Splenosis: a great mimicker of neoplastic disease

A large gastric splenosis mimicking gastrointestinal stromal tumor: A case report and literature review

Splenosis pertains to the phenomenon wherein a segment of the spleen undergoes detachment and becomes embedded in other anatomical regions subsequent to traumatic rupture or therapeutic resection, and then progressively establishing blood circulation to foster the regeneration of splenic tissue. Existing literature posits that splenosis predominantly manifests within the confines of the abdominal and pelvic cavities. The objective of the current study was to present an uncommon case involving the occurrence of splenosis within the gastric myometrium, thereby contributing to the current knowledge regarding splenosis. A 16-year-old female sought medical assistance owing to recurrent abdominal pain persisting for a duration of six months, and had a history of splenectomy two years prior. Gastroscopy, endoscopic ultrasound and computed tomography (CT) examination collectively identified a lesion in the submucosal prominence of the fundus of the stomach. Initial considerations based on imaging examinations leaned towards a gastrointestinal stromal tumor. Consequently, an endoscopic resection was undertaken. Remarkably, the pathological findings and histochemistry concurred with the alterations associated with ectopic spleen implantation, leading to a stable postoperative course. In conclusion, splenosis denotes the implantation of a segment of the spleen into extraneous anatomical sites, attributable to traumatic rupture or therapeutic resection. The preoperative diagnosis of splenosis can pose a challenge, potentially culminating in unnecessary radical clinical interventions. Therefore, the acquisition of a comprehensive medical history, with a particular focus on surgical and trauma events, emerges as pivotal for an accurate diagnosis. In light of novel diagnostic modalities, the non-invasive technology of nuclear medicine can efficaciously visualize ectopic splenic tissue, thereby averting superfluous surgical procedures. It is both feasible and imperative to implement individualized treatment strategies for patients afflicted with splenosis.

[18F]FDOPA PET/CT in Solid Pseudopapillary Tumor of the Pancreas: a Recurred Tumor Mimicking Splenosis

Solid pseudopapillary tumor (SPT) of the pancreas is a neoplasm with low malignant potential. It is often challenging to diagnose SPT due to its nonspecific clinical and radiological features, and [18F]FDOPA is effective in diagnosing SPT, particularly in differentiating SPT from benign conditions such as splenosis. A 55-year-old woman underwent distal pancreatectomy and splenectomy for histologically confirmed SPT. She was also initially diagnosed with splenosis. During follow-up, sizes of multiple nodular lesions were increased, raising the possibility of peritoneal seeding of SPT. For diagnosis, a spleen scan and SPECT/CT were performed using 99mTc-labeled damaged red blood cells, which showed no uptake in the peritoneal nodules. Subsequent [18F]FDOPA PET/CT revealed [18F]FDOPA-avidity of the nodules. The patient underwent tumor resection surgery, and the nodules were pathologically confirmed as SPT.

Incidental splenosis discovered during robotic assisted radical prostatectomy: A case report

Splenosis refers to the benign heterotopic auto transplantation of splenic tissue that most commonly arises following traumatic rupture of the spleen. It is most often associated with traumatic rupture of the spleen. While often asymptomatic, splenosis can mimic malignancy and may lead to unnecessary biopsy, chemotherapy, and surgery. This case report highlights an instance of splenosis discovered incidentally during robotic assisted radical prostatectomy. Splenules were sent for frozen section due to concern for malignancy. Retrospective analysis of imaging obtained prior to the procedure was consistent with splenosis.

