reduces resistance to Aeromonas hydrophila infection in zebrafish. Fish Shellfish Immunol 2019; 95:538-545. [PMID: 31678534 DOI: 10.1016/j.fsi.2019.10.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/26/2019] [Accepted: 10/29/2019] [Indexed: 06/10/2023]
Abstract
It is documented that tlx1, an orphan homeobox gene, plays critical roles in the regulation of early spleen developmental in mammalian species. However, there is no direct evidence supporting the functions of tlx1 in non-mammalian species, especially in fish. In this study, we demonstrated that tlx1 is expressed in the splenic primordia as early as 52 hours post-fertilization (hpf) in zebrafish. A tlx1-/- homozygous mutant line was generated via CRISPR/Cas9 to elucidate the roles of tlx1 in spleen development in zebrafish. In the tlx1-/- background, tlx1-/- cells persisted in the splenic primordia until 52 hpf but were no longer detectable after 53 hpf, suggesting perturbation of early spleen development. The zebrafish also exhibited congenital asplenia caused by the tlx1 mutation. Asplenic zebrafish can survive and breed normally under standard laboratory conditions, but the survival rate of animals infected with Aeromonas hydrophila was significantly lower than that of wild-type (WT) zebrafish. In asplenic zebrafish, the mononuclear phagocyte system was partially impaired, as demonstrated by retarded b7r expression and reduced ccr2 expression after injection with an inactivated A. hydrophila vaccine. Furthermore, the expression of MHCII/IgM was significantly reduced in the congenitally asplenic fish compared with that of the WT zebrafish. Taken together, our data suggest that tlx1 is a crucial regulator of spleen development in fish, as it is in mammals. We have also provided a new perspective for studying the role of the spleen during pathogen challenge in fish.
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Affiliation(s)
- Lang Xie
- Institute of Three Gorges Ecological Fisheries of Chongqing, College of Animal Science and Technology, Southwest University, Chongqing, 400715, China; Key Laboratory of Freshwater Fish Reproduction and Development (Ministry of Education), Key Laboratory of Aquatic Science of Chongqing, Southwest University, Chongqing, 400715, China
| | - Yixi Tao
- Institute of Three Gorges Ecological Fisheries of Chongqing, College of Animal Science and Technology, Southwest University, Chongqing, 400715, China; Key Laboratory of Freshwater Fish Reproduction and Development (Ministry of Education), Key Laboratory of Aquatic Science of Chongqing, Southwest University, Chongqing, 400715, China
| | - Ronghua Wu
- Institute of Three Gorges Ecological Fisheries of Chongqing, College of Animal Science and Technology, Southwest University, Chongqing, 400715, China; Key Laboratory of Freshwater Fish Reproduction and Development (Ministry of Education), Key Laboratory of Aquatic Science of Chongqing, Southwest University, Chongqing, 400715, China
| | - Qin Ye
- School of Chemistry and Chemical Engineering, Southwest University, Chongqing, 400715, China
| | - Hao Xu
- Institute of Three Gorges Ecological Fisheries of Chongqing, College of Animal Science and Technology, Southwest University, Chongqing, 400715, China; Key Laboratory of Freshwater Fish Reproduction and Development (Ministry of Education), Key Laboratory of Aquatic Science of Chongqing, Southwest University, Chongqing, 400715, China
| | - Yun Li
- Institute of Three Gorges Ecological Fisheries of Chongqing, College of Animal Science and Technology, Southwest University, Chongqing, 400715, China; Key Laboratory of Freshwater Fish Reproduction and Development (Ministry of Education), Key Laboratory of Aquatic Science of Chongqing, Southwest University, Chongqing, 400715, China.
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16
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Wang P, Jing H, Li F, Wang Z, Huo L. 99mTc-Labeled Native RBC Scintigraphy in Distinguishing Polysplenia From Abdominal Masses in a Patient With Situs Inversus Totalis. Clin Nucl Med 2019; 44:998-1000. [PMID: 31689285 DOI: 10.1097/rlu.0000000000002825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 39-year-old previously healthy woman presented possible hematuria. An ultrasound examination showed right adrenal mass and suggested pheochromocytoma. A Tc-HYNIC-TOC SPECT/CT was performed, which incidentally detected situs inversus totalis and suspicion of polysplenia without definite normal spleen in the right upper abdomen. In order to differentiate the polysplenia from other etiologies, a heat-damaged Tc RBC scintigraphy was performed. The images showed significant activity in the multiple soft tissue nodules in the posterior right abdomen, consistent with ectopic polysplenia.
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Affiliation(s)
- Peipei Wang
- From the Department of Nuclear Medicine, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Science and PUMC; and Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, People's Republic of China
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17
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Ishigami K, Nishie A, Nakayama T, Asayama Y, Kakihara D, Fujita N, Ushijima Y, Okamoto D, Ohtsuka T, Mori Y, Ito T, Mochidome N, Honda H. Superparamagnetic iron-oxide-enhanced diffusion-weighted magnetic resonance imaging for the diagnosis of intrapancreatic accessory spleen. Abdom Radiol (NY) 2019; 44:3325-3335. [PMID: 31420705 DOI: 10.1007/s00261-019-02189-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of superparamagnetic iron-oxide (SPIO)-enhanced diffusion-weighted image (DWI) for distinguishing an intrapancreatic accessory spleen from pancreatic tumors. MATERIALS AND METHODS Twenty-six cases of intrapancreatic accessory spleen and nine cases of pancreatic tail tumors [neuroendocrine tumor (n = 8) and pancreatic adenocarcinoma (n = 1)] were analyzed. Two blind reviewers retrospectively reviewed the SPIO-enhanced magnetic resonance imaging (MRI) scans. The lesion visibility grades were compared and the diagnostic performance of SPIO-enhanced DWI was compared to those of SPIO-enhanced T2WI and T2*WI with the use of a receiver operating characteristic (ROC) analysis. RESULTS The grade of lesion visibility was the highest on DWI [mean ± standard deviation (SD): 2.8 ± 0.3] followed by T2WI (2.3 ± 0.7, p < 0.001) and T2*WI (2.1 ± 0.7, p < 0.0001). Reviewers 1 and 2 correctly characterized the presence or absence of SPIO uptake in 34 of 35 cases (97.1%) on DWI, 24 (68.6%) and 25 (71.4%) cases on T2WI, respectively, and 16 (45.7%) and 17 (48.6%) cases on T2*WI. The area under the ROC curve (AUC) of DWI was 0.974 and 0.989 for reviewers 1 and 2, respectively. For Reviewer 1, the AUC of DWI was significantly higher than that of T2*WI (0.756, p < 0.01), although it was not significantly different from that of T2WI (0.868, p = 0.0857). For Reviewer 2, the AUC of DWI was significantly higher than those of T2WI (0.846, p < 0.05) and T2*WI (0.803, p < 0.01). CONCLUSION The diagnostic performance of SPIO-enhanced DWI was better than those of SPIO-enhanced T2*WI and T2WI for the diagnosis of intrapancreatic accessory spleen.
