Angioma esplénico de células litorales / Littoral cell angioma of the spleen

RESUMEN Presentamos el caso de un paciente varón de 62 años con masa dolorosa en hipocondrio izquierdo catalogado inicialmente como sarcoma irresecable, recibió quimioterapia y radioterapia sin respuesta, motivo por el cual se reintervino quirúrgicamente hallándose un tumor dependiente de bazo heterogéneo con perfil inmunohistoquímico de angioma de células litorales. El angioma de células litorales (ACL) es una lesión esplénica poco frecuente que se presenta asociado a síntomas genéricos como astenia, dolor regional y baja de peso, que requiere como manejo principal un abordaje quirúrgico. Suele ser una neoplasia asintomática de hallazgo incidental, afecta a ambos sexos por igual, cuyo diagnóstico es básicamente histológico e inmunohistoquímico con buen pronóstico luego de un abordaje quirúrgico inicial.

ABSTRACT A 62-year-old man with a medical history of a painful abdominal mass in left upper quadrant and general symptoms, who was classified initially as an unresectable sarcoma. He received chemotherapy and radiotherapy with no response, so he underwent a new surgery, finding a heterogeneous tumor with immunohistochemical consistent with littoral cell angioma. Littoral cell angioma (LCA) is a rare splenic lesion that presents general symptoms, so there are not many reports, which requires surgical management. Is usually an asymptomatic neoplasm of incidental finding, affecting both sexes equally, whose diagnosis is histological and immunohistochemical with a good prognosis always after a surgical approach.

Analysis of feasibility, safety and effectiveness of ultrasound-guided percutaneous microwave ablation of splenic neoplasm.

The present study aimed to analyze the feasibility, safety and effectiveness of ultrasound-guided percutaneous microwave ablation of splenic neoplasm. A total of 62 patients with splenic neoplasm admitted to Second People's Hospital of Liaocheng between January 2009 and December 2012 were selected, and randomly divided into the observation group (n=31) and control group (n=31). The control group was treated with open ablation, while the observation group was treated with ultrasound-guided percutaneous microwave ablation. The splenic hemodynamics and ablation effects of patients after treatment were detected via color Doppler ultrasound. The changes in peripheral blood cell count before treatment, and at 3, 7 and 14 days after treatment were monitored. The side effects and complications were compared between the two groups. Patients were followed up for 5 years to observe the survival rates of the two groups. At 1 week after treatment, the peak velocity of splenic artery in observation group was significantly lower than that in control group, and the diameter, velocity and flow of splenic vein were significantly lower than those in control group (P<0.05). After treatment, the white blood cell and platelet counts in both groups were significantly increased compared with those before treatment, and the counts in observation group were obviously higher than those in control group (P<0.05). There were no significant changes in the red blood cell counts in both groups before and after treatment (P>0.05). The ablation volume, ablation ratio and 1-week shrink ratio in both groups had no significant differences (P>0.05). The incidence rates of side effects and complications in observation group were significantly lower than those in control group (P<0.05). The 5-year survival rates of both groups were >50%, and the survival time and survival rate were not significantly different (P<0.05). The curative effects of open ablation and ultrasound-guided percutaneous microwave ablation in the treatment of splenic neoplasm were significant, and the 5-year survival rate of patients was higher; compared with open ablation. The ultrasound-guided percutaneous microwave ablation is characterized by the small trauma, lower incidence rates of adverse reactions and complications and better safety, which can increase the peripheral blood cell count, and improve the splenic blood flow and coagulation function, playing a role in the regulation of the patient's body status.

Clinicopathological features of splenic tumours of lymphoid tissue.

BACKGROUND: To study the effects of splenectomy on treatment and diagnosis of tumours of lymphoid tissue of the spleen. METHODS: Fifty-three cases were reviewed from Peking University People's Hospital from 2002 to 2017. According to WHO classification of tumours of haematopoietic and lymphoid tissues (2008) and classification updated (2016), the cases were studied by microscopy, immunohistochemistry and in situ hybridization, combined with the bone marrow biopsy and clinical examination. RESULTS: In 53 cases, the male to female ratio was 3.4:1, the mean age was 55.4 years old, the median survival time was 17.0 months, and all patients present with variable degree of splenomegaly. The elevated percentage of lymphocyte in peripheral blood can be seen in 22 cases, and elevated LDH level in 24 cases. Abnormal blood counts can be seen in 26 cases before operation, and 22 cases remission to normal level partly or completely after operation. The clinical symptoms included abdominal pain or distension, fatigue, fever, and weight loss, etc. Seventeen cases present with lymphoadenopathy of abdomen or other sites. Fourteen cases were stage I or II, whereas 6 were stage III, 28 were stage IV. Forty-three cases were splenic B-cell marginal zone lymphoma (SMZL)(48.8%,21/43), DLBCL(23.3%,10/43), splenic diffuse red pulp small B-cell lymphoma (SDRPSBL)(11.6%,5/43), mantle cell lymphoma (MCL)(9.3%,4/43), follicular lymphoma (FL)(4.7%,2/43), composite lymphoma (CL, DLBCL and classical Hodgkin lymphoma)(2.3%,1/43) in turn, and the remaining 10 cases were chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL/SLL) (n = 4), hairy cell leukaemia (HCL) (n = 1), hepatosplenic T-cell lymphoma (HSTL) (n = 5). The survival period of SMZL and DLBCL was 25.7, 18.6 months, respectively. Thirteen cases were dead (27.1%, 13/48). The chemotherapy protocol included Hyper-CVAD A/B with/without R (Rituximab), COP, CHOP with/without R etc. The prognosis of those with elevated LDH level, high clinical staging, B symptom, and older than 60 year old was obviously worse, and the prognosis of DLBCL was worse than that of SMZL. CONCLUSIONS: Most splenic lymphoid tumors present with splenomegaly and abnormal blood counts, and complete or part remission of blood counts can be seen after splenectomy, and splenectomy is also helpful for pathological diagnosis. The most common pathological types are SMZL and DLBCL. The definite diagnosis can be made by combining with clinical features, histopathology, immunophenotype, genetics, bone marrow biopsy and laboratory examination.