Transplantation of splenic tissue after splenectomy: A case report

Transplantation of splenic tissue is a rare condition that usually occurs after splenic trauma and splenectomy. It usually requires surgery for diagnosis and treatment. A 38-year-old Asian male with familial hemolytic disease underwent laparoscopic splenectomy for a traumatic rupture of the spleen one year prior. The patient developed middle-upper abdominal pain without any obvious cause, radiating to the back and chest seven months prior to presentation. The condition improved with conservative treatment but the patient experienced recurrent episodes. Abdominal CT suggested multiple gallstones in the gallbladder that changed after splenectomy and multiple nodules in the original splenic area; thus, transplantation of splenic tissue was considered. MRI suggested thick gall bladder bile, multiple stones and cholecystitis, and the spleen was not observed (the patient underwent laparoscopic splenectomy at our hospital one year previously due to traumatic splenic rupture); furthermore, there were multiple abnormal signal foci in the splenic area, so the possibility of spleen implantation was considered. Considering the patient's family history of a hereditary hemolytic disease, laparoscopic cholecystectomy was performed simultaneously with laparoscopic accessory splenectomy. The final pathological report revealed chronic cholecystitis, mixed calculi, red pulp dilation, hyperemia and bleeding in round tissue with blood clot formation and acute and chronic inflammatory cell infiltration. Clinicians must bear in mind the possibility of splenosis after splenic trauma and its image variations.

Abdominal and pelvic splenosis: atypical findings, pitfalls, and mimics

Splenosis is an acquired form of ectopic splenic tissue that typically arises after trauma or splenectomy. It is often an incidental image finding in an otherwise asymptomatic patient, but the spectrum of symptoms varies based on the site of implantation. Radiologists should be familiar with the imaging features of splenosis to avoid mistaking it for malignancy. Splenosis has identical imaging features to that of the native spleen on US, CT, MRI, and nuclear medicine examinations. Therefore, when the radiologic findings support the diagnosis of splenosis, the patient can be spared invasive procedures for tissue sampling.

Detection of Splenic Tissue Using 99mTc-Labelled Denatured Red Blood Cells Scintigraphy—A Quantitative Single Center Analysis

Background: Red blood cells (RBC) scintigraphy can be used not only for detection of bleeding sites, but also of spleen tissue. However, there is no established quantitative readout. Therefore, we investigated uptake in suspected splenic lesions in direct quantitative correlation to sites of physiologic uptake in order to objectify the readout. Methods: 20 patients with Tc-99m-labelled RBC scintigraphy and SPECT/low-dose CT for assessment of suspected splenic tissue were included. Lesions were rated as vital splenic or non-splenic tissue, and uptake and physiologic uptake of bone marrow, pancreas, and spleen were then quantified using a volume-of-interest based approach. Hepatic uptake served as a reference. Results: The median uptake ratio was significantly higher in splenic (2.82 (range, 0.58–24.10), n = 47) compared to other lesions (0.49 (0.01–0.83), n = 7), p < 0.001, and 5 lesions were newly discovered. The median pancreatic uptake was 0.09 (range 0.03–0.67), bone marrow 0.17 (0.03–0.45), and orthotopic spleen 14.45 (3.04–29.82). Compared to orthotopic spleens, the pancreas showed lowest uptake (0.09 vs. 14.45, p = 0.004). Based on pancreatic uptake we defined a cutoff (0.75) to distinguish splenic from other tissues. Conclusion: As the uptake in extra-splenic regions is invariably low compared to splenules, it can be used as comparator for evaluating suspected splenic tissues.

A case of hepatic splenosis in the setting of iron overload; multimodal and literature review

Hepatic splenosis, a rare entity, is the ectopic implantation of splenic tissue into the hepatic parenchyma, most often incidentally seen in patients with a history of splenic trauma and splenectomy. We present a unique case of hepatic splenosis in a patient with hemosiderosis and splenectomy following the incidental finding of hepatic masses on pretransplant imaging. Final diagnosis was made based on cross-sectional imaging characteristics matching that of the left upper quadrant splenules alone. We discuss common characteristics of hepatic splenosis on multiple modalities, the effect of iron deposition on the imaging characteristics of hepatic and splenic tissue and how that impacts the differential and diagnosis. This case highlights the unique imaging characteristics hepatic splenosis can have particularly in the setting of hemosiderosis. Hepatic splenosis imaging diagnosis has a significant advantage over tissue diagnosis in terms of decreased risk, time and cost.

