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Downs EM, Reeves S. Sonographic Discovery of Autotransplanted Splenic Implants in a Pregnant Patient. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479318812032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is important to include splenic implants in the differential diagnosis of patients with a history of splenic trauma. Autotransplanted splenic implants may have a sonographic appearance similar to that of pathologies such as lymphadenopathy or carcinomatosis. This is the first known case to discuss a pregnant patient with a history of autologous autotransplanted splenic tissue, which was discovered on sonography and confirmed during the patient’s cesearean section.
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Affiliation(s)
- Emily M. Downs
- Department of Ultrasound and Maternal Fetal Medicine, University of Colorado Hospital, Aurora, CO, USA
| | - Shane Reeves
- Department of Ultrasound and Maternal Fetal Medicine, University of Colorado Hospital, Aurora, CO, USA
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2
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Buisson G, Maissiat E, Dubernard G, Boussel L. [Pelvic nodules in a young woman: All is not endometriosis!]. J Gynecol Obstet Hum Reprod 2017; 46:197-200. [PMID: 28403978 DOI: 10.1016/j.jogoh.2016.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/24/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
Abstract
Splenosis is a pathology resulting from a rupture of the spleen due to a trauma or a surgery. We report the case of a patient presenting with a splenosis, initially diagnosed as endometriosis-related pelvic nodules, the most frequent cause of pelvic nodules in women. We will describe the imaging strategy that led to the final diagnosis of splenosis.
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Affiliation(s)
- G Buisson
- Service de radiodiagnostic et d'imagerie médicale, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France.
| | - E Maissiat
- Service de radiodiagnostic et d'imagerie médicale, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - G Dubernard
- Service de gynécologie-obstétrique, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - L Boussel
- Service de radiodiagnostic et d'imagerie médicale, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
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3
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Rizzuto I, Al-Samarrai M. Laparoscopic Management of Pelvic Splenosis. J Gynecol Surg 2013. [DOI: 10.1089/gyn.2012.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ivana Rizzuto
- Princess Alexandra Hospital NHS Trust, Harlow, Essex UK
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Mollo A, Granata M, De Placido G. Pelvic splenosis in an infertile patient. Int J Gynaecol Obstet 2011; 116:267. [PMID: 22153614 DOI: 10.1016/j.ijgo.2011.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 10/18/2011] [Accepted: 11/17/2011] [Indexed: 10/14/2022]
Affiliation(s)
- Antonio Mollo
- Department of Obstetrics, Gynecology, Urology and Reproductive Medicine, Federico II University of Naples, Naples, Italy.
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5
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Desai N, Parsons AK, Holmström SW. A painful reminder: the patient had sharp abdominal pain and a complicated medical history. Am J Obstet Gynecol 2010; 202:405.e1-2. [PMID: 19801143 DOI: 10.1016/j.ajog.2009.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 06/02/2009] [Accepted: 08/17/2009] [Indexed: 10/20/2022]
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6
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Zvi V, Moti P, Mendlovic S, Arie H, Maymon R. Pelvic splenosis – a gynaecological challenge. Reprod Biomed Online 2009; 18:421-3. [DOI: 10.1016/s1472-6483(10)60103-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Vellayan M, Lotfallah HN. Blue peritoneal implants--is it always endometriosis? Eur J Obstet Gynecol Reprod Biol 2006; 136:263-4. [PMID: 17134818 DOI: 10.1016/j.ejogrb.2006.10.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Revised: 10/15/2006] [Accepted: 10/24/2006] [Indexed: 11/19/2022]
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9
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Barbaros U, Dinççağ A, Kabul E. Minimally invasive surgery in the treatment of splenosis. Surg Laparosc Endosc Percutan Tech 2006; 16:187-9. [PMID: 16804467 DOI: 10.1097/00129689-200606000-00016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Splenosis has been serious etiologic reason in the recurrence of benign hematologic diseases after elective open or laparoscopic splenectomy. Although, the incidence of splenosis in patients splenectomized for trauma is high, as long as they are asymptomatic, they do not require surgical treatment. Herein, we report a case of idiopathic thrombocytopenic purpura recurrence due to splenosis 5 years after the initial laparoscopic splenectomy. Laparoscopic treatment of splenosis was performed successfully.
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Affiliation(s)
- Umut Barbaros
- Department of General Surgery, Istanbul Medical Faculty, Istanbul University, CAPA, Turkey.
