Angioma de células litorales esplénico. Presentación de caso clínico / Littoral cell angioma of the spleen. Report on a clinical case / Angioma de células litoraneas do baço: apresentação de um caso clínico

El angioma de células litorales del bazo es una neoplasia vascular benigna poco frecuente, de presentación clínica, paraclínica e imagenológica inespecífica. Se realizó en nuestro paciente la esplenectomía, el tratamiento indicado y curativo, y se logró el diagnóstico a través de la histología e inmunohistoquímica de la pieza de anatomía patológica.

Littoral cell angioma of the spleen is rather an unusual benign vascular neoplasm with non-specific clinical, paraclinical and imaging presentation. Our patient underwent splenectomy, performed as the appropriate and remedial treatment. Diagnosis was made by means of histology and immunohistochemistry techniques of the pathologic anatomy of the surgical piece.

O angioma de células litoraneas do baço é uma neoplasia vascular benigna rara com apresentação clínica, laboratorial e de imagem inespecíficas. A esplenectomia foi realizada em nosso paciente, sendo esse o tratamento indicado e curativo, obtendo-se o diagnóstico através da histologia e imunohistoquímica da peça anatomopatológica.

Angioma de células litorales del bazo: un diagnóstico de lesión focal esplénica: caso clínico / Littoral cell angioma of the spleen: report of one case

Splenic vascular neoplasms are the most common form of spleen tumors. Among them, littoral cell angioma is rare and it is frequently an incidental finding in imaging studies. It has no specific clinical, laboratory or imaging findings. Splenectomy allows definitive diagnosis throughout a histopathological examination. We report a 52-year-old man presenting with asthenia and abdominal distension. Computed tomography with intravenous contrast showed multiple splenic hypodense masses and a prostatic enlargement. Presuming a lymphoma, a laparoscopic splenectomy was performed. Histopathologic examination diagnosed littoral cell angioma. During urological follow-up, a prostate adenocarcinoma was diagnosed.

Manejode linfoma primario de bazo en paciente con ViH-Sida: reporte de caso / Management of primary lymphoma of the spleen in a patient with HIV-AIDS: case report

Los linfomas primarios de bazo afectan al bazo y/o sus ganglios linfáticos inicialmente. Representan <1% de los linfomas e implican un reto diagnóstico, por baja prevalencia y sintomatología inusual. Por lo tanto, el objetivo de este trabajo fue describir el manejo y evolución de un paciente con VIH-SIDA y la presentación de un Linfoma primario de bazo.En este reporte presentamos el caso de un paciente masculino de 52 años con VIH sin apego a tratamiento debuta con dolor abdominal, fiebre y pérdida de peso de 2 meses de evolución. La tomografía computarizada properatoria revela esplenomegalia y lesiones hipodensas sospechosas de neoformación. Es intervenido, realizándose una laparotomía exploratoria, con esplenectomía. El estudio histopatológico reporta linfoma no Hodgkin.El linfoma primario de bazo es poco frecuente. Es necesario su conocimiento para su sospecha diagnóstica y un diagnóstico diferencial en pacientes con esplenomegalia.Primary splenic lymphomas involve the spleen and/or its lymph nodes. They represent <1% of lymphomas and they imply a diagnostic challenge due to its poor symptomatology and low prevalence.There for, the objects this work describe the management and evolution of a patient with HIV-AIDS and presentation of a primary lymphoma of the spleenIn this report we present the case of a 52-year-old male patient with HIV infection without treatment presented with abdominal pain, fever and a 2-month weight loss. The pre-operative computed tomography showed splenomegaly and hypodense lesions suspected to be tumoral. He was operated on, performing an exploratory laparotomy, performing an splenectomy. The histopathological study reported a non-Hodgkin lymphoma.Primary splenic lymphoma is a non frequent entity. It is necessary to be acquainted with it in order to suspect it.