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Affiliation(s)
- Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Akihiro Nishie
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tomohiro Nakayama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshiki Asayama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Daisuke Kakihara
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Nobuhiro Fujita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuhiro Ushijima
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Daisuke Okamoto
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takao Ohtsuka
- Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuhisa Mori
- Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tetsuhide Ito
- Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Naoki Mochidome
- Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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18
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Berauer JP, Mezina AI, Okou DT, Sabo A, Muzny DM, Gibbs RA, Hegde MR, Chopra P, Cutler DJ, Perlmutter DH, Bull LN, Thompson RJ, Loomes KM, Spinner NB, Rajagopalan R, Guthery SL, Moore B, Yandell M, Harpavat S, Magee JC, Kamath BM, Molleston JP, Bezerra JA, Murray KF, Alonso EM, Rosenthal P, Squires RH, Wang KS, Finegold MJ, Russo P, Sherker AH, Sokol RJ, Karpen SJ. Identification of Polycystic Kidney Disease 1 Like 1 Gene Variants in Children With Biliary Atresia Splenic Malformation Syndrome. Hepatology 2019; 70:899-910. [PMID: 30664273 PMCID: PMC6642859 DOI: 10.1002/hep.30515] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 01/02/2019] [Indexed: 12/23/2022]
Abstract
Biliary atresia (BA) is the most common cause of end-stage liver disease in children and the primary indication for pediatric liver transplantation, yet underlying etiologies remain unknown. Approximately 10% of infants affected by BA exhibit various laterality defects (heterotaxy) including splenic abnormalities and complex cardiac malformations-a distinctive subgroup commonly referred to as the biliary atresia splenic malformation (BASM) syndrome. We hypothesized that genetic factors linking laterality features with the etiopathogenesis of BA in BASM patients could be identified through whole-exome sequencing (WES) of an affected cohort. DNA specimens from 67 BASM subjects, including 58 patient-parent trios, from the National Institute of Diabetes and Digestive and Kidney Diseases-supported Childhood Liver Disease Research Network (ChiLDReN) underwent WES. Candidate gene variants derived from a prespecified set of 2,016 genes associated with ciliary dysgenesis and/or dysfunction or cholestasis were prioritized according to pathogenicity, population frequency, and mode of inheritance. Five BASM subjects harbored rare and potentially deleterious biallelic variants in polycystic kidney disease 1 like 1 (PKD1L1), a gene associated with ciliary calcium signaling and embryonic laterality determination in fish, mice, and humans. Heterozygous PKD1L1 variants were found in 3 additional subjects. Immunohistochemical analysis of liver from the one BASM subject available revealed decreased PKD1L1 expression in bile duct epithelium when compared to normal livers and livers affected by other noncholestatic diseases. Conclusion: WES identified biallelic and heterozygous PKD1L1 variants of interest in 8 BASM subjects from the ChiLDReN data set; the dual roles for PKD1L1 in laterality determination and ciliary function suggest that PKD1L1 is a biologically plausible, cholangiocyte-expressed candidate gene for the BASM syndrome.
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Affiliation(s)
- John-Paul Berauer
- Department of Pediatrics; Division of Gastroenterology, Hepatology and Nutrition; Emory University School of Medicine and Children’s Healthcare of Atlanta; Atlanta, GA, 30322, USA
| | - Anya I. Mezina
- Department of Pediatrics; Division of Gastroenterology, Hepatology and Nutrition; Emory University School of Medicine and Children’s Healthcare of Atlanta; Atlanta, GA, 30322, USA
| | - David T. Okou
- Department of Pediatrics; Division of Gastroenterology, Hepatology and Nutrition; Emory University School of Medicine and Children’s Healthcare of Atlanta; Atlanta, GA, 30322, USA
| | - Aniko Sabo
- Human Genome Sequencing Center; Baylor College of Medicine; Houston, TX, 77030, USA
| | - Donna M. Muzny
- Human Genome Sequencing Center; Baylor College of Medicine; Houston, TX, 77030, USA
| | - Richard A. Gibbs
- Human Genome Sequencing Center; Baylor College of Medicine; Houston, TX, 77030, USA
| | - Madhuri R. Hegde
- Department of Human Genetics; Emory University School of Medicine; Atlanta, GA, 30322, USA
| | - Pankaj Chopra
- Department of Human Genetics; Emory University School of Medicine; Atlanta, GA, 30322, USA
| | - David J. Cutler
- Department of Human Genetics; Emory University School of Medicine; Atlanta, GA, 30322, USA
| | - David H. Perlmutter
- Department of Pediatrics; Washington University School of Medicine; St. Louis, MO, 63110, USA
| | - Laura N. Bull
- Department of Medicine; Institute for Human Genetics, and Liver Center Laboratory, University of California San Francisco; San Francisco, CA, 94143, USA
| | | | - Kathleen M. Loomes
- Department of Pediatrics; Division of Gastroenterology, Hepatology and Nutrition; Perelman School of Medicine at the University of Pennsylvania and Children’s Hospital of Philadelphia; Philadelphia, PA 19104, USA
| | - Nancy B. Spinner
- Department of Pathology and Laboratory Medicine; Division of Genomic Diagnostics; Children’s Hospital of Philadelphia; Philadelphia PA, 19104, USA
| | - Ramakrishnan Rajagopalan
- Department of Pathology and Laboratory Medicine; Division of Genomic Diagnostics; Children’s Hospital of Philadelphia; Philadelphia PA, 19104, USA
- Department of Biomedical and Health Informatics; Children’s Hospital of Philadelphia; Philadelphia PA, 19104, USA
| | - Stephen L. Guthery
- Department of Pediatrics; Division of Gastroenterology, Hepatology and Nutrition; University of Utah; and Intermountain Primary Children’s Hospital Salt Lake City, UT, 84112, USA
| | - Barry Moore
- Department of Human Genetics; University of Utah; Salt Lake City, UT, 84112, USA
| | - Mark Yandell
- Department of Human Genetics; University of Utah; Salt Lake City, UT, 84112, USA
| | - Sanjiv Harpavat
- Department of Pediatrics; Division of Gastroenterology, Hepatology and Nutrition; Baylor College of Medicine; Houston, TX, 77030, USA
| | - John C. Magee
- University of Michigan Medical School; Ann Arbor, MI, 48103, USA
| | - Binita M. Kamath
- Division of Gastroenterology, Hepatology and Nutrition; Hospital for Sick Children and University of Toronto; Toronto, ON, M5G 1X8, Canada
| | - Jean P. Molleston
- Department of Pediatrics; Division of Gastroenterology, Hepatology and Nutrition; Indiana University School of Medicine and Riley Hospital for Children; Indianapolis, IN, 46202, USA
| | - Jorge A. Bezerra
- Department of Pediatrics; Division of Gastroenterology, Hepatology and Nutrition; Cincinnati Children’s Hospital Medical Center; Cincinnati, OH, 45229, USA
| | - Karen F. Murray
- Department of Pediatrics; Division of Gastroenterology and Hepatology; University of Washington School of Medicine and Seattle Children’s Hospital; Seattle, WA, 98105, USA
| | - Estella M. Alonso
- Department of Pediatrics; Division of Gastroenterology, Hepatology and Nutrition; Ann and Robert H. Lurie Children’s Hospital of Chicago; Chicago, IL, 60611, USA
| | - Philip Rosenthal
- Department of Pediatrics; Division of Gastroenterology, Hepatology and Nutrition; University of California San Francisco; San Francisco, CA, 94143, USA
| | - Robert H. Squires
- Department of Pediatrics; Division of Gastroenterology, Hepatology and Nutrition; Children’s Hospital of Pittsburgh of UPMC; Pittsburgh, PA, 15224, USA
| | - Kasper S. Wang
- Department of Surgery; Division of Pediatric Surgery; Children’s Hospital of Los Angeles; University of Southern California; Los Angeles, CO, 90027, USA
| | - Milton J. Finegold
- Department of Pediatrics; Department of Molecular and Cellular Biology; Baylor College of Medicine; Houston, TX, 77030, USA
| | - Pierre Russo
- Department of Pathology and Laboratory Medicine; Children’s Hospital of Philadelphia; Philadelphia PA, 19104, USA
| | - Averell H. Sherker
- Liver Diseases Research Branch; National Institute of Diabetes and Digestive and Kidney Diseases; National Institutes of Health; Bethesda, MD, 20892, USA
| | - Ronald J. Sokol
- Department of Pediatrics; Section of Gastroenterology, Hepatology and Nutrition; Children’s Hospital Colorado and University of Colorado School of Medicine; Aurora, CO, 80045, USA
| | - Saul J. Karpen
- Department of Pediatrics; Division of Gastroenterology, Hepatology and Nutrition; Emory University School of Medicine and Children’s Healthcare of Atlanta; Atlanta, GA, 30322, USA
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Solum NO, Brosstad F, Østerud B, Sakariassen KS, Gogstad G. Professor Helge Stormorken, 1922-2019. J Thromb Haemost 2019; 17:1579-1580. [PMID: 31479185 DOI: 10.1111/jth.14585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Grosu S, Rübenthaler J, Knösel T, Trottmann M, Marcon J, Clevert DA. Splenogonadal fusion evaluation using Contrast Enhanced Ultrasound and Elastography. A case report. Med Ultrason 2019; 21:356-358. [PMID: 31476218 DOI: 10.11152/mu-1897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We present the case of splenogonadal fusion in a 53-year-old male patient assessed by ultrasound and MRI, confirmed by pathologic examination. In addition to B-mode and colour-coded Doppler ultrasound, shear wave elastography and CEUS were performed and are presented in detail. Splenogonadal fusion is a rare congenital anomaly presumably caused by an abnormal attachment of splenic tissue to the gonad during gestation. Diagnosis is challenging for clinicians and in unclear cases splenogonadal fusion might cause unnecessary orchiectomies with benign pathologic results. Ultrasound is the first-line imaging modality in the diagnosis of testicular pathologies. This case report summarizes all available modern ultrasound imagingtechnologies and highlights the possibilities for the diagnosis of splenogonadal fusion.
