Esplenúnculo intrapancreático simulando neoplasia / Intrapancreatic splenunculus simulating neoplasia

Introducción. El esplenúnculo se ha descrito con una incidencia global del 10 al 30 %. Puede ser una entidad de origen congénito o adquirida, frecuentemente está asociada a trauma abdominal o antecedente de esplenectomía por diversas causas. Caso clínico. Mujer en edad media, con antecedente de trauma abdominal y esplenectomía por ruptura traumática, quien 30 años después presenta un cuadro de dolor abdominal. Los estudios imagenológicos identificaron una masa sólida intrapancreática. Resultados. Fue llevada a pancreatectomía distal. Los hallazgos histológicos e inmunohistoquímicos confirmaron que la masa pancreática correspondía a un esplenúnculo intrapancreático adquirido, asociado al evento traumático previo. Conclusión. Los esplenúnculos suelen constituir un "incidentaloma". Los estudios imagenológicos se encuentran limitados, pues la tomografía computarizada, la resonancia nuclear magnética y la ultrasonografía presentan características imagenológicas similares con los tumores pancreáticos hipervascularizados, por lo que se debe practicar el estudio histopatológico durante su valoración. Esta entidad se debe incluir dentro de los diagnósticos diferenciales, con mayor énfasis en aquellos pacientes con historia de trauma abdominal y esplenectomía asociada, un escenario en el que esta lesión puede simular una neoplasia sólida del páncreas, con características malignas.

Introduction. Splenunculus has been described with an overall incidence of 10 to 30%. It can be an entity of congenital or acquired origin, it is frequently associated with abdominal trauma or a history of splenectomy for various reasons. Clinical case. Middle-aged woman, with a history of abdominal trauma and splenectomy due to traumatic rupture, who 30 years later presents with abdominal pain. Imaging studies identified a solid intrapancreatic mass. Results. She was taken to OR for distal pancreatectomy. The histological and immunohistochemical findings confirmed that the pancreatic mass corresponded to an acquired intrapancreatic splenunculus, associated with the previous traumatic event. Conclusion. Splenuncles usually constitute an "incidentaloma". Imaging studies are limited, since computed tomography, magnetic resonance imaging, and ultrasonography present similar imaging characteristics with hypervascularized pancreatic tumors, so histopathological study must be included during their evaluation. This entity should be included in the differential diagnoses, with greater emphasis on those patients with a history of abdominal trauma and associated splenectomy, a scenario in which this lesion can simulate a solid neoplasm of the pancreas, with malignant characteristics.

Salmonelosis Esplénica. Caso clínico / Splenic Salmonellosis. Case report

Introducción: El absceso esplénico es una entidad inusual que se observa en pacientes inmunodeprimidos por enfermedades como diabetes mellitus (DM), enfermedades hematooncológicas, síndrome de inmunodeficiencia adquirida (SIDA) y, en menor medida, en sujetos que presentaron traumatismo o infarto esplénico. El tratamiento ideal es la esplenectomía, aunque se deben considerar las alternativas conservadoras como drenaje percutáneo y resección laparoscópica. Se presenta un caso de un paciente con diagnóstico de absceso esplénico por salmonelosis, siendo este poco frecuente. Caso clínico: Paciente masculino de 53 años de edad con DM tipo 2. Refiere dolor abdominal difuso de aparición insidiosa tipo cólico de moderada intensidad, concomitante evacuaciones líquidas y alzas térmicas 40°. Al Examen físico FC: 114 lpm FR: 28 rpm TA: 130/70mmHg. Abdomen: globoso, RsHs presentes, depresible, doloroso a palpación con signos de irritación peritoneal. En radiografía de tórax se evidencia neumoperitoneo. Se realiza laparotomía xifopúbica, encontrando 1500ml de líquido purulento, absceso esplénico roto y hepatomegalia. Se realiza Esplenectomía + lavado y drenaje de cavidad. Conclusión: Los abscesos esplénicos son una entidad rara con manifestaciones clínicas no específicas. Métodos diagnósticos, la tomografía es el estudio de elección. El neumoperitoneo puede confundir el diagnostico realizándose de forma tardía por lo cual debemos tenerlo en cuenta como diagnostico diferencial. La esplenectomía es el tratamiento definitivo, el drenaje percutáneo se realiza en pacientes seleccionados(AU)

