Thoracic splenosis diagnosed by fine-needle aspiration cytology: a case report

A case of thoracoabdominal splenosis

We describe a case of a 38-year-old male with a remote history of motor vehicle trauma who presented to the emergency department with 1-week history of progressively worsening abdominal pain localized to the epigastric region. Patient history included splenectomy. Computerized tomography demonstrated multiple masses in the left pleural space as well as masses continuous with the diaphragm and abdominal wall in the left upper quadrant. In addition, a lobulated mass was identified in the right upper quadrant along the anterior right hepatic lobe. A diaphragmatic defect was noted containing splenic tissue. A diagnosis of splenosis was made. Disseminated splenosis presenting in both the thorax and abdomen is rare and poorly documented. This case serves to further illuminate this condition.

Spontaneous hemorrhage from splenic tissue 13 years after total splenectomy: report of a case

A 33-year-old man suffered sudden abdominal distension without traumatic episodes. He had undergone total splenectomy for hereditary spherocytosis 13 years ago. He was in shock, and his hemoglobin level was 10.5 g/dl. Contrast enhanced computed tomography revealed a giant mass in the left upper abdomen and extravasation of the contrast material into the mass. Excision of the mass was performed, and microscopic examination showed a giant hematoma surrounded by normal splenic tissue. We speculated that an accessory spleen or splenosis had enlarged for the 13 years and ruptured. The patient remained asymptomatic 4 months after the surgery. Spontaneous hemorrhage from accessory spleens or splenosis is extremely rare, and relevant case reports suggest that surgical resection of bleeding sites yields favorable prognosis although preoperative qualitative diagnosis seems to be difficult.

A rare benign intrathoracic mass in a patient with history of rocket explosion

Thoracic splenosis is rare benign condition that follows trauma leading to diaphragmatic injury. Most of the patients including ours present with a clear traumatic event leading to autotransplantation of spleen in thoracic cavity. Mostly diagnosed incidentally and we need to avoid unnecessary workup including radiological and invasive. It is a very important case which signifies importance of good history taking and initial imaging for making diagnosis and making our pulmonogist and internist aware of this diagnosis.

Thoracic splenosis as a differential diagnosis of juxtapleural nodules

Thoracic splenosis is rare and consists of ectopic implantation of splenic tissue into the chest after concomitant thoracic and abdominal trauma with diaphragm injury. It occurs in about 18% of cases of splenic ruptures. In almost all cases, diagnosis is given incidentally once patients are usually asymptomatic. Thoracic splenosis should be considered as a differential diagnosis in all patients with history of trauma presenting with juxtapleural nodules in chest computed tomography. However, malignant conditions should be ruled out firstly. Biopsy is not essential for the diagnosis once nuclear medicine can confirm splenosis in patients with pertinent history of trauma and suggestive tomographic image. We present a typical case of thoracic splenosis whose diagnosis was made by nuclear medicine and no invasive procedures were required.

Intrathoracic splenosis presenting as persistent chest pain

Thoracic splenosis is a rare entity resulting from splenic and diaphragmatic injury. Patients remain asymptomatic, and surgical intervention is not indicated in the majority of cases. We report a case of a 50-year-old male with a history of splenectomy due to a gunshot wound 30 years previously who presented with vague, progressively worsening chest pain. He was found to have a large intrathoracic splenosis. Unique features of our patient include the presence of symptoms, the significant interval growth of the splenic tissue, and the unprecedented size of the mass, which we believe to be the largest among those previously described.

