Splenosis mimicking lymphadenopathy

The Role of Fine-Needle Aspiration in Conjunction With Ancillary Immunophenotyping for Accurate Recognition of a Case of Splenosis in Perirectal Soft Tissue

Splenosis is the implantation of splenic tissue into other organs following splenectomy or traumatic spleen injury. It typically manifests in the peritoneal cavity but can appear in other locations. Splenic nodules are often incidentally discovered during imaging, with nuclear scintigraphy being the gold standard for recognition. We report a case of splenosis found incidentally upon computed tomography for evaluation of chronic anemia in the anterior perirectal space of a 74-year-old man who had previously undergone splenectomy. Despite advances in imaging techniques, tissue examination is necessary to confirm suspected splenosis and exclude neoplastic processes, and image-guided fine-needle aspiration biopsy is a valuable tool to this end. Our case was diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy with ancillary immunohistochemistry and flow cytometry. Cytomorphological features alone may not be sufficient to recognize splenosis; ancillary immunostaining can highlight littoral cells lining the red pulp sinuses, with characteristic positive expression of CD8, WT1, ERG, and CD68, helping clinch the diagnosis.

Posttraumatic thoracic splenosis in a 77-year-old patient after a motor vehicle accident

We present a rare case of autotransplantation of splenic tissue to the thoracic cavity, concerning for lung tumor, after splenic and diaphragmatic injury following a severe motor vehicle accident 27 years previous.

The use of fluorescence laparoscopy in the resection of splenic tissue replantation in the right lobe of the liver: A case report and literature review

BACKGROUND

Ectopic replantation and regeneration of splenic tissue fragments following splenic trauma or splenectomy is known as replantation of splenic tissue. It typically takes place in the abdominal cavity, however, splenic tissue replantation in the liver is extremely rare and difficult to diagnose. It is often misdiagnosed as a liver tumor and removed.

CASE PRESENTATION

We present the case of a patient with a history of traumatic splenectomy 15 years prior to the replantation of splenic tissue in the liver. A 4 cm mass in the liver was found during the most recent physical examination, and a computed tomography scan indicated the possibility of a malignant tumor. The tumor was then removed using fluorescence laparoscopy.

CONCLUSION

There is a possibility of intrahepatic replantation of splenic tissue in patients who have had a splenectomy in the past, have recently discovered an intrahepatic space-occupying lesion, and do not have any high-risk factors for liver cancer. Unnecessary surgery can be avoided if 99mTc-labeled red blood cells imaging using mass puncture or radionuclide examination provides a clear preoperative diagnosis. Globally, there are no reports of the use of fluorescence laparoscopy in resecting replanted splenic tissue in the liver. Specifically, in the current case, there was no indocyanine green uptake in the mass, and only a small amount was found in the normally functioning liver tissue surrounding the tumor.

Pelvic mass causing hematospermia: splenosis

Background

Most patients with splenosis have no clinical symptoms and do not need intervention. Hematospermia and testicular pain occurred in this patient, which was considered to be related to the huge pelvic implantation of the spleen, which was relatively rare in clinical practice, so we hereby report this case.

Case presentation

A 28-year-old male patient with a history of splenectomy was admitted to the Urology Department of the Second Affiliated Hospital of Anhui Medical University with the chief complaint of "Hematospermia for 1 month and testicular pain for 2 days". Preoperative imaging examination indicated pelvic mass. Combined with the patient's history of splenectomy for splenic rupture in childhood, the possibility of pelvic spleen implantation was considered. Laparoscopic pelvic exploration was performed. During the operation, multiple grayish-brown nodular tissues were observed in the space between the posterior bladder and rectum, and a lobulated grayish-brown mass with a diameter of about 9 cm was observed in the posterior upper part of the prostate gland and seminal vesicle at the pelvic floor. Two nodular tissues were removed intraoperatively and sent for quick frozen pathology, which was reported as spleen tissue. Further resection of the huge mass was performed, and the postoperative pathological results were consistent with the diagnosis of splenosis.

Conclusion

We report a rare case of splenosis presenting with hemospermia and testicular pain.

Primary splenic lymphoma on top of intrahepatic splenosis: A unique case report

Solid organ splenosis is a challenging diagnosis with many atypical imaging features that can overlap with neoplastic masses of the affected organ. We present a sporadic case of intrahepatic splenosis in a 68-year-old woman with transformation into a low-grade B cell lymphoma. Initial cross-sectional imaging suggested focal nodular hyperplasia (FNH) ruled out on contrast-enhanced Magnetic Resonance Imaging (MRI) using a hepatobiliary-specific contrast agent. A Tc-99m sulfur colloid scan was negative. The final diagnosis was confirmed by a needle-guided biopsy revealing intrahepatic splenosis with transformation into a low-grade B cell lymphoma.

Cecal splenosis mimicking gastrointestinal stroma tumor. Case report and review of the literature

Introduction

Abdominal splenosis is a rare condition where autotransplanted ectopic spleen tissue is found in the abdominal cavity after spleen injury or splenectomy. While abdominal splenosis is mostly described as asymptomatic, bowel splenosis can present with abdominal pain, obstipation or gastrointestinal (GI) bleeding. Scarce information on bowel splenosis exists and high index of suspicion is needed for diagnosis. We present the case of a patient with abdominal pain and a cecal mass mimicking gastrointestinal stroma tumor (GIST) found to have bowel splenosis after laparoscopic resection.

Presentation of case

A 45-year-old female was evaluated for a 6-month history of abdominal pain in right-lower quadrant. She had past medical history of blunt abdominal trauma and splenectomy 35 years before symptoms. An abdominal contrast-enhanced computed tomography (CT) reported a 4.2 × 4.6 × 4.6 cm solid mass located in the antimesenteric border of the cecum, with calcifications and arterial enhancement. Colonoscopy found no epithelial lesions. A diagnostic laparoscopy was done, and resection of the mass achieved. Transoperative histopathological diagnosis revealed ectopic spleen tissue.

Discussion

It is difficult to know whether abdominal pain in bowel splenosis is actually triggered by splenosis itself or by an unrelated cause, making diagnosis incidental. There are no particular imaging findings suggestive of splenosis, and surgical resection is often done under uncertain diagnosis.

Conclusion

Bowel splenosis could present as abdominal pain variable time after spleen injury or splenectomy. Clinical features and imaging characteristics are nonspecific and similar to those of GIST. Most cases of splenosis are diagnosed after surgery.

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Bowel splenosis is a rare entity scarcely reported in the literature.

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2nd case with more years from risk factor reported.

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We expose a review of the literature analyzing common findings.