Introduction: The splenic abscess is an unusual entity that is observed in immunosuppressed patients due to diseases such as diabetes mellitus (DM), hemato-oncological diseases, acquired immunodeficiency syndrome (AIDS) and, to a lesser extent, in subjects who presented trauma or splenic infarction. The ideal treatment is splenectomy, although conservative alternatives such as percutaneous drainage and laparoscopic resection should be considered. We present a case of a patient with a diagnosis of splenic abscess due to salmonellosis, this being rare.Clinical case : A 53-year-old male patient with type 2 DM. Refers to diffuse abdominal pain of insidious onset of moderate intensity, colic type, concomitant liquid stools and temperature rises 40°. On physical examination HR: 114 bpm FR: 28 rpm BP: 130/70mmHg. Abdomen: globular, RsHs present, depressible, painful on palpation with signs of peritoneal irritation. The chest X-ray shows pneumoperitoneum. A xiphopubic laparotomy was performed, finding 1500ml of purulent fluid, a ruptured splenic abscess and hepatomegaly. Splenectomy + lavage and cavity drainage is performed.Conclusion : Splenic abscesses are a rare entity with non-specific clinical manifestations. Diagnostic methods, tomography is the study of choice. Pneumoperitoneum can confuse the diagnosis, being carried out late, which is why we must have it as a differential diagnosis. Splenectomy is the definitive treatment; percutaneous drainage is performed in selected patients(AU)

Thoracic splenosis: Case report of a symptomatic case / 中华创伤杂志(英文版)

Thoracic splenosis is the autotransplantation of splenic tissue in the left thoracic cavity as a result of a splenic injury. This rare pathology is usually asymptomatic and may be discovered on incidental imaging, but the diagnosis often requires invasive procedures such as surgery in order to eliminate a neoplasic origin. We report a rare symptomatic case of a 39-year-old man presenting with chest pain and multiple nodules revealed on a computed tomography scan. The patient underwent a surgical exploration and the pathological studies concluded to a thoracic splenosis. Indeed, the previous medical history of the patient revealed a left thoraco-abdominal traumatism during childhood. The aim of this paper is to emphasize that the diagnosis can now be performed using only imaging techniques such as technetium-99 sulfur colloid or labelled heat-denatured red blood cell scintigraphy to avoid unnecessary invasive procedures including thoracotomy.

Thoracic Splenosis after Splenic and Diaphragmatic Injury / 대한흉부외과학회지

Thoracic splenosis is a rare disease that develops as a result of autotransplantation of splenic tissue into the thoracic cavity following splenic and diaphragmatic injury. We report the case of a 53-year-old man with a chief complaint of heartburn and cough. He had a history of traumatic diaphragmatic rupture treated with surgical repair and splenectomy 15 years ago. Imaging studies revealed a paraesophageal mass, and surgical resection was performed considering the possibility of Castleman disease or an esophageal submucosal tumor. Pathologic results showed findings of normal splenic tissue. The patient was discharged on postoperative day 5 without any complications.

Esplenosis abdominopélvica: Presentación de un caso y revisión de la literatura / Abdominopelvic Splenosis. Case Report and Literature Review

La esplenosis abdominal es el autotrasplante de tejido esplénico en la cavidad peritoneal en pacientes con antecedente de lesión traumática esplénica o esplenectomía. Es una condición asintomática y benigna que se diagnostica de forma incidental en estudios de imágenes o en cirugía. Las manifestaciones imaginológicas de la entidad generalmente se interpretan de manera equivocada como neoplasia secundaria. Presentamos un paciente con múltiples nódulos intraabdominales en tomografía computarizada (TC) de abdomen, secundarios a esplenosis abdominopélvica

Abdominal splenosis is the autotransplant of splenic tissue in the peritoneal cavity in patients with history of traumatic splenic injury and/or splenectomy. It is an asymptomatic and benign condition that is incidentally diagnosed in imaging studies or surgery. Imaging manifestations of this entity are generally misinterpreted as secondary neoplasia. We present a patient with multiple nodules in computed tomography (CT) of the abdomen, secondary to abdominopelvic splenosis.

Splenosis Mimicking Recurrence of Renal Cell Carcinoma after Radical Nephrectomy: A Case Report

Splenosis refers to the heterotropic autotransplantation of splenic tissue. Sometimes splenosis after surgical resection is difficult to differentiate from recurrence or metastasis of cancer. A 49-year-old male patient was diagnosed with clear cell renal cell carcinoma of left kidney. As there was no evidence of metastasis, he underwent radical nephrectomy with splenectomy. On surveillance computed tomography, masses at nephrectomy site and pleura were found and both were initially considered to be recurrence. After several cycle of pazopanib administration, pleural mass decreased in size while mass at nephrectomy site did not respond at all. Spleen scan showed increased uptake of the mass and therefore the mass was revealed to be splenosis. To avoid unnecessary treatment and planning optimal treatment, considering the possibility of splenosis is important and spleen scan can be helpful.