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Affiliation(s)
- Sergio Grosu
- Department of Radiology, Interdisciplinary Ultrasound-Center, University Hospital, LMU Munich, Munich, Germany.
| | - Johannes Rübenthaler
- Department of Radiology, Interdisciplinary Ultrasound-Center, University Hospital, LMU Munich, Munich, Germany.
| | - Thomas Knösel
- Department of Pathology, University Hospital, LMU Munich, Munich, Germany.
| | - Matthias Trottmann
- Department of Urology, University Hospital, LMU Munich, Munich, Germany.
| | - Julian Marcon
- Department of Urology, University Hospital, LMU Munich, Munich, Germany.
| | - Dirk-Andre Clevert
- Department of Radiology, Interdisciplinary Ultrasound-Center, University Hospital, LMU Munich, Munich, Germany.
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Ng MRA, McCullers M, Gamenthaler A. Wandering Spleen with 720-degree Torsion Treated with Splenectomy and Distal Pancreatectomy. Am Surg 2019; 85:e430-e432. [PMID: 31560339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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22
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Li WZ, Wan X, Li L, Xu B, Wang Z. Primary Hyperaldosteronism Induced by Aldosterone-Producing Adenoma Co-Existing with A Left Suprarenal Accessory Spleen: Two Case Reports and A Review of The Literature. Urol J 2019; 16:318-321. [PMID: 30120761 DOI: 10.22037/uj.v0i0.4134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We encountered 2 patients (a 33-year-old woman and a 66-year-old man) with an aldosterone-producing adenoma (APA) and a left accessory spleen. The patients' primary symptoms were hypertension and hypokalemia, and both had elevated serum aldosterone levels. Preoperative computed tomography a left suprarenal retroperitoneal mass and laparoscopic left adrenalectomy was performed in both cases. The postoperative microscopic examination revealed splenic tissue. Both patients experienced relief of their hypertension and hypokalemia, with an uneventful recovery.
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Affiliation(s)
- Wen-Zhi Li
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine.
| | - Xiang Wan
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
| | - Long Li
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
| | - Bin Xu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
| | - Zhong Wang
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
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Sharma UK, Thapa DK, Pokhrel D, Shah AK. Persistent Mullerian Duct Syndrome with Polysplenia and Short Pancreas: A Case Report. JNMA J Nepal Med Assoc 2019. [PMID: 31477947 PMCID: PMC8827582 DOI: 10.31729/jnma.4298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Persistent Mullerian duct syndrome is a rare entity and usually presents with common symptoms of undescended testis and hernia. The syndrome is caused by an insufficient amount of Mullerian inhibiting substance or due to the insensitivity of the target organ to Mullerian inhibiting substance. Polysplenia is a rare congenital disease manifested by multiple small accessory spleens. The association of these two entities, Persistent Mullerian duct syndrome and polysplenia, is rare and has not been reported in the literature. We reported a case of a 27 years old male presented with complains of right flank pain and nausea. Ultrasound showed right ureteric calculus with hydronephrosis and elongated soft tissue mass posterior to bladder. Contrast enhanced Computed Tomography showed soft tissue suggestive of infantile uterine structure with multiple splenculi and short pancreas. He was diagnosed as Persistent Mullerian duct syndrome with unilateral cryptorchidism, polysplenia and short pancreas, coincidentally detected while evaluating for ureteric colic. He underwent Ureteroscopic Lithotripsy with stenting for ureteric calculus, however, he refused laparotomy with excision of mullerian structures.
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Affiliation(s)
- Umesh Kumar Sharma
- Department of Radiology, B&C Medical College Teaching Hospital, Birtamod, Jhapa, Nepal
| | - Dinesh Kumar Thapa
- Department of Neurosurgery, B&C Medical College Teaching Hospital, Birtamod, Jhapa, Nepal
- Correspondence: Dr. Dinesh Kumar Thapa, Department of Neurosurgery, B&C Medical College, Teaching Hospital, Birtamod, Jhapa, Nepal. , Phone: +9779843123518
| | - Dinesh Pokhrel
- Department of Radiology, B&C Medical College Teaching Hospital, Birtamod, Jhapa, Nepal
| | - Amit Kumar Shah
- Department of Urology, B&C Medical College Teaching Hospital, Birtamod, Jhapa, Nepal
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Marín Serrano E, Barbado Cano A. Sometimes things are what they seem. Rev Esp Enferm Dig 2019; 111:334. [PMID: 30810326 DOI: 10.17235/reed.2019.5911/2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Accessory spleen is a frequent congenital abnormality (10-20%) resulting in the fusion failure of splenunculi. We present a case report of a 74 year-old man with a nodule identified in the tail of the pancreas of 1.8 cm x 1.5 cm in size. The CT scan showed soft tissue attenuation and arterial hyperenhancement with a lower uptake in the central area, low 18-FDG affinity and no evidence of 111-In-octretide uptake. A solid, round and well-circumscribed nodule was defined as an intrapancreatic accessory spleen (IPAS) by endoscopic ultrasound (EUS), due to shared ultrasonographic characteristics and a pattern of contrast enhancement with the spleen. The material obtained by EUS guided puncture was consistent with a lymph node. A distal pancreatectomy confirmed the presence of an IPAS.
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Abstract
Ca2+ release-activated Ca2+ (CRAC) channels are intimately linked with health and disease. The gene encoding the CRAC channel, ORAI1, was discovered in part by genetic analysis of patients with abolished CRAC channel function. And patients with autosomal recessive loss-of-function (LOF) mutations in ORAI1 and its activator stromal interaction molecule 1 (STIM1) that abolish CRAC channel function and store-operated Ca2+ entry (SOCE) define essential functions of CRAC channels in health and disease. Conversely, gain-of-function (GOF) mutations in ORAI1 and STIM1 are associated with tubular aggregate myopathy (TAM) and Stormorken syndrome due to constitutive CRAC channel activation. In addition, genetically engineered animal models of ORAI and STIM function have provided important insights into the physiological and pathophysiological roles of CRAC channels in cell types and organs beyond those affected in human patients. The picture emerging from this body of work shows CRAC channels as important regulators of cell function in many tissues, and as potential drug targets for the treatment of autoimmune and inflammatory disorders.
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Affiliation(s)
- Stefan Feske
- Department of Pathology, New York University School of Medicine, New York, NY, 10016, USA.
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Abstract
An accessory spleen is a rare entity which is usually asymptomatic. When symptomatic, it presents as an acute abdomen, with either torsion, rupture or haemorrhage. We present the case of a 20-year-old man who presented with chronic lower abdominal pain since 3 months and a lump in the left lower quadrant. On clinical examination and investigations, the lump was diagnosed as a mesenteric cyst, and an uncomplicated laparoscopic excision was performed. The postoperative histopathological examination reported it as an infarcted accessory spleen.