Primary splenic lymphomas involve the spleen and/or its lymph nodes. They represent <1% of lymphomas and they imply a diagnostic challenge due to its poor symptomatology and low prevalence.There for, the objects this work describe the management and evolution of a patient with HIV-AIDS and presentation of a primary lymphoma of the spleenIn this report we present the case of a 52-year-old male patient with HIV infection without treatment presented with abdominal pain, fever and a 2-month weight loss. The pre-operative computed tomography showed splenomegaly and hypodense lesions suspected to be tumoral. He was operated on, performing an exploratory laparotomy, performing an splenectomy. The histopathological study reported a non-Hodgkin lymphoma.Primary splenic lymphoma is a non frequent entity. It is necessary to be acquainted with it in order to suspect it.

Metastasis esplénica de un adenocarcinoma de colon derecho / Splenic metastasis of a right colon adenocarcinoma

Introducción: Las metástasis únicas en bazo de origen colorrectal son extremadamente infrecuentes. Sin embargo, debido el control postoperatorio más estricto de la patología oncológica con estudios por imágenes modernos, la incidencia ha ido aumentando en los últimos años. Objetivo: Exponer el caso de una paciente con una metástasis esplénica de un tumor colónico primario. Caso clínico: Paciente de sexo femenino, de 85 años con antecedentes de colectomía derecha laparoscópica. La anatomía patológica informó: adenocarcinoma de colon T2 N0, sin requerir tratamiento quimioterápico adyuvante. En el seguimiento postoperatorio, durante el segundo año intercurrió con aumento del antígeno carcinoembrionario (CEA). Se realizó PET-TC que evidenció nódulo hipercaptante único de 3 cm. en bazo. Se programó la esplenectomía laparoscópica, evolucionando satisfactoriamente. La anatomía patológica definitiva informó adenocarcinoma metastásico de origen colónico. Conclusión: La metástasis esplénica de un tumor colónico es extremadamente infrecuente, existiendo solamente casos aislados en la literatura. En pacientes sin otro compromiso sistémico la esplenectomía debe recomendarse. (AU)

Introduction: Isolated splenic metastases are highly uncommon. The incidence has been increasing during the last years due to better medical imaging and long term follow up. Objective: We report a case of a patient who developed isolated splenic metastasis from right colon cancer. Case presentation: Female, 85 years old who underwent a laparoscopic right colectomy. The pathologic investigation confirmed: colon adenocarcinoma staged as T2 N0, without need of oncologic adjuvant therapy. In the postoperative follow up, during the second year, an increased serum carcinoembryonic antigen level was noticed. A PET TC was carried out and demonstrated a 3 cm focus of high radiotracer uptake in the spleen. Laparoscopic splenectomy was performed, postoperative course was uneventful. Pathologic exam demonstrated splenic parenquima invaded with adenocarcinoma originated in colon. Conclusion: Isolated splenic metastases is a very rare clinical entity. Only few case reports can be found in the literature. If they are no other sites of disease, splenectomy should be the optimal approach.

Linfoma no Hodgkin folicular primario del bazo / Follicular Non-Hodgkin Primary Splenic Lymphoma

Se presenta el caso de una paciente de 79 años que desde hace 3 meses presenta marcada sudoración nocturna, dolor abdominal en zona de hipocondrio y flanco izquierdo y ligera pérdida de peso. Al examen físico se observa palidez de piel y mucosas, esplenomegalia que rebasa 7 cm el reborde costal izquierdo, superficie lisa, superficie regular. El resto del examen físico fue normal. Se realizan múltiples investigaciones básicas sin poderse identificar el diagnostico. Por la presencia de gran esplenomegalia y la pancitopenia se decide realizar esplenectomía confirmándose un linfoma no Hogkin folicular primario del bazo(AU)

We present the case of a 79-year-old patient who had marked night sweats, abdominal pain in the hypochondrium area and left flank and slight weight loss for 3 months. Physical examination showed pale skin and mucous membranes, splenomegaly that exceeds the left costal margin by 7 cm, smooth surface, and regular surface. The rest of the physical examination was normal. Multiple basic studies were conducted out but the diagnosis was not identified. Due to the presence of great splenomegaly and pancytopenia, it was decided to perform splenectomy, confirming a follicular non-Hodgkin primary splenic lymphoma(AU)

