Peritoneal splenosis mimicking peritoneal carcinomatosis: a case report

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.

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.

Gamna-Gandy bodies in fine-needle aspiration from abdominal splenosis: A clue to underlying portal hypertension

A 40-year-old woman presented with abdominal pain and jaundice. Past medical history was significant only for splenectomy following a motor vehicle accident. Owing to presence of multiple peritoneal nodules on computerized tomography (CT) and elevated serum CA-125, ovarian peritoneal carcinomatosis was suspected. Ultrasound-guided fine-needle aspiration (FNA) revealed presence of abundant hemosiderin, leukocytes, endothelial cells, and fungal hypha-like structures. No evidence of neoplasia was found. Findings were consistent with Gamna-Gandy bodies (GGBS) within splenic tissue. Based on history of splenectomy and FNA findings, a diagnosis of abdominal splenosis with presence of GGBS was made. Workup for hepatic cirrhosis and portal hypertension was recommended. Liver biopsy confirmed presence of cirrhosis. To our knowledge, this is the first report of GGBS identified within abdominal splenosis. It is important for pathologists to be able to recognize GGBS and to be aware of their relationship to portal hypertension and other conditions associated with severe vascular congestion or hemorrhage. History and pathogenesis of GGBS, their diagnostic morphologic features and a review of cases of GGBS diagnosed via cytology are given.

Splenosis Mimicking Lymphoma Relapse Confirmed by 18F-FDG PET/CT and Tc-99m Nano-colloid Scintigraphy Thirty Years After Splenectomy for Trauma

Splenosis is implantation of the splenic tissue in the abdominal region or elsewhere in the body as a consequence of trauma or splenectomy, which might mimic intra-abdominal involvement of several malignancies. This case report presents a patient with abdominal implants without ¹⁸F-FDG accumulation confirmed to be splenosis by Tc-99m nano-coloid scintigraphy.

Computed tomography imaging of ovarian peritoneal carcinomatosis: a pictorial review

Gynaecological malignancies are the most common malignancies in women and also an important public health issue. In developing countries, there is a paucity of screening facilities and cancer awareness, so patients present at an advanced stage of disease, which severely limits the prognosis and clinical outcome. Among the gynaecological malignancies, ovarian malignancy has the second highest incidence in women according to the incidences. Ovarian malignancy is usually diagnosed at the advanced stages, and to improve the patient’s survival, debulking surgery is very important. Advanced-stage disease is treated with either debulking surgery followed by adjuvant chemotherapy or initial neoadjuvant chemotherapy followed by debulking surgery. Imaging is very important in patient selection, in determining who will benefit from neoadjuvant chemotherapy just before debulking surgery. This article highlights the role of computed tomography (CT) in the detection of patterns of spread of ovarian malignancy, important for staging and management.

Diffuse intra-abdominal splenosis presenting as carcinomatosis exhibiting positron emitted tomography hypermetabolic activity

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Splenosis can mimic carcinomatosis upon many imaging modalities.

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History of splenectomy must be considered when evaluating carcinomatosis.

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Scintigraphy is the preferred for confirming the presence of splenosis.