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10
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Oláh KS. The laparoscopic appearances of pelvic splenosis: a case of mistaken identity. J OBSTET GYNAECOL 2006; 25:829-32. [PMID: 16368605 DOI: 10.1080/01443610500338396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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11
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Abstract
BACKGROUND Splenosis is a rare complication after splenectomy and generally does not cause clinical symptoms. CASE A 34-year-old woman who had splenectomy in childhood after trauma presented with a pelvic mass. Ultrasound examination demonstrated a right adnexal mass and a myomatous uterus. Exploratory laparotomy revealed multiple splenic implants along the small and large bowel and in the ileocecal region, including the appendix. Total hysterectomy, right salphengectomy, and appendectomy were performed. CONCLUSION After splenectomy, splenic implants may mimic benign or malignant tumors of the pelvis and may require surgical exploration.
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Affiliation(s)
- Yasemin Tasci
- Department of Gynecology, SSK Ankara Maternity Hospital, Ankara, Turkey
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Sarraf KM, Abdalla M, Al-Omari O, Sarraf MG. Diagnostic difficulties of pelvic splenosis: case report. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 27:220-1. [PMID: 16435336 DOI: 10.1002/uog.2661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
We report the case of a 38-year-old woman who presented with chronic lower abdominal pain. Her past medical history included a splenectomy due to abdominal trauma. Ultrasound examination revealed four pelvic tumors which, upon laparotomy, were found to be the result of splenosis. Approximately 100 cases of splenosis have been reported but only a minority of them have been published in the gynecological literature. Our case indicates that those involved in pelvic scanning (even of asymptomatic women) and/or treating those complaining of lower abdominal pain or presenting with pelvic tumors should be aware of splenosis as a possible diagnosis.
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Affiliation(s)
- K M Sarraf
- Department of Ultrasound and Fetal Health, Al-Amal Hospital, Amman, Jordan.
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Lamvu G, Tu F, As-Sanie S, Zolnoun D, Steege JF. The role of laparoscopy in the diagnosis and treatment of conditions associated with chronic pelvic pain. Obstet Gynecol Clin North Am 2004; 31:619-30, x. [PMID: 15450323 DOI: 10.1016/j.ogc.2004.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Laparoscopy is a useful tool for the diagnosis and treatment of conditions associated with chronic pelvic pain. In the evaluation of chronic pelvic pain, laparoscopic techniques vary from conservative procedures, such as pain mapping, excision, and nerve ablation, to more extensive procedures like oophorectomy and hysterectomy. Although useful for diagnosis, laparoscopy continues to have a controversial role in the treatment of chronic pelvic pain.
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Affiliation(s)
- Georgine Lamvu
- Division of Advanced Laparoscopy and Gynecologic, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, 27599-7508, USA.
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Khosravi M, Margulies D, Alsabeh R, Nissen N, Phillips E, Morgenstern L. Consider the Diagnosis of Splenosis for Soft Tissue Masses Long after Any Splenic Injury. Am Surg 2004. [DOI: 10.1177/000313480407001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Splenosis represents the autotransplantation of splenic tissue after splenic trauma or surgery. Disruption of the splenic capsule causes fragments of splenic tissue to be seeded mainly throughout the peritoneal cavity, where they are characterized by diffusely scattered bluish implants. Extraperitoneal locations are very rare and mainly include the thoracic cavity after thoracoabdominal trauma with simultaneous splenic rupture and diaphragmatic laceration. We retrospectively identified all patients in the pathology registry with the diagnosis of splenosis between December 1974 and July 2003 at our urban teaching hospital. Data collected included presenting signs and symptoms, history, imaging studies, treatment, pathology, and outcome. Five cases of splenosis were identified and described. Location of the splenosis was intraperitoneal in two and intrahepatic, intrathoracic, and subcutaneous in one each. In these cases, there was an average interval of 29 years between splenic injury and diagnosis, and most were found incidentally. One of the cases was managed entirely laparoscopically and another thoracoscopically.
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Affiliation(s)
- M.R. Khosravi
- From the Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - D.R. Margulies
- From the Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - R. Alsabeh
- From the Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - N. Nissen
- From the Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - E.H. Phillips
- From the Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - L. Morgenstern
- From the Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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15
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Abstract
OBJECTIVE Sampson's theory of reflux menstruation suggests that endometriosis is one form of a condition known as an autotransplant. This study seeks to characterize autotransplants as they are described in the literature and to determine whether endometriosis resembles an autotransplant. DESIGN Literature review of published studies containing the following types of information: [1] characterization of the histologic features, immunohistochemistry, or structural function of autotransplants; and [2] comparisons of endometriosis with endometrium. MAIN OUTCOME MEASURE(S) Characteristics of multiple types of autotransplants were noted. Similarity or dissimilarity of endometriosis and endometrium was tabulated to judge qualitatively whether the bulk of the evidence supports the notion that endometriosis is an autotransplant. RESULT(S) Autotransplants remain very similar or identical to eutopic tissues of origin, regardless of the length of time following autotransplantation. Endometriosis differs in many profound and fundamental ways from eutopic endometrium, including clonality of origin, enzymatic activity, protein expression, and histologic and morphologic characteristics. A minority of studies has found similarities between endometriosis and eutopic endometrium. CONCLUSION(S) Endometriosis is dissimilar to eutopic endometrium and therefore lacks characteristics of an autotransplant. Sampson's theory of origin of endometriosis is not supported by the results of this study. Studies of experimental endometriosis that have not used menstrual endometrium may be misleading.
