RESUMO
No abstract available.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Hepatocelular/diagnóstico , Diagnóstico Diferencial , Neoplasias Hepáticas/diagnóstico , Imageamento por Ressonância Magnética , Esplenose/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
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.
Assuntos
Adulto , Humanos , Masculino , Traumatismos Abdominais/complicações , Diagnóstico Diferencial , Prontuários Médicos , Baço/lesões , Esplenectomia , Esplenose/diagnóstico , Doenças Torácicas/diagnóstico , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios XRESUMO
We report on a case of hepatic splenosis. A 32-yr-old man underwent a splenectomy due to trauma at the age of 6. He had been diagnosed as being a chronic hepatitis B-virus carrier 16 yr prior to the surgery. The dynamic computer tomography (CT) performed due to elevated serum alpha-fetoprotein (128 ng/mL) demonstrated two hepatic nodules, which were located near the liver capsule. A nodule in Segment IVa had a slight enhancement during both the arterial and portal phases, and another nodule in Segment VI showed a slight enhancement only in the portal phases. Dynamic magnetic resonance imaging (MRI) of the mass in Segment VI showed enhanced development in the arterial phases and slight hyperintensivity to the liver parenchyma in the portal phases. These imaging findings suggested a hypervascular tumor in the liver, which could be either focal nodular hyperplasia, adenoma, or hepatocellular carcinoma (HCC). Even though these lesions were diagnosed as HCC, some of the findings were not compatible with typical HCC. On dynamic CT and MRI, all lesions showed a slight arterial enhancement and did not show early venous washout. All lesions were located near the liver capsule. These findings, along with a history of splenectomy, suggested a diagnosis of hepatic splenosis.
Assuntos
Adulto , Humanos , Masculino , Carcinoma Hepatocelular/complicações , Hiperplasia Nodular Focal do Fígado/diagnóstico , Hepatite B Crônica/complicações , Fígado/patologia , Neoplasias Hepáticas/complicações , Imageamento por Ressonância Magnética , Esplenose/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , alfa-Fetoproteínas/biossínteseRESUMO
The term splenosis applies to the autotransplanted splenic tissue resulting from seeding in the context of past splenic trauma or surgery. We report a 42-year-old man with a history of splenectomy observed for an incidentally found retrovesical mass thought to be an ectopic testicle. The abdominal laparotomy revealed multiple focuses of pelvic splenosis. As splenosis can be diagnosed through specific imaging studies one should always consider it in differential diagnosis of a mass discovered years after splenic surgery or trauma.
Assuntos
Humanos , Masculino , Adulto , Neoplasias Abdominais/diagnóstico , Esplenectomia , Esplenose/diagnóstico , Diagnóstico Diferencial , Achados Incidentais , Peritônio/patologia , Esplenectomia/efeitos adversos , Esplenose/etiologia , Tomografia Computadorizada por Raios X , Neoplasias Testiculares/diagnósticoRESUMO
El bazo "nómade" se produce por una anomalía en el mesogastrio dorsal embrionario en la que el bazo carece de su fijación normal. No se forman los ligamentos lienorenal y lienogástrico ni los vasos cortos. La falta de esta fijación permite que el bazo se mueva libremente por la cavidad peritoneal, unido solamente a su pedículo vascular sobre el que puede volvularse. El bazo "nómade" puede ser asintomático y palparse como una masa abdominal móvil. La ubicación anómala puede ser constante o intermitente. En los casos sintomáticos, el bazo se volvula causando un infarto esplénico que se manifiesta como un abdomen agudo, o como un dolor abdominal cólico recurrente, si se produce la detorsión espontánea. En la mayoría de los casos comunicados, la forma de presentación del bazo "nómade" fue un infarto esplénico por vólvulo, que obligó a realizar una esplenectomía. La exéresis del bazo expone al riesgo de una sepsis incontrolable y es aceptado que ante una patología esplénica traumática o no, debe intentarse conservar el bazo. Sólo en muy raras ocasiones ha sido posible realizar una esplenopexia electiva en un paciente asintomático con un bazo "nómade", como en el caso aquí presentado.