Thoracic Splenosis: A Case Report and Noninvasive Diagnosis

Thoracic splenosis is an autotransplantation of splenic tissue to thorax resulting from splenic and diaphragmatic injury. Thoracic splenosis is usually discovered incidentally on routine thoracic imaging as single or multiple left-sided pleural-based masses without symptoms. Traditionally, patients often undergo an invasive diagnostic procedures including thoracotomy to acquire tissue samples in order to exclude other causes of lung mass. The combination of imaging findings and clinical history make it avoid unnecessary invasive diagnostic procedure to confirm. Therefore, thoracic splenosis should be considered in the differential diagnosis of asymptomatic patients with multiple, left-sided pleural-based nodules and previous history of thoracoabdominal injury and splenectomy. Here we report a case of thoracic splenosis diagnosed without invasive procedure.

Laparoscopic management of pelvic splenosis

Splenosis is defined as heterotopic autotransplantation of spleen tissue following traumatic rupture of the spleen, or surgery. It is a benign disease that is generally without any symptoms and is discovered incidentally. Surgical intervention is recommended if symptoms are present. We report the successful laparoscopic management of a 49-year-old Korean woman with splenosis-associated symptoms who had undergone splenectomy.

Splenosis Mimicking Hepatocellular Carcinoma / 대한소화기학회지

No abstract available.

PANCREATIC SPLENOSIS MIMICKING NEUROENDOCRINE TUMORS: microhistological diagnosis by endoscopic ultrasound guided fine needle aspiration

Context Pancreatic splenosis is a benign condition which can mimic a pancreatic neoplasm. Objective To describe the role of the endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic nodules suspicious for pancreatic splenosis. Method From 1997 to 2011, patients with pancreatic solid tumors suspicious for splenosis by computed tomography and/or magnetic resonance imaging were referred to EUS-FNA. Those cases with pancreatic splenosis confirmed by EUS-FNA or surgery were included. Endosonographic findings and clinicopathologic features were also analysed. Results A total of 2,060 patients with pancreatic solid tumors underwent EUS-FNA. Fourteen (0.6%) cases with pancreatic splenosis were found. After applying exclusion criteria, 11 patients were selected. Most patients were male (7), young (mean age: 42 years) and asymptomatic (8). Endoscopic ultrasound imaging alone suspected pancreatic splenosis in 6 cases, and neuroendocrine tumors in 5 cases. Pancreatic splenosis was found most commonly in the tail, was round, hypoechoic, with homogeneous pattern, regular borders, and with scintigraphy negative for somatostatin receptors. The average diameter of these nodules identified by endoscopic ultrasound was 2.15 cm. Microhistology obtained by EUS-FNA confirmed the diagnosis in 9/10 patients. Conclusion Pancreatic splenosis can be diagnosed by EUS-FNA. Microhistology prevents unnecessary surgeries, and reassures asymptomatic patients with hypoechoic, homogeneous, and well circumscribed pancreatic nodules. .

Contexto A esplenose pancreática é uma afecção benigna que pode mimetizar uma neoplasia pancreática. Objetivo Descrever o papel da ecoendoscopia associada à punção aspirativa com agulha fina ecoguiada (EE-PAAF) dos nódulos de pâncreas suspeitos de esplenose pancreática. Método De 1997 a 2011, pacientes com tumores sólidos de pâncreas sugestivos de esplenose pancreática, conforme achados de exames de imagem por tomografia computadorizada e/ou ressonância magnética foram encaminhados para EE-PAAF. Os casos com esplenose pancreática confirmada pela ecoendoscopia ou pela cirurgia foram incluídos. Os achados endossonográficos e os aspectos clinicopatológicos foram analisados. Resultados Dois mil e sessenta pacientes com tumores sólidos do pâncreas foram submetidos a EE-PAAF. Quatorze (0,6%) casos com esplenose pancreática foram encontrados. Após emprego dos critérios de exclusão, 11 pacientes foram selecionados. A maioria dos pacientes era do sexo masculino (7), jovens (idade média: 42 anos) e assintomáticos (8). A imagem ecoendoscópica isolada suspeitou de esplenose pancreática em 6 casos, e tumores neuroendócrinos em outros 5 casos. A esplenose pancreática foi detectada mais comumente na cauda do pâncreas, era redonda, hipoecogênica, com padrão homogêneo, bordos regulares bem delimitados e com cintilografia negativa para os receptores de somatostatina. O diâmetro médio dos nódulos foi de 2,15 cm. A microhistologia obtida pela EE-PAAF confirmou o diagnóstico em 9/10 pacientes. Conclusão A esplenose pancreática pode ser diagnosticada pela punção aspirativa com agulha fina ecoguiada. A microhistologia evita cirurgias desnecessárias ...