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Syed S, Zaharopoulos P. Thoracic splenosis diagnosed by fine-needle aspiration cytology: a case report. Diagn Cytopathol 2001; 25:321-4. [PMID: 11747224 DOI: 10.1002/dc.2163] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A case of thoracic splenosis diagnosed by fine-needle aspiration (FNA) of subpleural lung lesions is presented. The patient, a 49-yr-old male with a history of gunshot wound to his trunk with splenic rupture and splenectomy several years previously, presented with recent hemoptysis and multiple subpleural solid nodules shown in the left lung field by CT scan. As the possibility of a metastatic malignancy vs. mesothelioma was entertained, an FNA was performed on one of these lesions, revealing lymphoid tissue with abundant vascularity simulating the structure of splenic tissue. In view of this finding, supported by the absence of splenic outline in the CT radiograph, the diagnosis of splenosis was made. This is the fourth reported case of thoracic splenosis in which FNA cytology was utilized for diagnosis, yet the first in which the diagnosis was based exclusively on the FNA cytologic findings. Clinical, pathologic, and diagnostic aspects of this entity are discussed.
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Affiliation(s)
- S Syed
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas 77555-0548, USA
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Abstract
A 48-year-old man presented with recurrent gastrointestinal bleeding and anemia. Routine endoscopic evaluation was nondiagnostic. Angiography demonstrated multiple apparent arteriovenous malformations. Exploratory laparotomy revealed numerous splenic implants along the small and large bowels, some of which had apparently eroded through the bowel mucosa and bled. Excision of these penetrating lesions prevented further bleeding. An incidentally noted renal cell cancer was also resected. The patient's splenosis was the result of childhood trauma that caused splenic rupture and precipitated splenectomy. Splenosis develops frequently following traumatic splenic rupture. Experimental evidence suggests that the presence of an intact spleen suppresses the growth and development of splenic implants. Following splenectomy, splenules may replace some of the "housekeeping" and immunologic functions of the spleen, but even patients with documented splenosis should be considered functionally hyposplenic. While in most cases splenules cause no symptoms, splenosis must be considered in the differential diagnosis of previously splenectomized patients who present with unexplained masses or occult bleeding.
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Affiliation(s)
- W M Sikov
- Department of Medicine, The Miriam Hospital, Brown University School of Medicine, Providence, Rhode Island, USA.
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Abstract
Endometriosis generally causes pain that is cyclic and generally responds to medication and/or surgery. When endometriosis is found coincidentally, it may need no treatment because many women have endometriosis as a self-limited disease. In other women, the biologic behavior is much more unpredictable. Severe dysmenorrhea, focal pelvic tenderness, and deep dyspareunia are suggestive of endometriosis. Diagnosis at laparoscopy includes concerns about subtle appearance, endometriosis hidden within adhesions, retroperitoneal disease, and intra-ovarian lesions. Negative laparoscopy results do not mean that patients have no endometriosis. In contrast, a response to GnRH agonists can occur in patients with no endometriosis because conditions other than endometriosis are estrogen sensitive. Coexistent disease can confuse the picture at the time of surgery. Some coexistent diseases also can cause pain that is similar to that of endometriosis. Distinguishing those patients who need no treatment from those who need intermediate or extensive treatment can be very difficult. Care is needed to ensure that patients are neither overtreated or undertreated. An integrated approach involving a multidisciplinary team is needed in some. Other patients respond to primary care techniques.
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Dockery WD, George DJ, Rodriguez R. Splenosis presenting as a mass on digital rectal examination. J Urol 1997; 158:2244. [PMID: 9366362 DOI: 10.1016/s0022-5347(01)68217-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- W D Dockery
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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20
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Abstract
This article reviews extrapelvic endometriosis, emphasizing classic papers as well as recent research. Because of the nature of the existing literature, specifically case reports and retrospective analyses, this article is primarily descriptive in nature. Extrapelvic endometriosis is discussed based on some main areas of occurrence, including gastrointestinal, urinary, and thoracic; other areas are also reviewed. What is known about the epidemiology, pathogenesis, diagnosis, and treatment of extrapelvic endometriosis is highlighted. Areas for future direction of research in the field are also identified.
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