Large platelet aggregates in endoscopic ultrasound-guided fine-needle aspiration of the pancreas and peripancreatic region: a clue for the diagnosis of intrapancreatic or accessory spleen

Intrapancreatic and intraabdominal accessory spleens (IPIASs) are rarely encountered in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsies. However, as incidentally discovered IPIAS can mimic a benign or malignant pancreatic neoplasm on imaging studies, a definitive diagnosis made by EUS-FNA can avert an unnecessary surgical intervention or additional radiologic follow-up. We report five cases of intrapancreatic splenules and one case of accessory spleen (AS) in which a definitive diagnosis was made on EUS-FNA. Previously recognized FNA cytomorphologic features of splenic tissue, including ASs and splenosis, are endothelial cells and polymorphous lymphocytes admixed with neutrophils, eosinophils, plasma cells, histiocytes, and lymphoglandular bodies. We describe the additional finding of abundant large platelet aggregates as another distinguishing feature of splenic tissue on FNA. In all six cases, large platelet aggregates were identified along with polymorphous lymphoid cells, lymphoglandular bodies, loose aggregates of endothelial cells and scattered or aggregated bland spindle cells. A review of 10 consecutive cases of EUS-FNA-sampled benign intraabdominal lymph nodes showed that the presence of large platelet aggregates, three-dimensional aggregates of lymphoid cells and of bland slender spindle cells and the absence of follicular germinal cell components (tingible body macrophages and lymphohistiocytic aggregates) are useful in differentiating IPIASs from reactive lymph nodes. Immunoperoxidase stains were useful to confirm a suspected IPIASs by showing CD31-positive acellular flocculent material, consistent with large platelet aggregates and a rich CD8-positive endothelial cell network between CD45-positive lymphoid cells and CD68-positive histiocytes in all six cases.

Parenchymal thoracic splenosis: history and nuclear imaging without invasive procedures may provide diagnosis

Splenosis is a rare finding of ectopic splenic tissue found within the thoracic cavity, abdomen or peritoneal cavity. Most cases occur in the abdomen and the thoracic location is a comparatively rare finding. In thoracic splenosis the splenic tissue most often grows in the form of a nodule and the autotransplantation is usually caused by a previous operation and/or most commonly a penetrating or blunt trauma to the thoracoabdominal region, resulting in splenic rupture and in some cases left diaphragmatic tear. In majority of the cases the patients are asymptomatic and are incidentally diagnosed with left hemithorax pulmonary lesions found via chest radiography or thoracic computed tomography. We present a 45-year-old Caucasian male who was incidentally diagnosed with parenchymal thoracic splenosis secondary to a gunshot wound to the abdomen 13 years ago that resulted in distal pancreatectomy, splenectomy and gastrorrhaphy. In this case report we will briefly discuss the current updates in the literature regarding thoracic splenosis, and highlight the fact that the findings raise the suspicion of malignancy requiring numerous investigations yet early recognition of thoracic splenosis can prevent unnecessary tests and procedures. Preoperative diagnosis of splenosis should be made with the use of nuclear imaging studies such as the ^99mTc heat-damaged erythrocyte study rather than computed tomography-guided biopsy or invasive surgery.

Thoracic splenosis: know it--avoid unnecessary investigations, interventions, and thoracotomy

Thoracic splenosis (TS) is autoimplantation of ectopic splenic tissue in the thoracic cavity that occurs following splenic injury. Most cases of TS are asymptomatic and are diagnosed during the course of an evaluation of incidentally discovered pulmonary lesions. Some cases may be difficult to diagnose, especially if features suggesting TS are not recognized. This may lead to an extensive workup and unnecessary invasive diagnostic procedures including thoracotomy. Multiple, asymptomatic, left-sided pleura-based lesions associated with a history of thoracoabdominal injury and splenectomy are the key points that should alert one to suspect TS, which can then simply be confirmed with a (99m)Tcsulfa colloid radionuclide scan. If TS is suspected and radionuclide imaging studies are performed, further extensive investigations, such as bronchoscopy, biopsy, thoracoscopy, and thoracotomy, are not required as the radionuclide scan is definitive for diagnosis. Most cases are asymptomatic, so further treatment is rarely required; all cases are managed conservatively. We emphasize that all physicians, radiologists, pathologists, and interventionalists should recognize key features that suggest the diagnosis of TS, order appropriate imaging when it is suspected, and avoid unnecessary invasive diagnostic procedures including thoracotomy.