Metástasis esplénica solitaria en una paciente con adenocarcinoma colorrectal / Splenic metastases secondary to colorrectal carcinoma

Introduction: Splenic metastases are unusual, arising in less than 1 percent of all metastases. Splenic metastases from colorrectal carcinoma is considered excepcional. If present, they generally occur in concert with disseminated disease. Case report: We present a case of 78 year old man operated of colon tumor by right hemicolectomy. Nine months after first surgical, CT scan showed metastases in spleen, splenectomy was performed.

Introducción: Las metástasis esplénicas son inusuales, representando menos del 1 por ciento de todas las metástasis. Que este tipo de localización secundaria sea ocasionado por carcinomas colorrectales puede considerarse como algo excepcional. Cuando se presentan generalmente lo hacen en el contexto de una enfermedad diseminada. Caso clínico: Presentamos el caso de un varón de 78 años de edad que fue intervenido de un carcinoma colorrectal mediante hemicolectomía derecha. nueve meses después de la primera cirugía el escáner muestra metástasis en el bazo, por lo que se realizó una esplenectomía.

Rituximab monotherapy for splenic marginal zone lymphoma with villous lymphocytes: report on long-term disease control for two patients with recurrence after splenectomy / Monoterapia com rituximab no linfoma da zona marginal esplênico com linfócitos vilosos: relato de dois casos de pacientes com controle prolongado da doença depois de recidiva após esplenectomia

CONTEXT: Splenic marginal zone lymphoma (SMZL) is a lymphoproliferative B-cell disorder that has a favorable prognosis, with estimated overall five-year survival of 70 percent. The majority of symptomatic patients undergo splenectomy, while a few receive first-line chemotherapy, especially with purine analogues. There are no specific treatment guidelines for patients for whom splenectomy fails to provide a cure. It is still unclear whether these patients should undergo cytotoxic chemotherapy, considering they have now a relapsed lymphoma (which is theoretically more aggressive), or whether they should be spared from treatments of greater toxicity, given that their disease usually develops with a more indolent course, even when it recurs. CASE REPORT: Here, we present two patients whose disease recurred after splenectomy and for whom rituximab monotherapy provided satisfactory treatment. From these cases, it can be suggested that postponement of cytotoxic treatments may be possible in at least some situations. It needs to be emphasized that the evidence to support this approach is based only on case reports, since there are no randomized clinical trials on this subject.

CONTEXTO: Os linfomas da zona marginal esplênicos constituem uma desordem linfoproliferativa de células B que apresenta um prognóstico favorável, com sobrevida global de cinco anos estimada em 70 por cento. A maioria dos pacientes sintomáticos é submetida a esplenectomia enquanto alguns recebem quimioterapia terapêutica de primeira linha, especialmente com análogos de purinas. Não existem diretrizes específicas para o tratamento dos pacientes que falham à esplenectomia: ainda é incerto se deveriam ser tratados com quimioterapia citotóxica, em virtude de apresentarem um linfoma recidivado (e teoricamente mais agressivo) ou se deveriam ser poupados de um tratamento mais tóxico pelo fato de apresentarem uma doença que usualmente se desenvolve de forma mais indolente, mesmo quando recidivada. RELATO DE CASO: Nesta publicação, são apresentados dois casos nos quais a doença recidivou após esplenectomia e que foram satisfatoriamente tratados com monoterapia com rituximabe. A observação desses casos sugere que a postergação de tratamentos citotóxicos pode ser possível pelo menos em algumas situações. Cabe ressaltar que a evidência para essa conduta é embasada apenas em relatos de caso, uma vez que não existem ensaios clínicos randomizados a respeito desse tema.