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Affiliation(s)
- Harsh Sheth
- General Surgery, Seth GS Medical College and KEM Hospital, Mumbai, Maharshtra, India
| | - Sadashiv Chaudhari
- General Surgery, Seth GS Medical College and KEM Hospital, Mumbai, Maharshtra, India
| | - Yash Sinha
- General Surgery, Seth GS Medical College and KEM Hospital, Mumbai, Maharshtra, India
| | - Ramlal Prajapati
- General Surgery, Seth GS Medical College and KEM Hospital, Mumbai, Maharshtra, India
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Abstract
Accessory spleen (AS) is common anomaly, and 20% of AS cases occur in the pancreatic tail. An intrapancreatic AS can be difficult to distinguish from pancreatic neoplasms. In most cases, an AS is described as a hypervascular and solitary tumor, but an AS sometimes takes other forms. We herein report a rare case of an intrapancreatic AS with temporal changes in its appearance after splenectomy, which mimicked aspects of pancreatic cancer. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and 99mTc sulfur colloid scintigraphy were useful for the diagnosis.
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Affiliation(s)
- Daisuke Uchida
- Department of Gastroenterology, Okayama University Hospital, Japan
| | | | - Hironari Kato
- Department of Gastroenterology, Okayama University Hospital, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology, Okayama University Hospital, Japan
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Val-Bernal JF, Martino M, Yllera-Contreras E, Castro-Senosiain B, Bueno-Ortiz P. Intrapancreatic accessory spleen. Report of four cases diagnosed by ultrasound-guided fine-needle aspiration biopsy. Rom J Morphol Embryol 2018; 59:619-624. [PMID: 30173273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Intrapancreatic accessory spleen (IPAS) is a congenital anomaly usually misdiagnosed as a pancreatic neoplasm. For five years and four months, we collected seven IPASs located in the tail of the pancreas in four patients diagnosed by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). All cases had associated cell block preparations. Each patient underwent endoscopic ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) studies. The patients ranged in age from 57 to 73 years (mean age 65.7 years old). All lesions were well-defined, 1-1.9 cm in size (mean 1.5 cm). To our knowledge, a case with four IPASs in the tail of the gland has not been previously reported. Cytological features of IPAS included a polymorphous population of hematopoietic cells admixed with occasional blood vessels. Cell blocks comprised spleen red pulp. CD8 immunostaining of cell blocks highlighted splenic endothelial cells and confirmed the diagnosis. IPAS presented as an asymptomatic lesion detected on imaging studies. It may mimic a pancreatic neoplasm, mainly a neuroendocrine tumor. The use of EUS-FNA is an essential tool in the diagnosis of the lesion. The endothelial cells of the splenic sinuses characterized by their positivity for CD8 are evident in the sections of the cell blocks. This staining is considered specific and can be used as a confirmatory marker. EUS-FNA biopsy provides a reliable diagnosis that prevents unnecessary surgery.
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Affiliation(s)
- José Fernando Val-Bernal
- Pathology Unit, Department of Medical and Surgical Sciences, University of Cantabria and IDIVAL Research Institute, Santander, Spain;
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Golestaneh S, Kashef MA, Hiser WL, Lotfi AS, Egan TG. Ruptured Sinus of Valsalva Aneurysm Associated with Situs Ambiguus, Isolated Levocardia, and Polysplenia. Tex Heart Inst J 2017; 44:416-419. [PMID: 29276443 DOI: 10.14503/thij-16-6106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aneurysm of the sinus of Valsalva, a rare cardiac condition, results from dilation of an aortic sinus. Sudden aneurysm rupture can trigger rapidly progressive heart failure. We discuss the case of a 57-year-old woman with situs ambiguus, isolated levocardia, and polysplenia who presented with acute-onset heart failure. Transesophageal echocardiograms revealed an aneurysm of the right coronary sinus of Valsalva that had ruptured into the right atrial cavity. The patient underwent successful surgical repair. To our knowledge, this is the first report of a sinus of Valsalva aneurysm in a patient with this combination of congenital abnormalities. We briefly review the association between congenital heart disease, situs ambiguus, and ciliary dysfunction.
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Araújo NC, Orlando MMC, Neves MB, Rioja SS, de Lucena SBG, Mandarim-de-Lacerda CA. Howell-Jolly bodies and liver-spleen scanning for assessment of splenic filtrative function yields discordant results in renal transplant recipients. Medicine (Baltimore) 2017; 96:e9242. [PMID: 29390481 PMCID: PMC5758183 DOI: 10.1097/md.0000000000009242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Given discrepancies between methods for diagnosing hyposplenism, the purpose of this study was to evaluate the effect of the spleen size on the correlation between the methods, and to propose a model for improving the interpretation. Patients with renal allografts were included, in whom the spleen was assessed using Doppler ultrasound, scintiscan, and the presence of Howell-Jolly bodies (HJBs) in peripheral smears. In 35 subjects, scintiscan and HJBs were normal (Group 0); 20 had an abnormal result in both methods (Group 1); 34 had discordant results with HJBs present (Group 2); and 14 had discordant results with decreased spleen uptake (Group 3). There was no association between HJBs and scintiscan. The patients of Groups 1 and 2 had smaller spleens. The patients with smaller spleen had more hematological evidence of hyposplenism and exhibit smaller discrepancies between the methods than patients with larger spleen. The spleen can tip the balance from a normal to impaired function provided that the spleen size is below the critical mass required to maintain splenic function. A mild impairment of phagocytic function and slight dyserythropoiesis along with a small spleen would result in decreased take up of radiocolloid or the appearance of HJBs in blood smears.
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31
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Pagkratis S, Kryeziu S, Lin M, Hoque S, Bucobo JC, Buscaglia JM, Georgakis GV, Sasson AR, Kim J. Case report of intestinal non-rotation, heterotaxy, and polysplenia in a patient with pancreatic cancer. Medicine (Baltimore) 2017; 96:e8599. [PMID: 29245220 PMCID: PMC5728835 DOI: 10.1097/md.0000000000008599] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Heterotaxy with polysplenia is an extremely rare congenital condition resulting from abnormal arrangement of organs in the abdominal and thoracic cavities during embryologic development. When a malignancy such as pancreatic cancer develops under these conditions, surgical resection becomes particularly complex. This case report demonstrates successful pancreatic cancer resection despite the patient's complicated anatomy. PATIENT CONCERNS An 82-year-old female presented to our institution with complaints of mild right upper quadrant pain radiating to the mid-epigastric region. DIAGNOSES Physical examination revealed jaundice with scleral icterus consistent with obstructive jaundice. Radiographic imaging revealed hepatic duct dilation with several anatomic anomalies including small bowel location in the right upper abdomen, cecum, and appendix in the left lower quadrant, reversed superior mesenteric artery and superior mesenteric vein positions, and right-sided duodenal-jejunal flexture as well as an entirely right-sided pancreas, and left lower pelvis with ≥6 separate splenules. These findings resulted in a diagnosis of heterotaxy syndrome with polysplenia. INTERVENTIONS Careful preoperative planning and total pancreatectomy was performed without complication. OUTCOMES The patient recovered well. Pathologic examination of the pancreatic mass revealed moderately/poorly differentiated invasive pancreatic duct adenocarcinoma. The patient remains alive and well without signs of recurrent disease at the 2-year follow-up. LESSONS Given the wide range of anatomical variants observed in patients with heterotaxy syndrome, a thorough radiologic assessment is necessary before engaging in any surgical procedure. In our case, preoperative identification of the various anatomic anomalies, such as the short and vertically oriented pancreas, the porta hepatis position anterior to the duodenum, the nonrotation of the intestines and the anomalous origin of the right hepatic artery allowed us to perform a safe and uncomplicated total pancreatectomy.
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32
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Affiliation(s)
- Mohammed Fadel
- Children's Intensive Care Unit, Leicester Royal Infirmary, Leicester LE1 5WW, UK
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Tendler R, Farah RK, Kais M, Odeh M, Bornstein J. Symptomatic pelvic accessory spleen in a female adolescent: Case report. J Clin Ultrasound 2017; 45:600-602. [PMID: 28186623 DOI: 10.1002/jcu.22448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 09/12/2016] [Accepted: 12/07/2016] [Indexed: 06/06/2023]
Abstract
Accessory spleens are congenital foci of healthy splenic tissue that are separate from the main body of the spleen. They occur in 10-30% of individuals; a wandering accessory spleen located in the pelvis is uncommon. Most patients are asymptomatic. We describe the case of a female adolescent presenting with acute abdominal pain who had a pelvic accessory spleen that mimicked an adnexal mass. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:600-602, 2017.