Coincidence of Intra-Abdominal Splenosis in a Patient with Advanced Ovarian Cancer: Case Report and Review of the Literature

Splenosis is a rare disease, which is often discovered incidentally years after surgical procedures on the spleen or traumatic splenic lesions. Through injury of the splenic capsule, splenic cells are able to spread and autoimplant in a fashion similar to the process of metastatic cancer. Here we present the case of a 62-year-old female patient with a palpable tumor of the lower abdomen. Her medical history was unremarkable, except for splenectomy after traumatic splenic lesion in her childhood. Clinical examination and diagnostic imaging raised the suspicion of advanced ovarian cancer, which was further substantiated by the typical presentation of adnexal masses and disseminated peritoneal metastases during the following staging laparotomy. Surprisingly, we also found peritoneal implants macroscopically similar to splenic tissue. Microscopic examination of tissue specimens by intrasurgical frozen section confirmed the diagnosis of intra-abdominal splenosis. The patient then underwent cytoreductive surgery with complete resection of all cancer manifestations, sparing the remaining foci of splenosis to avoid further morbidity. This case demonstrates the rare coincidence of intra-abdominal carcinoma and splenosis, which could lead to intraoperative difficulties by misinterpreting benign splenic tissue. Therefore, splenosis should be considered in patients with medical history of splenic lesions and further diagnostic imaging like Tc-99m-tagged heat-damaged RBC scan could be used for presurgical distinguishing between tumor spread in the abdominal cavity and disseminated splenosis. The presented case report should not only raise awareness for the rare disease splenosis, but also emphasize the need to consider the possibility of simultaneous incidence of benign and malignant intra-abdominal lesions, as to our knowledge this is the first published case of simultaneous peritoneal carcinomatosis and splenosis.

Robotically assisted removal of pelvic splenosis fifty-six years after splenectomy: A case report

BACKGROUND

‘Splenosis’ is defined as the autotransplantation of splenic tissue following trauma or surgery, usually in the form of intraperitoneal nodules. The proliferation of imaging techniques has resulted in increased unexpected discoveries of splenosis nodules, and achieving a differential diagnosis can be challenging. Nuclear medicine studies have been playing an increasingly important role in this process, but the clinical significance of asymptomatic nodules remains uncertain.

CASE SUMMARY

We present a case of pelvic splenosis in a 73-year-old man diagnosed 56 years after a splenectomy during a computed tomography (CT) follow-up for B-cell lymphoma, presenting intense contrast enhancement of an 18 mm nodule in the right recto-vesical space. 18F-fluorodeoxyglucose demonstrated weak metabolic activity. Since histological diagnosis was deemed necessary, the nodule was easily removed with robotically assisted laparoscopy, together with another 6 mm left a paracolic lesion. The latter was previously undiagnosed but retrospectively visible on the CT scan.

CONCLUSION

In a patient requiring differential diagnosis of splenosis nodules from lymphoma recurrence, the robotic approach provided a safe en bloc removal with short hospitalization. The Da Vinci Xi robot was particularly helpful because its optics can be introduced from all ports, facilitating visualization and lysis of multiple intra-abdominal adhesions.

Non-neoplastic conditions mimicking peritoneal carcinomatosis at CT imaging

The general appearance of peritoneal carcinomatosis at abdominal CT and other cross-sectional imaging modalities consists of varying amounts of peritoneal-based soft tissue implants (mass-forming or infiltrative), peritoneal fluid, and occasionally calcification. However, a wide variety of common and uncommon neoplastic and non-neoplastic conditions can closely mimic peritoneal carcinomatosis at imaging. Neoplastic mimics of peritoneal carcinomatosis include primary peritoneal and sub peritoneal tumors, as well as peritoneal lymphomatosis and sarcomatosis.Broad categories of non-neoplastic mimics of peritoneal carcinomatosis include tumor-like conditions, systemic processes, atypical infections, and fat-based conditions. For many entities, suggestive or specific patient information and/or CT imaging findings exist that may allow the radiologist to narrow the differential diagnosis. In this article, we review the salient clinical and cross-sectional imaging features of non-neoplastic mimics of peritoneal carcinomatosis and malignancy, with emphasis on the CT findings and the additional clues that may suggest the correct benign diagnosis.