Linfangioma esplénico gigante: Caso clínico / Gigantic cystic splenic lymphangioma: Report of one case

Splenic lymphangiomas are benign primary simple or multiple tumors. They are incidentally diagnosed in children and people younger than 20 year-old. We report a 26-year-old female presenting with a history of five months of abdominal pain localized over the left upper hemi abdomen. A computed tomographic abdominal scan demonstrated a cystic tumor of 16 cm diameter originating from the spleen. Hydatic serology was negative and all blood tests were normal. At surgery, a spienic cyst was found and almost all the cystic wall was excised, leaving only a small portion attached to the spleen. The pathological report described spienic parenchyma with endothelial lining over the internal side of the cyst. Immunohystochemical stains of the endothelial cells were positive for VIII Factor and D2-40 that are specific for lymphatic endothelium, yielding the final diagnosis of a cystic spienic lymphangioma.

Quiste esplénico gigante con elevación del CA19-9: reporte de un caso / Giant splenic cyst with Ca-19-9 elevated: report of a case

Los quistes esplénicos verdaderos constituyen una rareza, es por ello que presentamos el caso de una paciente de 21 años de edad tratada por un quiste esplénico gigante (30 cm) con elevación del Ca 19-9 (1670U/mL) a quien se le realizó esplenectomía con evolución satisfactoria y sin complicaciones. La biopsia definitiva reportó quiste esplénico verdadero, siendo estas lesiones pocofrecuentes, más aun cuando cursan con elevación del Ca19-9, encontramos que se han publicado en la literatura consultada alrededor de 30 casos.

The true cyst spleen are a poor known pathology, for these reason we report the case of a 21-year-old woman with a giant true spleen cyst (30 cm) with a high CA 19-9 serum level (16 70 U/mL). The patient underwent splenectomy without complications and she has a successful postoperative course. The histopathological diagnosis was a true splenic cyst being these lesions very rare; approximately 30 cases of benign true splenic cysts with a high CA 19-9 serum level have been published in the literature.

Angiosarcoma primario del bazo: Caso clínico / Primary angiosarcoma of the spleen: Report of one case

Primary angiosarcoma of the spleen is rare and almost always fatal. The pathogenesis is unknown. It has an aggressive behavior and frequently presents with hematological abnormalities or metastatic disease. We report a 49 year-old male that presented with spleen and lymph node enlargement. He was subjected to a splenectomy and the biopsy disclosed an angiosarcoma of the spleen. Metastases were detected in the lung and bones and the patient was considered beyond any therapeutic option, dying fifteen months later.

Esplenectomía parcial en quiste epidermoide de bazo / Partial splenectomy in epidermoid splenic cyst

Se describe el caso de una paciente de sexo femenino,de 4 años de edad que presentó quiste esplénico epidermoide, diagnosticado por ecografía y TAC abdominal. El tratamiento efectuado fue esplenectomía parcial, resecando el segmento del bazo donde se encontraba el quiste. Recomendamos el uso de la vacuna para Pneumococo y Hemophilus influenzae preoperatorio en todo paciente sometido a cirugía del bazo, aunque se piense efectuar un procedimiento conservador. La patología confirmó el diagnóstico, al reportar el recubrimiento epitelial de la pared del quiste

Isolated splenic metastasis from colorectal carcinoma: a case report

Isolated splenic metastasis arising from colorectal carcinoma is very rare and there has been only 6 cases reported in the English literature. A new case is esented, and its possible pathogenesis was considered with previously reported ses. A 65-year-old male patient had received a right hemicolectomy for cending colon cancer 36 months earlier. He was followed up regularly with rial measurement of serum carcinoembryonic antigen (CEA). Rising serum CEA was scovered from 33 months postoperatively and CT revealed an isolated splenic tastasis. He therefore underwent splenectomy, which was proven to be a tastatic adenocarcinoma with similar histological feature to the original mor. As all reported cases showed elevated serum CEA at the time of tastasis, isolated splenic metastasis might be associated with CEA in regard its biological functions of immunosuppression and adhesion.