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Affiliation(s)
- Rene Tendler
- Department of Obstetrics and Gynecology, Galilee Medical Center-Nahariya, POB 21, Nahariya, 22100, Israel
| | - Rola Khamise Farah
- Department of Obstetrics and Gynecology, Galilee Medical Center-Nahariya, POB 21, Nahariya, 22100, Israel
| | - Mohamad Kais
- Department of Obstetrics and Gynecology, Galilee Medical Center-Nahariya, POB 21, Nahariya, 22100, Israel
| | - Marwan Odeh
- Galilee Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Jacob Bornstein
- Galilee Faculty of Medicine, Bar Ilan University, Safed, Israel
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Shan GD, Chen WG, Hu FL, Chen LH, Yu JH, Zhu HT, Gao QQ, Xu GQ. A spontaneous hematoma arising within an intrapancreatic accessory spleen: A case report and literature review. Medicine (Baltimore) 2017; 96:e8092. [PMID: 29019877 PMCID: PMC5662300 DOI: 10.1097/md.0000000000008092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONAL Hematoma arising within an intrapancreatic accessory spleen (IPAS) is an extremely rare pathological entity. PATIENT CONCERN We present the case of a 39-year-old man with acute abdominal pain. DIAGNOSES The patient was initially diagnosed as pancreatic cystic neoplasm according to CT and MRI imaging. INTERVENTIONS Distal pancreatectomy was conducted because of the possibility of malignancy. OUTCOMES Surgical resection showed that the lesion was a hematoma in an IPAS. LESSONS Our case indicated that the differential diagnosis of hematoma in IPAS should be born in mind for cases with cystic neoplasm in tail of pancreas and an epidermoid cyst arising within an intrapancreatic accessory spleen (ECIAS).
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Affiliation(s)
| | | | | | | | | | | | - Qi-Qi Gao
- Department of Pathology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Abstract
RATIONALE Accessory spleen torsion is a rare cause of the acute abdomen. The complications of accessory spleen torsion, such as intestinal obstruction, are rarer. We herein report a case of colonic obstruction caused by accessory spleen torsion because of the unusual condition. PATIENT CONCERNS A 15-year-old patient presented with acute intestinal obstruction with signs of peritoneal irritation. Abdominal computed tomography (CT) and ultrasonography examinations revealed a soft tissue mass in the left midabdomen. Systemic inflammatory response syndrome (SIRS) was observed in this case. DIAGNOSES The diagnosis of peritonitis and colonic obstruction secondary to accessory spleen torsion was made. Pathologic examination showed infracted splenic tissue. INTERVENTIONS We performed emergency laparotomy and found that accessory spleen torsion pressured against splenic flexure and descending colon, and caused colon obstruction. The patient underwent accessory splenectomy and enteral decompression. OUTCOMES At 6 months follow-up, the patient recovered well with perfect digestion. LESSONS Accessory spleen torsion and its complications are extremely rare. This entity should be considered in differential diagnosis of acute abdomen. However, in case of acute abdomen with critical clinical situation, emergency surgical intervention is necessary for timely diagnosis and treatment.
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Affiliation(s)
| | | | | | | | | | | | - Zhili Pan
- Department of Radiology, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui, China
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Back SJ, Maya CL, Khwaja A. Ultrasound of congenital and inherited disorders of the pediatric hepatobiliary system, pancreas and spleen. Pediatr Radiol 2017; 47:1069-1078. [PMID: 28779194 DOI: 10.1007/s00247-017-3869-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/26/2017] [Accepted: 04/11/2017] [Indexed: 12/17/2022]
Abstract
Ultrasound is often the initial imaging examination performed of the solid organs of the pediatric abdomen. The sonographic appearance of the hepatobiliary system, pancreas and spleen changes with growth and development. This article reviews the normal US appearance of these organs in children and illustrates, through case examples, congenital and inherited conditions that affect them.
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Affiliation(s)
- Susan J Back
- Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Carolina L Maya
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Asef Khwaja
- Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
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Barra S, Lepore R, Cappabianca A, Barra F. Bilobate wandering spleen with doble torsion of the vascular pedicle. A case report. Ann Ital Chir 2017; 6:S2239253X17026536. [PMID: 28272028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Wandering spleen is a rare clinical condition which is often an incidental finding. It is characterized by excessive mobility and displacement of the spleen within the abdomen; although the spleen is usually of normal size it has an elongated vascular pedicle . CASE STUDY We present the case of an adult woman who complaining of abdominal pain who was brought to our institution for emergency treatment. She later developed an acute abdomen due to infarction of a wandering spleen caused by double torsion of the vascular pedicle. Emergency splenectomy was performed. RESULTS Surgical treatment of a wandering spleen is generally conservative and consists in splenoplexy. In our case, complicated by ischemia leading to irreversible damage of the spleen, splenectomy was the solution. DISCUSSION The long vascular pedicle of a migrant spleen is at risk of torsion which can cause irreversible acute ischemia of the spleen. Therefore a timely diagnosis with the use of modern imaging techniques is of primary importance. CONCLUSIONS Early interpretation of the symptoms and computed tomography angiography can prevent the complications that result from torsion of the elongated pedicle. KEY WORDS Acute abdomen, Bilobate wandering spleen, Splenectomy.
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Li X, Ye J, Jiang G. Sonographic diagnosis of splenogonadal fusion in a 2-year-old boy. J Clin Ultrasound 2017; 45:179-182. [PMID: 27813097 DOI: 10.1002/jcu.22392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/29/2016] [Accepted: 08/06/2016] [Indexed: 06/06/2023]
Abstract
Splenogonadal fusion (SGF) is a rare congenital abnormality. It is typically identified during orchiectomy for a suspected testicular tumor or during orchiopexy. We describe the sonographic findings in a case of SGF that could help with correct diagnosis preoperatively. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:179-182, 2017.
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Affiliation(s)
- Xiaoying Li
- Department of Ultrasound, Zhejiang University School of Medicine, Childrens Hospital, Hangzhou, 310003, Zhejiang, Peoples Republic of China
| | - Jingjing Ye
- Department of Ultrasound, Zhejiang University School of Medicine, Childrens Hospital, Hangzhou, 310003, Zhejiang, Peoples Republic of China
| | - Guoping Jiang
- Department of Ultrasound, Zhejiang University School of Medicine, Childrens Hospital, Hangzhou, 310003, Zhejiang, Peoples Republic of China
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Teoh KH, Balraj S, Navarasi SR. Intrapancreatic accessory spleen: An eluding diagnosis. Med J Malaysia 2017; 72:68-70. [PMID: 28255147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Intrapancreatic accessory spleen (IPAS) is a benign anomaly of splenic embryology and a rare cause of pancreatic pseudotumour. Here, we report a case of a 70-year-old Malay lady whose IPAS was discovered incidentally during her surveillance computed tomography for her underlying left lower lung fibrosis. Radiologically, the lesion mimicked a neuroendocrine pancreatic tumour and was only diagnosed pathologically as IPAS after surgery. In conclusion, recognising IPAS as a differential for enhancing pancreatic mass allows us to exhaust all non-invasive diagnostic means to diagnose this benign lesion. It will allow the patient to avoid unnecessary surgery and its accompanying complications.