Combined Intrathoracic and Intraperitoneal Splenosis after Splenic Injury: Case Report and Review of the Literature / 결핵및호흡기질환

Splenosis is defined as an autotransplantation of the splenic tissue after splenic rupture or splenectomy, and occurs most frequently in the peritoneal cavity. Splenosis is usually asymptomatic and is found incidentally. We report a case of combined intrathoracic and intraperitoneal splenosis in a 54-year-old male who worked as a miner for 10 years in his twenties, and was a current smoker. He was referred to our hospital for further evaluation of an incidental left diaphragmatic mass. Positron emission tomography-computed tomography and bronchoscopy were performed to evaluate the possibility of malignancy. There was no evidence of malignancy, but the spleen was not visualized. Reviewing his medical history revealed previous splenectomy, following a dynamite explosion injury. Therefore, splenosis was suspected and technetium-99m-labeled heat-damaged red blood cell scan confirmed the diagnosis. Radionuclide imaging is a useful diagnostic tool for splenosis, which could avoid unnecessary invasive procedures.

Esplenosis torácica: presentación de caso / Thoracic splenosis: a case report

La esplenosis torácica se define como la presencia de implantes de tejido esplénico en la pleura parietal o visceral, secundaria a una rotura del bazo o traumatismo esplénico o diafragmático. Es una entidad rara, con síntomas poco específicos, que presenta un curso benigno. Entre las modalidades de imágenes para el diagnóstico se encuentran métodos convencionales, como el ultrasonido, la tomografía axial computarizada y la medicina nuclear, que son técnicas útiles para determinar tejido esplénico residual. En el artículo se presenta el caso de un hombre joven con antecedente de trauma esplénico, al cual se le diagnostica esplenosis torácica como parte del estudio de síndrome febril prolongado y síntomas respiratorios.

Subepithelial Lesion of the Gastric Fundus Caused by an Accessory Spleen / 대한내과학회지

When a submucosal lesion is discovered at the gastric fundus by gastroscopy, it may be difficult to distinguish a gastric external compression from a true submucosal tumor (SMT). The stomach is a hollow organ centrally placed in the upper abdomen, and it is possible to have a protruding external compression at the fundus, particularly from an enlarged spleen or splenic artery. An accessory spleen or splenosis is not a very unusual finding but may rarely produce such external compression at the gastric fundus. We experienced a case of an accessory spleen mimicking a gastric SMT diagnosed through a gastroscopy after a splenectomy.

Subepithelial Lesion of the Gastric Fundus Caused by an Accessory Spleen / 대한내과학회지

When a submucosal lesion is discovered at the gastric fundus by gastroscopy, it may be difficult to distinguish a gastric external compression from a true submucosal tumor (SMT). The stomach is a hollow organ centrally placed in the upper abdomen, and it is possible to have a protruding external compression at the fundus, particularly from an enlarged spleen or splenic artery. An accessory spleen or splenosis is not a very unusual finding but may rarely produce such external compression at the gastric fundus. We experienced a case of an accessory spleen mimicking a gastric SMT diagnosed through a gastroscopy after a splenectomy.

Intrahepatic Splenosis Mimicking Liver Metastasis in a Patient with Gastric Cancer

A 54 year old man was referred to our hospital with gastric cancer. The patient had a history of splenectomy and a left nephrectomy as a result of a traffic accident 15 years earlier. The endoscopic findings were advanced gastric cancer at the lower body of the stomach. Abdominal ultrasonography (USG) and magnetic resonance imaging demonstrated a metastatic nodule in the S2 segment of the liver. Eventually, the clinical stage was determined to be cT2cN1cM1 and a radical distal gastrectomy, lateral segmentectomy of the liver were performed. The histopathology findings confirmed the diagnosis of intrahepatic splenosis, omental splenosis. Hepatic splenosis is not rare in patients with a history of splenic trauma or splenectomy. Nevertheless, this is the first report describing a patient with gastric cancer and intrahepatic splenosis that was misinterpreted as a liver metastatic nodule. Intra-operative USG guided fine needle aspiration should be considered to avoid unnecessary liver resections in patients with a suspicious hepatic metastasis.

Thoracic Splenosis: A Case Report and the Importance of Clinical History

We present a case of thoracic splenosis in a 42-yr-old man with a medical history of abdominal surgery for a penetration injury with an iron bar of the left abdomen and back. He had been in good condition, but a chest radiograph taken during a regular checkup showed a multinodular left pleura-based mass. Computed tomography (CT) showed that the mass was well-enhanced and homogeneous, indicating a sclerosing hemangioma. Following its removal by video-assisted thoracoscopic surgery, the mass appeared similar to a hemangioma, with marked adhesion to the left side diaphragmatic pleura and lung parenchyma. Frozen section showed that the lesion was a solid mass consisted with abundant lymphoid cells, suggesting a low grade lymphoma. On permanent section, however, the mass was found to be composed of white pulp, red pulp, a thick capsule and trabeculae and was diagnosed as ectopic splenic tissue, or thoracic splenosis. Review of the patient's history and chest CT at admission revealed that the patient had undergone a splenectomy for the penetration injury 20 yr previously.