A case of epidermoid cyst of the intrapancreatic accessory spleen

A 54-year-old woman presented with a huge palpable mass on left upper quadrant of the abdomen. After preoperative work-up, a cystic disease of pancreatic tail or accessory spleen was initially suspected. We performed exploratory laparotomy and resected both the spleen and a 15 x 11 cm-sized huge cystic mass containing a part of solid component which extended continuously to the pancreatic tail. The solid component, comprising the upper portion of the resected cyst, was reddish brown and granular like as normal splenic tissue. The inner surface of the cyst was smooth and was filled with yellowish white material. Histologic examination showed an epidermoid cyst originating in the accessory spleen of the pancreatic tail lacking hair or skin appendages.

Linfoma primário do baço: relato de caso / Primary splenic lymphoma: case report

Os autores relatam caso de linfoma primário do baço, em paciente do sexo masculino, leucoderma, 38 anos, encaminhado para avaliaçäo de esplenomegalia e perda de peso. Após extensos estudos propedêuticos, os quais foram incapazes de demonstrar evidências da doença linfoproliferativa, o diagnóstico de linfoma linfocítico difuso foi estabelecido por cirurgia (esplenectomia). O estudo imuno-histoquímico foi compatível com linfoma de célula B. Manifestaçöes neurológicas, tais como paresia e parestesia das pernas, dor lombar, retençäo urinária progressiva e constipaçäo intestinal apareceram no oitavo dia de pós-operatório. Tomografia computadorizada subsequente revelou infiltraçäo linfomatosa da coluna lombar. A raridade da doença associada à ausência de critérios diagnósticos bem definidos e a conhecimento imcompleto da história natural da condiçäo destacam a necessidade de estudos controlados e com longo tempo de acompanhamento, possibilitando abordagem adequada da doença

Quistes esplénicos no parasitarios / Nonparasitic cysts of the spleen

En un período de 12 años (1983-1994) se intervinieron 6 quistes esplénicos no parasitarios. La edad media fue de 28 años y predominó el sexo masculino 66 por ciento. Consultaron por tumor visible o palpable en el hipocondrio izquierdo y molestias en el abdomen superior. La ecografía permitió establecer en todos los enfermos el origen esplénico de la lesión, su contenido líquido y apreciar su forma y dimensiones. La tomografía axial computada realizada en 5 enfermos precisó mejor las relaciones con las vísceras vecinas y la localización del quiste. La vacuna antineumocóccica se aplicó en el preoperatorio de 4 enfermos y se realizó heparinización profiláctica en 2 de ellos. El tratamiento quirúrgico varió con el paso del tiempo. En las 3 primeras observaciones se realizó esplenectomía total, en las 2 siguientes esplenectomía segmentaria y en la última enferma intervenida, quistectomía parcial por vía laparoscópica. La evolución postoperatoria inmediata fue satisfactoria, se los dió de alta a los 3,6 días de promedio, y sobrevivieron sanos, sin haber presentado episodios de sepsis fulminante post esplenectomía, hasta la actualidad. La anatomía patológica informó 2 quistes epidermoides, 2 quistes serosos, 1 hemangioma cavernoso y 1 pseudoquiste hemático. Se hace una revisión de la bibliografía nacional, se exponen los nuevos conceptos embriológicos, anatomopatológicos e inmunohistoquímicos. El tratamiento, aun ante el quiste asintomático mayor de 5 cm de diámetro, es quirúrgico. Permite obtener un diagnóstico anatomopatológico preciso y sobre todo prevenir la aparición de complicaciones evolutivas graves

Hemangioma cavernoso del bazo: reporte de 2 casos / Cavernous hemangioma of the spleen: report on 2 cases

Se exponen 2 casos operados en nuestro centroo por presentar manifestaciones abdominales, en uno de ellos éstas constituyeron un cuadro agudo por el cual se le realizó una laparatomía exploradora de urgencia; en ambos se obtiene el informe anatomopatológico de hamangioma cavernoso del bazo. Se recogieron 2 casos en 25 años