Thoracic splenosis: mimicry of a neurogenic tumor

Silent pelvic splenosis: Case report

INTRODUCTION

Splenosis is a benign, usually asymptomatic, condition involving autotransplantation of splenic tissue that occurs frequently after splenic rupture caused by trauma or surgery [1]. Up to 67% of the patients presenting splenic rupture may develop splenosis [2]. The interval of time between the initial trauma and the diagnosis varies from 3 to 45 years with an average interval of 21 years [3]. Since the finding of this entity is usually accidental, the real incidence is not well known. Although splenosis following traumatic splenectomy after traffic accidents is well-documented in the literature, there do not seem to be many reported cases where splenosis produced gynecological complications [4]. There were fewer than 100 cases of splenosis reported since the first report of Buchbinder and Lipkoff in 1939 [5] in the English language medical literature of which only a minority appeared in the gynecological literature.

PRESENTATION OF CASE

A case of pelvic and omentum majus splenosis in a patient is presented.

DISCUSSION

Pelvic splenosis remains a rare finding in clinical practice. In most reported cases in the literature, the diagnosis was not considered before surgery. This approach may obviate the need for invasive evaluation for a primary or secondary neoplasm, and thus unnecessary surgery, and therefore preserve probable functional splenic tissue. Our case was diagnosed using non-surgical modalities.

CONCLUSION

Our case emphasizes the rare diagnosing of pelvic splenosis in the evaluating pelvic mass with the tissue evidence instead of surgery.

Thoracic splenosis after a gunshot: diffusion-weighted MRI findings

BACKGROUND

Intrathoracic splenosis is a rare condition resulting from concomitant rupture of the spleen and left hemidiaphragm after a traumatic event involving the spleen and the diaphragma and is defined as autotransplantation of splenic tissue in thorax.

CASE REPORT

The aim of this study was to present a case report of a combined intrathoracic and subcutaneous splenosis in a patient 19 years after penetrating trauma. She has left dorsal side pain and routine chest roentgenogram shows pleural nodular masses. The patient was referred to us for radiologic work up.

CONCLUSIONS

The MRI scans revealed the intrathoracic and subcutan masses as mainly hypointense on T1-weighted images and hyperintense on T2-weighted images and significant restriction in diffusion-weighted images. Scintigraphy revealed abnormal hot spots in subcutaneous tissue and diaphragmatic pleura of the left hemithorax.

Splenosis: a review

Splenosis is a common benign condition that occurs after splenic rupture via trauma or surgery. Splenosis is usually found incidentally and unless symptomatic, therapy is not indicated. However, since radiographically it can mimic malignancy, most patients have an extensive workup. The diagnostic method of choice is nuclear scintigraphy, specifically, a heat-damaged red blood cell scan. Splenosis usually occurs within the abdominal and pelvic cavities, but patients have been described with intrathoracic, subcutaneous, intrahepatic and intracranial lesions.

Intrathoracic splenosis

Intrathoracic splenosis is a rare condition involving autotransplantation of the splenic tissue into the pleural cavity. It is typically a result of diaphragmatic and splenic rupture after blunt or penetrating abdominal trauma. The diagnosis is usually determined by surgical biopsy of an incidental asymptomatic mass on a radiograph or computed tomography. The process is benign and can be generally followed with serial chest radiographs. We herein discuss a 34-year-old male who presented with sharp chest pains.

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.

Consider the Diagnosis of Splenosis for Soft Tissue Masses Long after Any Splenic Injury

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.