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Affiliation(s)
- K H Teoh
- Penang General Hospital, Department of General Surgery, Penang, Malaysia.
| | - S Balraj
- Penang General Hospital, Department of General Surgery, Penang, Malaysia
| | - S R Navarasi
- Penang General Hospital, Department of Pathology, Penang, Malaysia
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40
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Basta AM, Lusk LA, Keller RL, Filly RA. Spleen Behind the Heart Complicates Lung-to-Head Ratio Measurement in Left-Sided Congenital Diaphragmatic Hernia. J Ultrasound Med 2016; 35:2717-2721. [PMID: 27872422 DOI: 10.7863/ultra.15.11063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 12/23/2015] [Accepted: 02/26/2015] [Indexed: 06/06/2023]
Abstract
In fetuses with left-sided congenital diaphragmatic hernia, intrathoracic herniation of the spleen is a common occurrence. The herniated spleen can reside posterior to the left atrium of the heart in the right hemithorax and is increasingly differentiated from the lung with the use of newer sonographic equipment. Estimation of the neonatal prognosis relies on accurate measurement of fetal lung size, particularly with commonly used measurements such as the lung-to-head ratio. Here we describe how herniation of the spleen behind the heart can complicate measurement of the lung-to-head ratio on sonography and lead to overestimation, with implications for perinatal prognostication and management.
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Affiliation(s)
- Amaya M Basta
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Medical Center, San Francisco, California USA
| | - Leslie A Lusk
- Department of Pediatrics, Division of Neonatology, University of California, San Francisco, Benioff Children's Hospital, San Francisco, California USA
| | - Roberta L Keller
- Department of Pediatrics, Division of Neonatology, University of California, San Francisco, Benioff Children's Hospital, San Francisco, California USA
- University of California, San Francisco, Fetal Treatment Center, San Francisco, California USA
| | - Roy A Filly
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Medical Center, San Francisco, California USA
- University of California, San Francisco, Fetal Treatment Center, San Francisco, California USA
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Tartaglia D, Sandomenico R, Cobuccio L, Bertolucci A, Decanini L, Galatioto C, Chiarugi M. An unusual case of repeated splenectomy: traumatic rupture of an accessory spleen in a previously splenectomized patient. Ann Ital Chir 2016; 2627:S2239253X1602627X. [PMID: 27881834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED The traumatic rupture of an accessory spleen is a very rare condition and only few cases have been reported in the literature. We describe the case of a 51-year-old man undergone splenectomy for trauma several years before, who developed hemoperitoneum due to a laceration of a voluminous accessory spleen, following an accidental two-meter fall. As a conservative management of the injury was not possible, an accessory splenectomy was then required. Thus, a briefly review of the literature about this uncommon topic was perfomed. KEY WORDS Accessory spleen, Laparotomy, Trauma.
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42
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Hesse N, Rentsch M, Reichelt A. [Acute abdomen with abdominal mass and missing spleen]. Radiologe 2016; 56:990-992. [PMID: 27638821 DOI: 10.1007/s00117-016-0164-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- N Hesse
- Institut für Klinische Radiologie, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
| | - M Rentsch
- Institut für Klinische Radiologie, LMU München, Marchioninistr. 15, 81377, München, Deutschland
| | - A Reichelt
- Institut für Klinische Radiologie, LMU München, Marchioninistr. 15, 81377, München, Deutschland
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Ates I, Yazici O, Yazilitas D, Ozdemir N, Zengin N. Accessory spleen hypertrophy mimicking colon cancer metastasis. Exp Oncol 2016; 38:202-203. [PMID: 27685531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Accessory spleen is a congenital form of an ectopic splenic tissue. In this report, we present a case of a patient who was followed with the diagnosis of rectal and sigmoid colon cancer and an accessory spleen hypertrophy, which was thought to be colon cancer metastasis in the left hypochondriac region. After colectomy and splenectomy, accessory spleen that mimics cancer metastasis was diffrentially diagnosed using scintigraphy.
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Affiliation(s)
- I Ates
- Department of Oncology, Ankara Numune Education and Research Hospital, Ankara 06100, Turkey
| | - O Yazici
- Department of Oncology, Ankara Numune Education and Research Hospital, Ankara 06100, Turkey
| | - D Yazilitas
- Department of Oncology, Ankara Numune Education and Research Hospital, Ankara 06100, Turkey
| | - N Ozdemir
- Department of Oncology, Ankara Numune Education and Research Hospital, Ankara 06100, Turkey
| | - N Zengin
- Department of Oncology, Ankara Numune Education and Research Hospital, Ankara 06100, Turkey
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Ibukuro K, Takeguchi T, Fukuda H, Abe S, Tobe K. Spatial anatomy of the round ligament, gallbladder, and intrahepatic vessels in patients with right-sided round ligament of the liver. Surg Radiol Anat 2016; 38:1061-1067. [PMID: 27068289 DOI: 10.1007/s00276-016-1674-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/28/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE To analyze the vascular structure of the liver in patients with a right-sided round ligament. METHODS We reviewed 16 patients with a right-sided round ligament and 3 polysplenia and situs inversus patients with a left-sided round ligament who underwent multidetector row CT with contrast media. The patient population consisted of 13 men and 6 women (mean 62 years). We analyzed the axial and volume-rendered images for the location of the round ligament, gallbladder, portal veins, hepatic veins, and hepatic artery. The following imaging findings for the patients with polysplenia and situs inversus were horizontally reversed. RESULTS The prevalence of a right-sided round ligament with and without polysplenia was 75 and 0.11 %, respectively. The gallbladder was located to the right, below, and left of the round ligament in 27.7, 38.8 and 33.3 %, respectively. Independent branching of the right posterior portal vein was noted in 57.8 %. PV4 was difficult to identify in 36.8 %. The middle hepatic vein was located to the left of the round ligament. Two branching patterns for the lateral and medial branches of the right anterior hepatic artery were noted: the common (44.4 %) and separated types (55.5 %). Both of the right anterior hepatic artery and portal vein ramified into two segments; the lateral segment with many branches and the medial segment with a few branches. CONCLUSIONS The right-sided round ligament divided the right anterior section into the lateral and medial segments based on the portal vein and hepatic artery anatomy.
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Affiliation(s)
- Kenji Ibukuro
- Department of Radiology, Mitsui Memorial Hospital, 1-Kanda Izumicho Chiyoda-ku, Tokyo, 101-8643, Japan.