Abdominal splenosis and its differential diagnoses: What the radiologist needs to know

Splenosis is a benign acquired condition characterized by the presence of heterotopic viable splenic tissue in other organs or within cavities such as peritoneum, retroperitoneum, or thorax after splenic trauma or surgery. Abdominal splenosis is often an incidental finding and computed tomography and magnetic resonance usually allow a confident diagnosis. The typical enhancement that parallels the spleen is a useful hallmark of splenosis. Splenic implants lack contrast uptake in the hepatobiliary phase and show high signal at high b-values on diffusion-weighted images. In some cases splenosis may mimic malignant and benign conditions in the peritoneum as well as in hollow and parenchymal abdominal organs and further investigations - including scintigraphy with Tc99m-labelled heat-denatured red blood cells or biopsy - are sometimes required in challenging cases. This pictorial essay reviews the imaging presentation and potential differential diagnosis of splenosis according to the site of implantation. A prompt and accurate radiological diagnosis of splenosis can avoid unnecessary biopsy or surgery.

Incidental finding of abdominal splenosis with mononucleated cell infiltration leading to a diagnosis of acute myeloid leukemia

Splenosis refers to ectopic splenic implants that are often found incidentally years after splenic rupture/splenectomy, and the nodules of splenosis are usually small, less than 3 cm for the majority. We report a case of splenosis with a 5-centimeter large mass in the anterior abdomen in a 79 year-old male with a remote history of splenic rupture/splenectomy. Unexpectedly, needle core biopsy of the abdominal mass demonstrated splenic tissue with a mononucleated cell infiltrate blurring the splenic architecture that was highlighted only by CD8 stain. This finding prompted a bone marrow examination resulting in the diagnosis of acute myeloid leukemia in the patient. Retrospectively, enlargement of this ectopic spleen may have been caused by this leukemic infiltrate. This case underscores the importance of being aware of this rare pathological condition and its retained vulnerability for involvement by hematolymphoid neoplasms, as well as significance of identifying splenic architecture highlighted by CD8 stain to reach a correct diagnosis.

Follicular lymphoma in a patient with splenosis: a case report

Splenosis refers to the seeding of splenic cells associated with surgery or trauma. Splenosis mimicking other diseases has been reported in the literature. To the best of our knowledge, this is the first case of follicular lymphoma in a patient with splenosis whose diagnosis of lymphoma was delayed because of a known history of splenosis. We report a 48-year-old male patient who underwent splenectomy because of injury from a high fall 20 years previously. He had no symptoms other than mild abdominal pain until 2 years previously, which was thought to be associated with splenosis. When his symptoms began to increase, he had explorative laparotomy for diagnosis, which was later confirmed as follicular lymphoma. Splenosis may delay the diagnosis of other conditions that can be underestimated. Clinicians should be aware of unusual symptoms in patients with splenosis.

A Multinodular Mass of Abdominal Splenosis: Case Report of Uncommon Images of a Rare Disease

Splenosis is a rare disease which typically forms single or multiple round masses. A 45-year-old male was referred for investigation of an abdominal mass. He had a history of splenic injury from a traffic accident at age 19. Contrast-enhanced computed tomography showed a well-enhanced, multi-nodular mass lesion, 3.5 cm in size, located below the stomach. An endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) for the mass was inconclusive. A surgery was performed, and pathology of the resected mass confirmed splenosis. Clinicians must bear in mind the possibility of occurrence of splenosis after splenic trauma and its image variations.