Diagnosis and treatment of primary splenic tumor: an analysis of 63 cases / 中华肝胆外科杂志

Objective To summarize the experience in diagnosis and treatment of primary splenic neoplasm (PSN) to promote understanding of the disease. Methods The clinical data of all admitted patients with PSN treated in this hospital from February 1989 to February 2004 were retrospectively analyzed. Results A total of 63 patients were treated by surgery and pathologically confirmed as PSN. Twenty-one patients were treated by splenectomy alone. Twenty-seven patients underwent distal pancreatectomy and splenectomy. Fifteen patients received splenectomy combined with excision of tumor, the 5-year survival rate was 35.9%(15/42). Conclusion PSN should be diagnosed mainly according to clinical manifestations, image examination, and fine needle aspiration biopsy. CT and angiography play an important role in the identification of benign and malignant splenic mass. Early diagnosis, radical resection and comprehensive treatment are important for improving the prognosis of PSN.

Synchronous Isolated Splenic Metastasis from Colon Cancer

Isolated splenic metastases from colon cancer has been rarely reported in English literatures. Furthermore synchronous isolated splenic metastasis is very rare. We report a 63-year-old man with synchronous isolated splenic meta-stasis from colon cancer. He was suspicious to ascending colon cancer with isolated splenic metastasis by colono-fiberoscope, abdominal CT, fusion PET scan and elevated CEA level. He underwent right hemicolectomy and splenectomy. Histologic examinations revealed colonic adeno-carcinoma with splenic metastasis. He was discharged uneventfully and was planned to take chemotherapy. Although it appears to be rare, splenic mass with colon cancer patient should be evaluated to rule out metastasis and splenectomy for isolated splenic metastasis from colon cancer is warranted.

Clinical diagnosis and treatment of primary splenic tumor / 中华肝胆外科杂志

Objective To summarize the experience in diagnosis and treatment of primary splenic neoplasm (PSN). Methods The clinical data of 31 patients with PSN treated in our hospital were retrospectively analyzed. Results Amongst the patients, 25 were diagnosed as PSN postoperatively. Fifteen out of the 19 patients with benignancy were treated with splenectomy, and the others underwent partial splenectomy or tumor excision. Eleven out of the 12 patients with malignancy received splenectomy (including two by excision of pancreatic body and tail), and the other one underwent biopsy alone. The pathological types were as follows: varieties of cyst in 11, angiocavemoma in 4, inflammatory pseudotumor in 2, cavernous lymphangioma in 1, cystic degeratin of liomyoma in 1, malignant lymphoma and lymphsarcoma in 6, hemangiosarcoma in 3, fibrosarcoma in 1, liomyosarcoma in 1 and malignant fibrous histiocytoma in 1. Three patients with malignancy survived for 5 years. The reason was that they received radical splenectomy in combination with chemotherapy or radiotherapy and immunotherapy. Conclusions PSN should be diagnosed mainly according to clinical manifestations and image examination. The differentiation between benignancy and malignancy depends on CT, hemangiography and determination of seros AKP and ? GT levels. Early diagnosis, radical operation and comprehensive treatment are important for improving the prognosis of PSN.

The clinical analysis of 13 children with primary splenic tumor / 临床外科杂志

Objective To discuss the clinical characteristics and treatment of children with primary splenic tumor.Method A retrospective analysis was made on 13 children with primary splenic tumor from January 1970 to December 2001.Results There were splenic hemangioma in 5,splenic lymphoma in 4,splenic cysts in 2 and splenic malignant lymphoma in 2.In the primary splenic benign tumors,4 cases were treated with splenectomy,7 cases were treated with partily splenectomy;2 cases of splenectomy often had respiratory tract infection 1 year postoperatively.2 of the splenic malignant lymphoma were treated with splenectomy and chemotheraphy postoperatively;1 of them died 23 months postoperatively,another is still alive 8 months postoperatively.Conclusions The diagnosis of primary splenic tumor in children is mainly depended on B-ultrasound examination and CT scanning.Children with primary splenic benign tumors should be retained normal spleen as far as possible intraoperatively.It is important for splenectomy to pay more attention to the clinical infection 2 years postoperatively.Splenectomy combined with chemotherapy may provide optimum therapy for children with primary splenic malignant lymphoma.Early detection and treatment are crucial to increase the survival rate of children with primary splenic malignant lymphoma.