| | - Takaya Takeguchi
- Department of Radiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyounanchou, Musashino, Tokyo, 180-8610, Japan
| | - Hozumi Fukuda
- Department of Radiology, Mitsui Memorial Hospital, 1-Kanda Izumicho Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Shoko Abe
- Department of Radiology, Mitsui Memorial Hospital, 1-Kanda Izumicho Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Kimiko Tobe
- Department of Radiology, Mitsui Memorial Hospital, 1-Kanda Izumicho Chiyoda-ku, Tokyo, 101-8643, Japan
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Gottschalk I, Stressig R, Ritgen J, Herberg U, Breuer J, Vorndamme A, Strizek B, Willruth A, Geipel A, Gembruch U, Berg C. Extracardiac anomalies in prenatally diagnosed heterotaxy syndrome. Ultrasound Obstet Gynecol 2016; 47:443-449. [PMID: 25847110 DOI: 10.1002/uog.14871] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/29/2015] [Accepted: 03/31/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To assess the incidence and impact of extracardiac anomalies on the prognosis of fetuses with heterotaxy syndrome. METHODS All fetuses diagnosed with heterotaxy syndrome by three experienced examiners over a period of 14 years (1999-2013) were reviewed retrospectively. RESULTS In total, 165 fetuses with heterotaxy syndrome were diagnosed in the study period. One hundred and fifty (90.9%) had cardiac defects; extracardiac anomalies that did not involve the spleen were present in 26/165 (15.8%) cases. Of the total study cohort, termination of pregnancy was performed in 49 (29.7%) cases, intrauterine death occurred in 11 (6.7%), postnatal death occurred in 38 (23.0%) and 67 (40.6%) were alive at the latest follow-up, resulting in a total perinatal and pediatric mortality of 59.4%. Among the 105 liveborn neonates, 15 (14.3%) had extracardiac anomalies with significant impact on the postnatal course: one neonate died following repair of an encephalocele, six had successful treatment for various types of intestinal malrotation and/or atresia and one underwent hiatal hernia repair; the remaining seven had biliary atresia, of which five died and the two survivors are awaiting liver transplantation. The status of the spleen was assessed in 93/105 liveborn children and was found to be abnormal in 84/93 (90.3%). There were three cases of lethal sepsis, all associated with asplenia. Of the 38 postnatal deaths, 29 (76.3%) had a cardiac cause, seven (18.4%) had an extracardiac cause and in two (5.2%) the reason was uncertain. CONCLUSIONS Although the leading causes of death in fetuses and children with heterotaxy syndrome are cardiac, a small subset of fetuses have extracardiac anomalies with significant impact on outcome. These anomalies often escape prenatal detection, and therefore neonates at risk should be monitored for bowel obstruction, biliary atresia and immune dysfunction in order to allow timely intervention through a multidisciplinary approach. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- I Gottschalk
- Division of Prenatal Medicine and Gynecologic Sonography, Department of Gynecology and Obstetrics, University of Köln, Köln, Germany
| | - R Stressig
- praenatal.de, Prenatal Medicine and Genetics, Köln, Germany
- Congenital Cardiac Center ('Deutsches Kinderherzzentrum'), Sankt Augustin, Germany
| | - J Ritgen
- praenatal.de, Prenatal Medicine and Genetics, Köln, Germany
| | - U Herberg
- Department of Pediatric Cardiology, University of Bonn, Bonn, Germany
| | - J Breuer
- Department of Pediatric Cardiology, University of Bonn, Bonn, Germany
| | - A Vorndamme
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - B Strizek
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - A Willruth
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - A Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - U Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - C Berg
- Division of Prenatal Medicine and Gynecologic Sonography, Department of Gynecology and Obstetrics, University of Köln, Köln, Germany
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
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46
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Puvabanditsin S, February M, Stefano VD, Vinod S, Minerowicz C, Hussein K, Mayne J, Mehta R. Osteocraniosplenic Syndrome-Hypomineralized Skull with Gracile Long Bones and Splenic Hypoplasia: A Case Report and Literature Review. Genet Couns 2016; 27:149-157. [PMID: 29485259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Osteocraniosplenic syndrome-hypomineralized skull with gracile long bones and splenic hypoplasia: a case report and literature review: We report herein an intrauterine growth-restricted preterm nwonate with a lethal bone dysplasia characterized by severe hypomineralization of the skull, absent medullary lucency flared metaphyses fishbone-like diaphysis and overtubulated long vones. Dysmorphic features included flat facies, bulging forehead, vevus flammeus, depressed nasas bridge, short philtrum, inverted U-shape mouth, mild micrometic dwarfism, and brachydactyly. The infant's lungs and spleen were hypoplastic. The findings are compatible with the 19 previously reported cases that used different terminology: osteocraniostenosis, gracile bone disorders and osteocraniosplenic syndrome. We present the clinical, pathological and cytogenetic findings of this rare disorder.
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47
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LEO C, PRAVISANI R, BIDINOST S, BACCARANI U, BRESADOLA V, RISALITI A, TERROSU G. Postsplenectomy recurrence of idiopathic thrombocitopenic purpura: role of laparoscopic splenectomy in the treatment of accessory spleen. G Chir 2015; 36:153-7. [PMID: 26712069 PMCID: PMC4732584 DOI: 10.11138/gchir/2015.36.4.153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM Idiopatic thrombocytopenic purpura (ITP) is the most common indication for splenectomy. The failure rate of surgery is about 8% and the failure rate after splenectomy is approximately 28% for all patients. When the presence of an accessory spleen is diagnosed, splenectomy is recommended. Laparoscopic approach is considered the first choice. PATIENTS AND METHODS At our Department, between July and November 2011 two patients underwent laparoscopic accessory splenectomy for recurrence of ITP. Both patients had a previously laparoscopic splenectomy. Preoperative Magnetic Resonance (MR) was performed in both the cases revealing the presence of an accessory spleen. RESULTS The operative time was 105 and 100 minutes respectively. No perioperative complications occured. Hospital stay was four days in both cases. The first patient had a disease free period of two months; the second one of one month. Both patients restarted immunosuppressive therapy. CONCLUSIONS The relapse of thrombocytopenia post-splenectomy can be associated with the presence of an accessory spleen. The laparoscopic accessory splenectomy should be considered the first choice approach. Surgical accessory splenectomy allows a transitory remission of the disease.
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Affiliation(s)
- C.A. LEO
- General Surgery and Transplantation Unit, Medical and Biological Sciences Department, University Hospital of Udine “Santa Maria della Misericordia”, Udine, Italy
| | - R. PRAVISANI
- General Surgery and Transplantation Unit, Medical and Biological Sciences Department, University Hospital of Udine “Santa Maria della Misericordia”, Udine, Italy
| | - S. BIDINOST
- General Surgery and Transplantation Unit, Medical and Biological Sciences Department, University Hospital of Udine “Santa Maria della Misericordia”, Udine, Italy
| | - U. BACCARANI
- General Surgery and Transplantation Unit, Medical and Biological Sciences Department, University Hospital of Udine “Santa Maria della Misericordia”, Udine, Italy
| | - V. BRESADOLA
- General Surgery and Transplantation Unit, Medical and Biological Sciences Department, University Hospital of Udine “Santa Maria della Misericordia”, Udine, Italy
| | - A. RISALITI
- General Surgery and Transplantation Unit, Medical and Biological Sciences Department, University Hospital of Udine “Santa Maria della Misericordia”, Udine, Italy
| | - G. TERROSU
- General Surgery and Transplantation Unit, Medical and Biological Sciences Department, University Hospital of Udine “Santa Maria della Misericordia”, Udine, Italy
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Markello T, Chen D, Kwan JY, Horkayne-Szakaly I, Morrison A, Simakova O, Maric I, Lozier J, Cullinane AR, Kilo T, Meister L, Pakzad K, Bone W, Chainani S, Lee E, Links A, Boerkoel C, Fischer R, Toro C, White JG, Gahl WA, Gunay-Aygun M. York platelet syndrome is a CRAC channelopathy due to gain-of-function mutations in STIM1. Mol Genet Metab 2015; 114:474-82. [PMID: 25577287 PMCID: PMC4355183 DOI: 10.1016/j.ymgme.2014.12.307] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 11/18/2022]
Abstract
Store-operated Ca(2+) entry is the major route of replenishment of intracellular Ca(2+) in animal cells in response to the depletion of Ca(2+) stores in the endoplasmic reticulum. It is primarily mediated by the Ca(2+)-selective release-activated Ca(2+) (CRAC) channel, which consists of the pore-forming subunits ORAI1-3 and the Ca(2+) sensors, STIM1 and STIM2. Recessive loss-of-function mutations in STIM1 or ORAI1 result in immune deficiency and nonprogressive myopathy. Heterozygous gain-of-function mutations in STIM1 cause non-syndromic myopathies as well as syndromic forms of miosis and myopathy with tubular aggregates and Stormorken syndrome; some of these syndromic forms are associated with thrombocytopenia. Increased concentration of Ca(2+) as a result of store-operated Ca(2+) entry is essential for platelet activation. The York Platelet syndrome (YPS) is characterized by thrombocytopenia, striking ultrastructural platelet abnormalities including giant electron-opaque organelles and massive, multilayered target bodies and deficiency of platelet Ca(2+) storage in delta granules. We present clinical and molecular findings in 7 YPS patients from 4 families, demonstrating that YPS patients have a chronic myopathy associated with rimmed vacuoles and heterozygous gain-of-function STIM1 mutations. These findings expand the phenotypic spectrum of STIM1-related human disorders and define the molecular basis of YPS.