Fine-needle aspiration of intrapancreatic accessory spleen, mimic of pancreatic neoplasms

Intrapancreatic accessory spleen (IPAS) is a congenital abnormality, which mimics neoplasm. Distinguishing IPAS from pancreatic neoplasm/malignancy is extremely important from a treatment perspective. We report the case of a 67-year-old asymptomatic man who had a 1.3-cm, incidentally detected, pancreatic tail mass. The mass was round, well-circumscribed, and hypervascular with uniform enhancement. The image findings were highly suggestive of a pancreatic endocrine neoplasm. An endoscopic ultrasound-guided fine-needle aspiration was performed. Conventional smears revealed a polymorphous population of lymphocytes admixed with a subset of other inflammatory cells. Hematoxylin-eosin–stained cell block sections showed conspicuous thin-walled blood vessels in addition to inflammatory cells. Immunostaining for CD8 demonstrated strong positivity in endothelial cells of the thin-walled vessels. By correlating the cytologic findings with the result of immunostaining, we rendered the diagnosis of IPAS. Our experience supports the view that endoscopic ultrasound-guided fine-needle aspiration may enable a reliable, preoperative diagnosis of IPAS and thus prevent unnecessary surgery.

Intrapancreatic accessory spleen: mimic of pancreatic endocrine tumor diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy

Intrapancreatic accessory spleen forms a well-defined nodule within the tail of the pancreas and is commonly mistaken by imaging studies as a neuroendocrine tumor. We report three cases of intrapancreatic accessory spleen diagnosed by endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) biopsy. Imaging studies showed well-circumscribed nodules in the tail of the pancreas. Two lesions were clinically suspicious for pancreatic neuroendocrine tumors and one appeared to be a cyst. EUS-guided FNA revealed predominantly small lymphocytes with a subset of histiocytes, conspicuous eosinophils, and plasma cells. There was also characteristic CD8 positive immunostaining of endothelial cells in cell block sections. We report the first series of accessory spleen in the pancreas diagnosed by EUS-guided FNA with the aid of CD8 immunostaining of splenic sinus endothelial cells.

Thoracic splenosis: diagnosis of a case based on history and computerized tomography findings

Thoracic splenosis is an uncommon cause of multiple pleural-based nodules. We present a case where a diagnosis of thoracic splenosis was made on the basis of radiologic findings and past history.

Intra-abdominal splenosis: how clinical history and imaging features averted an invasive procedure for tissue diagnosis

A 47-year-old man with a past history of splenectomy was referred for biopsy of a liver lesion. A subsequent (99m)technetium heat-damaged red cell scan helped make the diagnosis of splenosis and averted a biopsy procedure.

Thoracic splenosis twenty-nine years after traumatic splenectomy mimicking intrathoracic neoplasm

Thoracic splenosis refers to a condition of ectopic splenic tissue in the thoracic cavity. It is usually a consequence of splenic tissue seeding in the pleural cavity after thoracoabdominal trauma. A rare case of thoracic splenosis, in a 62-year-old man who had had a traumatic splenectomy due to thoracoabdominal trauma 29 years earlier, is reported. The patient, a heavy smoker, was admitted for evaluation of a left-side thoracic lesion discovered on a plain chest film. Bronchoscopy, CT scan and needle biopsy proved inconclusive for the diagnosis. Exploratory thoracotomy was necessary to establish the diagnosis. During the operation, a thoracic splenosis was confirmed. To date, only 28 cases of thoracic splenosis have been reported in the literature. The purpose of this report is to present a new case of splenosis of the thoracic cavity simulating intrathoracic neoplasm.

Radionuclide imaging in thoracic splenosis and a review of the literature

Splenosis is defined as the autotransplantation of splenic tissue to abnormal locations after splenic injury. Although abdominal splenosis is the most common form and is usually discovered at laparotomy, thoracic splenosis is less common and occurs as an asymptomatic peripheral pulmonary nodule, incidentally discovered on a routine chest radiograph. Given the long interval between the initial trauma and its discovery, thoracic splenosis is rarely considered in the differential diagnosis of left-sided, pleural-based pulmonary nodules or masses. The diagnosis is often a result of surgery. The authors report an additional case of thoracic splenosis, review the literature, and discuss nonsurgical diagnostic methods.