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Affiliation(s)
- Thomas Markello
- NIH Undiagnosed Diseases Program, Common Fund, Office of the Director, National Institutes of Health, Bethesda, MD 20892, USA
| | - Dong Chen
- Division of Hematopathology, Department of Laboratory of Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Justin Y Kwan
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | | | - Alan Morrison
- Joint Pathology Center, Defense Health Agency, Silver Spring, MD 20910, USA
| | - Olga Simakova
- Hematology Section, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Irina Maric
- Hematology Section, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jay Lozier
- Hematology Section, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Andrew R Cullinane
- Section on Human Biochemical Genetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Tatjana Kilo
- Pediatric Hematology, The Children's Hopsital at Westmead, Westmead, NSW 2145, Australia
| | - Lynn Meister
- Pediatric Hematology, Joe DiMaggio Children's Hospital, Hollywood, FL 33021, USA
| | - Kourosh Pakzad
- Hematopathology, Pathology Consultants of South Broward, Memorial Healthcare System, Hollywood, FL 33021, USA
| | - William Bone
- NIH Undiagnosed Diseases Program, Common Fund, Office of the Director, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sanjay Chainani
- NIH Undiagnosed Diseases Program, Common Fund, Office of the Director, National Institutes of Health, Bethesda, MD 20892, USA
| | - Elizabeth Lee
- NIH Undiagnosed Diseases Program, Common Fund, Office of the Director, National Institutes of Health, Bethesda, MD 20892, USA
| | - Amanda Links
- NIH Undiagnosed Diseases Program, Common Fund, Office of the Director, National Institutes of Health, Bethesda, MD 20892, USA
| | - Cornelius Boerkoel
- NIH Undiagnosed Diseases Program, Common Fund, Office of the Director, National Institutes of Health, Bethesda, MD 20892, USA
| | - Roxanne Fischer
- Section on Human Biochemical Genetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Camilo Toro
- NIH Undiagnosed Diseases Program, Common Fund, Office of the Director, National Institutes of Health, Bethesda, MD 20892, USA
| | - James G White
- Department of Laboratory Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - William A Gahl
- NIH Undiagnosed Diseases Program, Common Fund, Office of the Director, National Institutes of Health, Bethesda, MD 20892, USA; Section on Human Biochemical Genetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Meral Gunay-Aygun
- Section on Human Biochemical Genetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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49
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Cofré F, Cofré J. [Children with asplenia or hyposplenia: Preventing overwhelming post splenectomy infection]. Rev Chilena Infectol 2015; 31:66-72. [PMID: 24740777 DOI: 10.4067/s0716-10182014000100010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 10/11/2013] [Indexed: 11/17/2022] Open
Abstract
The spleen's ability to prevent overwhelming post-splenectomy infection (OPSI) is mainly given by its capacity to filter and phagocyte bacterial elements from the blood, remove foreign elements from it, and the early production of opsonins. The anatomic absence of the spleen is usually secondary to a surgical resection, but it could also be congenital. Streptococcus pneumoniae has been identified as the main agent of OPSI in asplenic patients with an extremely high global mortality associated. This article is an exhaustive review of the current evidence and recommendations available for prevention of invasive infections in asplenic patients.
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50
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Ornek A, Kurucay M, Henning BF, Pagonas N, Schlottmann R, Schmidt WE, Giese A. Sonographic assessment of spleen size in Turkish migrants with Familial Mediterranean fever in Germany. J Ultrasound Med 2014; 33:1991-1997. [PMID: 25336487 DOI: 10.7863/ultra.33.11.1991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Familial Mediterranean fever (FMF) can be associated with splenomegaly. Prospective quantitative data are lacking. We performed a sonographic assessment of spleen size in patients with FMF and healthy control participants to assess its diagnostic value. METHODS Patients with FMF according to the criteria of Livneh et al (Arthritis Rheum 1997; 40:1879-1885) who were in an asymptomatic interval and control participants were prospectively included in this study in Germany and underwent sonographic measurement of the spleen as well as a structured interview and a physical examination. Patients and controls were Turkish migrants. RESULTS Thirty-six patients and 27 controls were included. Patients and controls did not differ significantly in age (mean ± SD, 34.8 ± 9.7 versus 33.3 ± 10.0 years, respectively; P = .56), sex, height, weight, or body mass index (26.7 ± 4.7 versus 26.1 ± 4.3 kg/m(2); P = .63). Spleen size was greater in patients than controls in width (4.3 ± 1.0 versus 3.7 ± 0.7 cm; P = .008) and also length (12.1 ± 1.9 versus 10.5 ± 1.4 cm; P = .001). Twenty-six of 36 patients (72.2%) had a history of appendectomy compared to 3 of 27 controls (11.1%; P < .001). The combination of an enlarged spleen (length >11 cm and/or width >4 cm) gave specificity of 100% (95% confidence interval, 87%-100%) and a positive predictive value of 100% (95% confidence interval, 78%-100%) for the diagnosis of FMF in our study. CONCLUSIONS Spleen size as evaluated by sonography is larger in patients with FMF compared to healthy controls. Most patients with FMF included in this study had undergone appendectomy. Familial Mediterranean fever should be considered as a differential diagnosis in Turkish migrants in Germany if the spleen is enlarged and a history of appendectomy is reported.
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Affiliation(s)
- Ahmet Ornek
- Department of Internal Medicine I, Marienhospital Herne, Medical Center of Ruhr University Bochum, Herne, Germany (A.Ö., M.K., B.F.H., N.P., A.G.); Institute for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Bergmannsheil, Ruhr University Bochum, Bochum, Germany (A.Ö.); and Department of Internal Medicine I, St Josef-Hospital, Medical Center of Ruhr University Bochum, Bochum, Germany (R.S., W.S., A.G.)
| | - Mustafa Kurucay
- Department of Internal Medicine I, Marienhospital Herne, Medical Center of Ruhr University Bochum, Herne, Germany (A.Ö., M.K., B.F.H., N.P., A.G.); Institute for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Bergmannsheil, Ruhr University Bochum, Bochum, Germany (A.Ö.); and Department of Internal Medicine I, St Josef-Hospital, Medical Center of Ruhr University Bochum, Bochum, Germany (R.S., W.S., A.G.)
| | - Bernhard F Henning
- Department of Internal Medicine I, Marienhospital Herne, Medical Center of Ruhr University Bochum, Herne, Germany (A.Ö., M.K., B.F.H., N.P., A.G.); Institute for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Bergmannsheil, Ruhr University Bochum, Bochum, Germany (A.Ö.); and Department of Internal Medicine I, St Josef-Hospital, Medical Center of Ruhr University Bochum, Bochum, Germany (R.S., W.S., A.G.)
| | - Nikolaos Pagonas
- Department of Internal Medicine I, Marienhospital Herne, Medical Center of Ruhr University Bochum, Herne, Germany (A.Ö., M.K., B.F.H., N.P., A.G.); Institute for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Bergmannsheil, Ruhr University Bochum, Bochum, Germany (A.Ö.); and Department of Internal Medicine I, St Josef-Hospital, Medical Center of Ruhr University Bochum, Bochum, Germany (R.S., W.S., A.G.)
| | - Renate Schlottmann
- Department of Internal Medicine I, Marienhospital Herne, Medical Center of Ruhr University Bochum, Herne, Germany (A.Ö., M.K., B.F.H., N.P., A.G.); Institute for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Bergmannsheil, Ruhr University Bochum, Bochum, Germany (A.Ö.); and Department of Internal Medicine I, St Josef-Hospital, Medical Center of Ruhr University Bochum, Bochum, Germany (R.S., W.S., A.G.)
| | - Wolfgang E Schmidt
- Department of Internal Medicine I, Marienhospital Herne, Medical Center of Ruhr University Bochum, Herne, Germany (A.Ö., M.K., B.F.H., N.P., A.G.); Institute for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Bergmannsheil, Ruhr University Bochum, Bochum, Germany (A.Ö.); and Department of Internal Medicine I, St Josef-Hospital, Medical Center of Ruhr University Bochum, Bochum, Germany (R.S., W.S., A.G.)
| | - Arnd Giese
- Department of Internal Medicine I, Marienhospital Herne, Medical Center of Ruhr University Bochum, Herne, Germany (A.Ö., M.K., B.F.H., N.P., A.G.); Institute for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Bergmannsheil, Ruhr University Bochum, Bochum, Germany (A.Ö.); and Department of Internal Medicine I, St Josef-Hospital, Medical Center of Ruhr University Bochum, Bochum, Germany (R.S., W.S., A.G.).
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